Early Psychosis Care: Insights from Missouri

A deep dive into the critical importance of early identification and intervention in psychosis, based on insights from the Early Psychosis Care Center Conference in Missouri.

Navigate

I recently had the opportunity to attend the Early Psychosis Care Center Conference in Missouri, an event focused on the critical importance of early identification and intervention in psychosis. As someone who works in a program called Navigate, dedicated to early psychosis care, attending this conference was particularly valuable. The conference brought together a diverse group of professionals, individuals with lived experience, and family members, all dedicated to improving care for those affected by psychosis. It was an incredibly insightful experience, highlighting key areas for enhancing support and treatment. You can learn more about the conference at EPCMissouri.org.

Key Takeaways

1. The Power of Lived Experience

One of the most impactful presentations was by Dr. Pat Deegan. Dr. Deegan is a powerful voice in the mental health recovery movement, drawing from her own lived experience with a schizophrenia diagnosis as a teenager. Her work emphasizes the potential for recovery and empowerment for individuals with mental illness. Dr. Deegan’s insights underscored the importance of seeing the person beyond the diagnosis and supporting their journey towards a meaningful life.

2. Understanding Moral Agency

Another concept that resonated deeply was Moral Agency, presented by Dr. Neely Myers. Dr. Myers, a medical and psychological anthropologist, explores how experiencing psychosis can diminish moral agency, which she defines as:

The freedom to aspire to and achieve a “good life” that allows for intimate relationships and being recognized as a good person within one’s social context.

Her research highlights the importance of restoring this sense of agency in the recovery process and the need for “peopled opportunities” and social support for individuals to rebuild their lives.

3. The Vital Role of Family Engagement

The conference strongly emphasized the crucial role of engaging families in psychosis care. This important presentation was given by Dr. Michelle Sherman, highlights the significant impact of family involvement. Research shows that family involvement leads to better patient outcomes, including:

  • Fewer relapses
  • Reduced hospitalizations
  • Better treatment adherence
  • Improved communication with providers

Educating families about psychosis and providing them with communication strategies, such as those based on motivational interviewing, can help decrease conflict and create a more supportive home environment.

4. Medication Treatment: The Case for Early Clozaril and Long-Acting Injectables

Medication treatment was a significant topic, with discussions including the early use of Clozaril and the importance of long-acting injectables (LAIs). While Clozaril is known for its efficacy in treatment-resistant schizophrenia, there’s often a delay in prescribing it. The idea presented was to consider starting Clozaril earlier, potentially after two failed trials of other first-line antipsychotic medications, particularly for young people who are still symptomatic. This approach aims to improve outcomes when initial treatments are not fully effective. Clozaril does require careful monitoring due to potential side effects, but for some individuals, it can be a critical step towards recovery.

A particularly important discussion centered around long-acting injectables (LAIs). As someone who strongly advocates for LAIs, I was pleased to see this topic receive significant attention. LAIs offer several crucial advantages in early psychosis treatment:

  • Improved Adherence: LAIs eliminate the need for daily pill-taking, which can be challenging for anyone, especially young people experiencing their first episode of psychosis. This leads to more consistent medication levels in the body.

  • Better Outcomes: Studies show that LAIs are associated with lower relapse rates and fewer hospitalizations compared to oral medications. This is particularly important in early psychosis, where preventing relapse can significantly impact long-term recovery.

  • Reduced Burden: For families and caregivers, LAIs can reduce the stress of monitoring daily medication adherence. This allows everyone to focus more on recovery and less on medication management.

  • Early Intervention: Starting with LAIs early in treatment can establish a strong foundation for recovery. It’s often easier to maintain a treatment regimen than to restart one after a relapse.

The conference highlighted that LAIs should be considered as a first-line treatment option, not just as a solution for non-adherence. This aligns with my experience and preference for LAIs in early psychosis care. The key is to present LAIs as a positive choice for better outcomes rather than a last resort.

In a later blog, I’ll explain more about the different Long Acting Injectables and their benefits.

5. Cannabis and Psychosis: A Complex Relationship

The complex relationship between cannabis and psychosis was also addressed. Research indicates that:

  • Cannabis use, especially during adolescence, can be a risk factor for developing psychotic disorders
  • It may worsen symptoms in those already experiencing psychosis
  • High-potency cannabis products and regular use are particularly concerning
  • While some individuals may use cannabis to cope with symptoms, studies suggest it can actually exacerbate paranoia and hallucinations

This highlights the importance of discussing substance use in the context of early psychosis and providing education on the potential risks.

6. Trauma’s Impact on Psychosis

Dr. Kim Mueser, PhD delivered a compelling presentation on the significant influence of trauma on psychosis. His research and clinical experience provided strong evidence suggesting that:

  • Trauma is a risk factor for the development of psychosis
  • Individuals with a history of trauma may experience more severe symptoms and poorer outcomes
  • Different types of trauma, particularly interpersonal violence and neglect, have been linked to an increased risk
  • The cumulative effect of experiencing multiple types of trauma can significantly increase the likelihood of psychosis

Dr. Mueser emphasized the critical need for trauma-informed care and integrated approaches that address both psychosis and trauma, highlighting how this dual focus can lead to better treatment outcomes.

Conclusion

Attending the Early Psychosis Care Center Conference in Missouri was an invaluable experience. It reinforced the importance of early intervention, highlighted the power of lived experience and moral agency in recovery, and emphasized the critical role of families. The discussions on medication, cannabis, and trauma provided crucial information for improving care and support for individuals experiencing early psychosis. The commitment and passion of everyone at the conference were truly inspiring, offering hope for better outcomes and a more supportive future for those affected by psychosis.