Week 3 RF-Psychosis and Early Intervention Flashcards
What is the Context of Early Intervention Services?
(Wyatt, 1991; Wyatt, 1991; Birchwood et al., 1998)
-Moved to support individuals in community services
-Development of more acceptable antipsychotic medication
Developments in research:
-Critical Period: greatest impact on outcomes when we support people within first 3 years
-Duration of untreated psychosis (DUP): long DUP linked to poorer outcomes
-Community teams not meeting needs of young people with FEP
-Individuals interested in Early Intervention for Psychosis
What are the symptoms of Psychosis?
-Lack of interest in activities previously enjoyed
-Suspiciousness of others
-Smelling things others do not
-Thinking that others are out to harm you
-Hearing voices
-Emotional withdrawal
-Unusual thoughts
-Disorganised speech
-Memory problems
-Withdrawing
-Feelings of importance (special powers/missions)
-Difficulty with concentration
-Seeing things which others do not see
-Thought insertion
-Thought broadcasting
-Hypervigilant
-Excessive mood lability
-Feeling someone/something touching you when no one is there
-Blunted affect
What is the challenge with Psychosis?
-Overlap between autism and psychosis (Ribolsi et al., 2022)
-Mood disorders: bipolar and major depression (Toh et al., 2015, Aminoff et al., 2022)
-Post-traumatic stress disorder (Andrew et al., 2008, Steel et al., 2011)
-Borderline personality disorder (BPD; Kindgon et al., 2010; Slotema et al., 2012b)
-Substance use (Steel et al., 2011)
-Present in the general population who are not experiencing psychological distress.
-Symptoms can be present in those who use substances, especially stimulants and can remain long after substance use had ended.
-Paranoia, voice hearing
-It can be difficult for those with ASD to distinguish between fantasy and reality, so hard to assess for delusions, evidence to suggest that those experiencing psychosis and ASC have under developed ToM paranoia, Anomalous Perceptual Experiences without presence of a source
How is their Diagnostic uncertainty?
-Embrace diagnostic uncertainty support offered across the psychosis spectrum
-Boundaries are unclear and thresholds not always easy to establish
-Support young people (14+)
-Extended assessment? delay in treatment
-Capacity?
Early Interventions in Psychosis Services offers interventions with which 2 primary pathways?
- Early Intervention Team (EIT) for people experiencing a First Episode Psychosis (FEP)
- Early Detection and Intervention Team (EDIT) for people experiencing an ‘At Risk Mental State’ (ARMS)
How do is a first episode psychosis diagnosed? (between 14-65 y/o)
-The symptom must have lasted throughout the day for several days or several times a week, not being limited to a few brief moments
-The above symptoms must be present for a period of over seven days duration over the last 12 months (or if less than this then the improvement must be attributable to antipsychotic treatment).
-The above must be impacting on functioning
-Score 4 or above on the unusual experiences or unusual beliefs (hallucinations or delusions)
-Score 5 or above on suspiciousness/persecution related thoughts and beliefs
What is the exclusion criteria for diagnosing psychosis?
-35 y/o+ and DUP of over 12 months
-Where the primary difficulty and clinical need is not psychosis related (e.g., primary difficulties involving Personality Disorder, Substance Misuse, Eating Disorders, etc.), we will refer to more appropriate service. If primary need is psychosis and dual diagnosis is present, EI will support.
Who is the service not suitable for?
-Where an individual has significant learning disability or communication related difficulties that impact on their ability to engage with/benefit from treatments offered
-Individuals are receiving inpatient care in long-term residential units outside the area.
-Individuals are receiving intensive residential rehabilitation (24-hour support).
-Individuals whose psychotic symptoms clearly occur only in the context of acute intoxication (i.e. when a clear link is observed between the remission of symptoms with cessation of drug or alcohol use within 7 days).
-Psychosis that is organic in origin
-Individuals who have received a therapeutic dose of antipsychotic medication, which started 12 months or more, prior to the point of referral
-Service Users who receive a significant custodial prison sentence
-Those assessed as not wanting to engage in therapy will not be offered a service
-EDIT MDT might not accept a referral where there is significant risk- though we can sometimes work with other services (CAMHS, CMHT) to manage risk
What criteria makes someone at risk for psychosis? (14-35 y/o)
At risk of developing psychosis (CAAMS):
-Experienced an onset or worsening of attenuated psychotic symptoms in the past year (intensity and frequency)
-Evidence of Brief Limited Intermittent Psychotic Symptoms (BLIPS) in the past year (resolved within a week)
-The Service User having a first-degree relative who has psychosis (or bipolar disorder with psychotic features)
-Have experienced chronic low social functioning or a significant reduction in functioning during the past year
-Not prescribed anti-psychotic medication
Support offered in EI: What is the Care Programme Approach?
-Care Coordination
-Medication management (CAMHS hold medical responsibility for 14-18 y/o)
-Psychological therapy (1:1 and family intervention)
-Employment and education support
-Occupational therapy – 1:1 and group
-Support to access community – STR worker
-Physical health assessment and care
-Carers support: carers assessment/psychoeducation
Over 35 y/o: 2 years of support
Under 35 y/o: 3 years of support
What support is offered in EDIT?
-Support offered for 2 years
-One to one psychological therapy (van der Gaag et al., 2019)
-Monitoring appointments
-Signposting
What is the role of a Clinical Psychologist in EI?
-Delivery of NICE concordant therapy- CBT and FI
-Assessment and formulation
-Consultation
-Deliver training on psychosocial interventions
-Facilitate team formulations
-Provide reflective practice space
-Provide peer supervision
-One to one supervision
-Develop psychology resources
-Attend and lead MDTs to provide a psychological perspective
-Complete audits and service development projects
-Promote engagement with research
Does early intervention work?
-Better engaged
-Valued by patients and their loved ones
-Quicker access to support and provision of specialist support
-Better clinical, social and vocational outcomes
-Reduced rates of detention under the Mental Health Act
-Higher employment levels
-Reduction in relapse
-Reduced in-patient stays
-Lower rates of suicide compared with generic services
What are some issues with early interventions?
-We are failing to make service accessible to all communities
-Lack of culturally appropriate intervention
-CaFi
-Trauma and Psychosis
-Need for more personalised care
