UofM Medicine - Barrier Busters Presentation.pptx

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1. Psychosis: Early Identification and Intervention Alyssa Smith, M.S., L.L.P. PREP Clinician

2. What is the PREP Clinic? 2 Multidisciplinary clinical team in Psychiatry Target population: Youth 14-35 with emerging and early psychosis Services: Evaluation and consultation Individual psychotherapy (CBT for Psychosis, CBTp ) MultiFamily Group Case management Medication management Research involvement (voluntary) Consultation for clinicians: Monthly CBTp group supervision (1 st W 12pm) Individual consultation available

3. 3 Schizophrenia 1% of population Hallucinations & Delusions Emotional disturbances, social withdraw Cognitive impairment Functional impairment WHO: Top 10 most debilitating diseases

4. 4 Cost of Schizophrenia in the U.S. Heinssen , R., NIMH Congressional briefing, 2015

5. Phases of schizophrenia PREMORBID ACTIVE Functioning Course of Illness Onset of illness First treatment AT RISK RECOVERY

6. Phases of schizophrenia PREMORBID AT RISK ACTIVE Functioning Course of Illness Onset of illness First treatment Duration of untreated psychosis (mean = 1.5 years)

7. Phases of schizophrenia PREMORBID AT RISK ACTIVE Functioning Course of Illness Onset of illness First treatment Shortened duration of untreated psychosis

8. Phases of schizophrenia PREMORBID AT RISK ACTIVE Functioning Course of Illness Onset of illness  functioning Mild psychotic-like symptoms

9. Phases of schizophrenia PREMORBID AT RISK ACTIVE Functioning Course of Illness EARLY INTERVENTION & PREVENTION Prevention & Recovery

10. Why should you care? 10 Onset age of schizophrenia/psychotic disorder Chapter: Prevention of Schizophrenia From: Treating and preventing adolescent mental health disorders: What We Know and What We Don't Know. A Research Agenda for Improving the Mental Health of Our Youth Editor(s): Dwight L. Evans, Edna B.  Foa , Raquel E. Gur, Herbert  Hendin , Charles P. O'Brien, Martin E. P. Seligman and B. Timothy  Walsh Incidence of psychosis : 21.4 per 100,000 person per year Michigan : 2,000 new cases every year

11. Why should you care? 11 Onset age of psychosis risk syndrome Estimated prevalence : ~1 in 30 young people Chapter: Prevention of Schizophrenia From: Treating and preventing adolescent mental health disorders: What We Know and What We Don't Know. A Research Agenda for Improving the Mental Health of Our Youth Editor(s): Dwight L. Evans, Edna B.  Foa , Raquel E. Gur, Herbert  Hendin , Charles P. O'Brien, Martin E. P. Seligman and B. Timothy  Walsh

12. Why should you care? 12 You will see it in your office! Chapter: Prevention of Schizophrenia From: Treating and preventing adolescent mental health disorders: What We Know and What We Don't Know. A Research Agenda for Improving the Mental Health of Our Youth Editor(s): Dwight L. Evans, Edna B.  Foa , Raquel E. Gur, Herbert  Hendin , Charles P. O'Brien, Martin E. P. Seligman and B. Timothy  Walsh

13. 13 General non-specific signs Concentration/attention impairments Reduced drive/motivation Depressed mood Anxiety Sleep disturbances Social withdraw Declining interest in people, activities, and self-care

14. 14 Signs that might indicate psychosis Feel that “something’s not quite right” Odd thinking, ideas of reference, persecution Hear sounds/voices that are not there Jumbled thoughts, confusion, perplexity Fearful for no good reason

15. At Risk vs. Psychotic 15 “Would you at least consider the possibility that it’s not real or it could be your imagination?” At risk Psychotic

16. 16 Useful screening questions Do you have jumbled thoughts and confusion? Do you feel something’s not quite right? Does it sound like your ears/eyes/mind are/is playing tricks on you? Do you seem to be fearful for no good reason and exhibit declining interest in people, activities, and self-care?

