Acadia Hospital in Maine is improving the odds for people who may develop psychosis through a program wholly dedicated to early detection.
The Aware program’s mission is to research, educate and provide community outreach about the symptoms indicating that a person is at “ultra-high” risk, or prodrome, to develop a psychotic illness. Common diagnoses the program helps identify are schizophrenia, bipolar disorder and schizoaffective disorder.
According to the program’s director and lead investigator Jessica Pollard, Ph.D., a specialized assessment called the Structured Interview for Prodromal Syndromes (SIPS) is used to detect the warning signs, which include deficits with executive function, trouble organizing school work, multi-step directions, planning ahead and visual tracking. Aware program staff works with the patient and the patient’s family to teach tools for coping with the symptoms, reducing stress and targeting overall health.
Symptom-reducing treatments can include individual and group cognitive behavior therapy; use of computer games that act as brain teasers; and a regimen of high-doses omega-3 fatty acids, which an Australian study by Paul Amminger and others – presented at the 2008 International Conference on Early Psychosis – showed to reduce risk by up to 23 percent.
“We can’t really say that we’ve prevented psychosis, but certainly we have seen dramatic reduction in the stress on families,” says Pollard. “We’re very clear that [the SIPS assessment] makes us right about 70 percent of the time,” adding that if left untreated, patients could present with full-blown psychosis in about two years.
The average age for a first episode of psychosis is around 19 and the prodrome period can last between two and five years. “We’re really talking about the teens, between 14 and 16,” says Pollard. “The first five years is the critical period that predicts how people will do with their symptoms,” noting that patient treatment and prevention-oriented services have been shown to obliterate symptoms enough so that full-blown instances of the illnesses don’t develop.
Pollard joined Acadia Hospital after completing a fellowship at Yale University School of Medicine’s prodrome and first psychosis episode clinics, PRIME and STEP. “Before 2008, Acadia Hospital was assessing patients and making recommendations, but essentially referencing back to existing hospital providers,” she says. Since June 2009, Aware has been a stand-alone program with a dedicated staff and budget.
Outreach is a major component to Aware, which strives to help parents, community members and schools and mental health providers recognize the early warning signs of psychosis. Education and outreach will be the focus of a two-year, $60,000 grant from the Bingham Program’s Advisory Committee, which funded the Aware program. Grant money will fund programs that educate schools, families and other mental health providers about what to look for when dealing with someone showing warning signs.
Only a few early psychosis detection programs in the country are non-academic as the handful that exist are affiliated with universities and driven by researchers, says Pollard. “The U.S. is behind the rest of the world in early detection,” she says, citing the Netherlands and Great Britain as having healthcare policies more advanced and prevention-driven than ours.
“The most important thing to us is that people get help, early,” says Pollard. “It’s just essential that anyone who works with young people gets as familiar as they can with what the warning signs are. We can develop about the best prevention program in the world, but … it takes the whole community to really make this happen.”
By Jennifer E Chase