U program aims to prevent future psychotic episodes

Likelihood of repeat incidents goes up when intervention is delayed.

Kali Dingman

 

An early intervention program at the University of Minnesota Medical Center aims to help patients understand and live with mental illness after their first episode.

The University’s Medical Center’s First Episode Psychosis Program, created in 2008 for 13- to 29-year-olds, is an early intervention program that also provides support for families who realize their loved one has a mental illness.

A person with a psychotic disorder has a major mental illness that affects the mind like schizophrenia, bipolar disorder or depression. The majority of people who have a psychotic episode develop their first one when they are between 18 and 24 years old.

Most of the patients enter the first episode program after hospitalization for an incident like trying to harm themselves or others. They may also be admitted by a concerned teacher or parent who notices a change in their day-to-day routine.

The program is set up to intervene in the early stages of major mental illness by medication and social support to the patient and his or her family.

Michael O’Sullivan, a psychologist and the medical director for the program, said a delay in intervention causes an increase in the severity of symptoms, the likelihood of hospitalization, the risk of self-harm and a greater loss of functioning capabilities.

“The philosophy is to get them an early intervention before substantial damage is done [after a first episode],” Sullivan said.

Once in the program, doctors combine medication, therapy and communication to help the patient live a normal life.

The aim is to evaluate the patient one to two weeks after he or she has been discharged from the hospital or called into the program. Without the program, it can take up to 6 months to have an evaluation, Sullivan said.

By preventing future episodes, the program tries to relieve patients of the high costs of hospital stays. Sullivan said, on average, a hospital stay is around $300 per day, and the patient usually stays two to three weeks.

Doctors make an effort to see patients on a regular basis rather than once every few months.

“We see patients every one to two weeks, when usually the patient is seen every three months for 15 minutes for medication management,” Sullivan said.

The University’s program is run for clinical purposes, not for research.

Clinical director Nancy Lindquist offers moral support to the families while providing tips on how to approach the diagnosis.

“Many families feel in the dark,” Lindquist said.

Rabindra Tambyraja, an assistant professor of child and adolescent psychiatry, speaks highly of the First Episode Psychosis Program.

Tambyraja said the program works well because it’s not like a typical trip to the doctor’s office.

“The program is not just the patient, it’s their families as well,” Tambyraja said. “It’s not just sitting in a doctor’s office.  It’s more sufficient.”

It’s common for patients to skip their sessions or stop taking their medications. Lindquist said teenagers especially have a tendency to miss medications and appointments. Instead of dropping the patient from the program, which many others would do, the University’s program focuses on maintaining a good relationship between the doctors and the patients.

“We don’t end a relationship because they are not taking their meds,” Lindquist said. “The relationship is more important than those things.”

A young adult group meets every Friday for an informal session where members of the group can talk about ordinary things with other people who have mental illnesses. Sometimes, the group will participate in outings like bowling. It’s a time when patients can check in with their doctors and for the doctors to see how their patients interact in a group.

“It helps them see other people who are having the same issues,” said child psychologist Danielle Goerke. “It’s also helpful to show them we see them as people. How often do you go bowling with your doctor?”