Early Identification + Early Interventions = Improved Health Outcomes for the Treatment of Psychosis By: Suzanne Jasberg, MD

Oct 08, 2018 by Suzanne Jasberg, MD

In the current culture when one develops symptoms of illness or injury, they perhaps wait a few days to see if it gets better.  They may take some over the counter medications; or take a day off to rest.  If the issue persists for a few days or even a whole week, most will seek out a health professional, will receive medical advice and perhaps a prescription, they will complete the recommended course of treatment and will resume “normal” activities.

Why is this not the case when it comes to symptoms of mental illness?  On average people delay seeking mental health treatment for 8-10 years from the first onset of symptoms.  There are a number of potential explanations for this delay.  Stigma and fear of being judged negatively likely tops this list of explanations.  However, lack of understanding about symptoms and the perception that one with mental illness might not have autonomy or choice about their mental health care can also play into this delay to seeking care.

Let us look at one particular mental health diagnosis, psychosis in which early intervention can be crucial to positive treatment outcomes. Early identification of Psychosis = early intervention = more successful treatment outcomes!

Often times the early symptoms of psychosis can mirror other mental illnesses such as depression, anxiety or PTSD.  It is important to seek out a mental health professional trained in working with psychosis in particular, as thorough diagnosis and treatment can take time.

Signs and symptoms that present first called, “Prodromal Symptoms” include the presence of these symptoms and should prompt further evaluation:

  • Lowered functioning in work and/or school performance such as attendance problems, disciplinary events, and/or sudden loss of job or school status.
  • Less attention paid to personal appearance like not showering as much or wearing the same clothes for multiple days.
  • Isolating from peer group and family – spending more time alone.
  • Odd and disorganized behavior – perhaps worried, or taking more precautions to avoid certain things – this could look like taking a long out of the way route to work or school to avoid a certain intersection.
  • Paranoia – more guarded in communication, suspicion of your motives even in general conversations.

Symptoms that should prompt immediate mental health intervention:

Hallucinationshearing, seeing, smelling things that are not present.   Auditory (hearing) hallucinations are the most common.  This could be voices, or hearing ringing sounds.  These hallucinations can cause confusion about reality versus the hallucination.  A common perception is that people who experience hallucinations are likely to be aggressive this is not necessarily true.

DelusionsFixed false beliefs. Delusional thoughts will cause one to believe things that are not true, even when confronted with evidence to the contrary. These can be plausible things, like being watched or followed-which could potentially happen but are very unlikely. Or it can be bizarre things, that are hard to believe could happen at all. Often delusions are persecutory or paranoid, and feel like a threat to someone’s safety and are typically quite unsettling.

Ideas of reference; perhaps holding a belief that something they have heard on the news or radio is sending them a specific message.  Trying to make meaning out of things where there is no personal meaning intended – like license plates on the road communicating in code to them personally.

Worries about thoughts: people may feel as though their thoughts are not private (broadcasted)-and that people are reading their mind. They may also feel like people or things have the power to put thoughts into their head or take them out.

Feelings of being persecuted or attacked;  For instance, concern that people are tampering with their food leaving the person worried about eating anything they have not prepared a certain way.

Confused thinking; often observed through speech patterns like moving from one topic to the next topic but not really connected.  Trying to make meaning out of things that do not logically connect.  At times can appear to be talking in circles, but the circles/topics are not related.

Lack of insight: to situations that are odd or not “normal”. This can show when confronted about concerns of odd behavior where they may become defensive and lack insight to other explanations or perceptions of a situation.

Catatonianot moving, responding.  Very still, slow to move or react to stimuli in the environment.  If severe, this can include not eating and incontinence.

If there are any concerns for your own safety or your loved one, call 911 or proceed directly to the closest Emergency Department.

Autonomy and Choice in Treatment

Concern about being in treatment for life is a perception reinforced throughout our culture.  The reality is quite different.  If there are no immediate safety concern psychiatric patients have a wide range of treatment options.

Levels of care provided for those living with mental illness:

Outpatient therapy and medication management is an appropriate level of care for those whose symptoms have stabilized and are able maintain functions of daily living while having informal and formal supports in place.

Intensive Outpatient Programs (IOPare helpful for people who have active symptoms that are interfering with their ability to function optimally in their activities and responsibilities of daily living.  IOP’s typically take place for a few hours a day, for three to five days per week.  During programming patients work with social workers, therapists and psychiatrists to learn skills for management of symptoms and overall health. (PrairieCare Edina offers a specialty IOP for those experiencing their first episode of psychosis)

Partial Hospitalization Programs (PHP) is a higher level of mental health care provided to those whose symptoms of mental illness are negatively affecting their daily living, but are safe enough to be home in the evening.  PHP care overseen by psychiatrists, and managed by a treatment team of mental health professionals to work alongside patients and their support systems to provide education and therapy for ongoing symptom management.

Aftercare Groups provide ongoing support for the management of symptoms of mental illness.

Inpatient Hospitalization is the level of care required when safety of the patient due to symptoms of psychosis and mental illness are the primary concern.  During inpatient hospitalization, it is safer for medication changes to take place, as well as taking time to determine the outpatient supports and care that will be required to maintain safety and symptom management upon discharge.

It is possible that you will have one and only one psychotic episode in your lifetime.  Like with all health conditions maintaining a healthy lifestyle can help minimize the need for future hospitalizations or formal treatments.

Health maintenance skills for the management psychosis, other mental illnesses and overall physical health:

  • Adherence to Medications, including ongoing communication and consultation with ones psychiatrist and medical professionals
  • Avoid Use of non-prescribed substances
  • Managing Stress – Use of coping skills to deal with stressful situations; seek support from family and friends, setting boundaries.
  • Maintain healthy sleep schedule
  • Maintain a healthy diet with a variety of foods
  • Exercise on a regular basis, striving for 30 minutes of movement a day. This could be walking, jogging, yoga, dancing, or biking etc.
  • Have and call upon a strong support network. This should include informal supports like family and friends as well as formal supports like your psychiatrist, therapist and social worker.

The goal for all health maintenance, mental health included is to remain aware of symptoms, coping skills and to reach out when in need of more support!

Dr. Suzanne Jasberg is the Co-Director and Adult Interventional Psychiatrist at the PrairieCare Medical Group Center for Neurotherapeutics in Edina.  Her specialty is in providing care for those living with psychosis as well as treatment resistant depression.

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