17. 17 Screening Instrument 21 questions Major symptom domains: Change in perceptual functions Change in emotional experience Change in thought process Not included: Change in functional level

18. PQ-B Perceptual functions Emotional experience Thought process 18

19. PQ-B Perceptual functions Emotional experience Thought process 19

20. PQ-B 20 Used as a screening tool ONLY NOT used for diagnosing! Good sensitivity, but high false positive Recommended for help-seeking populations only Interpret positive results with caution Need further specialized evaluation

21. Reduces duration of untreated psychosis (7 mos vs. 2 yrs) Improves long-term outcome Saves $$ in the long run Reduces hospitalizations Benefits of early detection and intervention Prevent/delays conversion to psychosis (6-10% vs. 16-35%)

22. Take home message #2: Psychosis risk syndrome is a promising area of clinical treatment and research That may lead to the primary prevention of schizophrenia

23. Grand Rapids Name : InterAct Address: 1131 Ionia SE, Grand Rapids, MI 49503 Contact: Carey Cutcher , LMSW Phone: [phone] Email : [email protected] Kalamazoo Name : InterAct Address : 610 S. Burdick, St. Kalamazoo, MI 49007 Phone : [phone] Email : [email protected] Auburn Hills Name : Easter Seals Address : 22170 W. Nine Mile Rd, Southfield, MI 48033 Contact : Laura Brdak, LLP Phone : [phone] Email : [email protected] East Lansing Name : ETCH Address : 4572 S. Hagador Rd. Ste 1E, East Lansing, MI 48823 Contact : Cathy Adams, LMSW Phone : [phone] Email : [email protected] 23 First Episode Clinics in Michigan

24. Clinical High Risk Programs in the U..S. 24 1. University of Michigan PREP Clinic 2. Yale University PRIME Clinic 3. Mass Mental Health Center/Harvard CEDAR Clinic 4. Columbia University COPE Clinic 5. UC Davis EDAPT / SacEDAPT Clinic 6. UCSD CARE Clinic 7. UCLA CAPPS Clinic

25. PREP Clinic Program for Risk Evaluation and Prevention ( PREP), UMHS Clinical high risk & early psychosis Clinical Director: Ivy Tso, PhD Medical Director: Stephan Taylor, MD Appointment: 734-764-0231 Referral inquiry: Alyssa Smith, [email protected] Website for PREP Clinic: https:// medicine.umich.edu/dept/psychiatry/programs/prep

26. Interventions Antipsychotics Dietary supplements Individual, family and group therapy Cognitive training

27. Online Resources for APS and First Episode Psychosis Prodrome and Early Psychosis Program Network (PEPPNET) www.med.Stanford.edu/peppnet Early Assessment and Support Alliance (EASA) www.easacommunity.org TED Talks Eleanor Longden : The voices in my h ead Elyn Saks: A tale of mental illness National Association of State Mental Health Program Directors www.nasmphpd.org/content/what-psychosis Michigan Minds www.michiganminds.org Hearing Voices Network www.hearingvoicesusa.org (Ann Arbor chapter) 27

28. PREP Clinical Team Stephen Taylor, M.D. Psychiatrist Director, PREP Professor of Psychiatry Ivy Tso, PhD., L.P . Clinical Psychologist Clinical & Training Director, PREP Assistant Professor of Psychiatry Alyssa Alfieri, M.S., L.L.P. Therapist / Case Manager Limited Licensed Psychologist Julie Kuebler, N.P., M.S., APRN, B.C. Nurse Practitioner Jim Svensson, LMSW Therapist / Case Manager Social Worker Tyler Grove, PhD, Post Doctoral Fellow

29. PREP Research Team Laura Stchur, MSW Research Manager Carly Lasagna, B.A. Research Coordinator Stephen Taylor, M.D. Professor of Psychiatry Ivy Tso, PhD., L.P. Assistant Professor of Psychiatry Cynthia Burton, PhD. Alyssa Alfieri, M.S., L.L.P. Therapist / Case Manager Limited Licensed Psychologist Daniela Lopez, M.S. Research Coordinator Tyler Grove, PhD., Psychology Post Doctoral Fellow

30. 30 PREP Research Studies BI drug trial (PI: Taylor) Adolescents & young adults (16-30) with APS Eye gaze perception in schizophrenia (PI : Tso ) Adults (18-55) with schizophrenia or schizoaffective disorder fMRI TMS + fMRI: neural mechanisms of gaze (PI : Tso) Healthy adults (18-55) TMS ( cTBS ) + fMRI Neuromodulation plus cognitive training (PI: Burton) Adults (18-60) with psychosis (schizophrenia, schizoaffective disorder, bipolar disorder) Cognitive training + transcranial direct current stimulation

31. Thank you! Questions?