What do you know about psychosis?
Psychosis is a disruption in our connection with external reality – a condition that may include such experiences as developing implausible beliefs, confusing speech and behavior, loss of motivation, or hallucinations.
About 17% of adults report having at least one psychotic experience in their lifetime. In addition, about 3% of the population will experience at least one psychotic “episode” – a prolonged period of psychotic experiences that disrupt normal functioning and can be highly distressing.
Psychotic episodes are relatively common: by comparison, they have about the same lifetime prevalence as drug dependence.
Consider that for a moment. While the prevention of drug dependence has become a health care priority that has sparked nation-wide campaigns and the creation of federal government policies, psychosis prevention is relatively unheard of. We however believe that prevention can make a remarkable impact in the field of psychosis.
I’m part of the Focus on Youth Psychosis Prevention (FYPP) Clinic at CAMH, a unique service providing consultation, assessment and intervention for youth experiencing early warning signs of psychosis. Unlike other psychosis services, our mandate is to intervene during the “Clinical High Risk” (CHR) state – a period that precedes a psychotic episode. The CHR state is not an episode of illness per se, but a set of signs that indicate that an episode may develop within the next two to three years. Similar high-risk group detection approaches have proven invaluable in areas such as breast cancer intervention, but are relatively new in mental health care.
FYPP is also home to a growing number of members of the psychology discipline.
There’s a perception that psychology has little to contribute to the psychosis field, other than perhaps supportive counselling or medication adherence support. But psychology in fact provides several key aspects of assessment, treatment and research innovation in this field, and in CHR in particular.
For example, recently-released guidelines recommend psychosocial treatments (such as Cognitive Behavioral Therapy, or CBT) as the first line of treatment in preventing psychosis during the CHR state, with medical treatments (such as antipsychotic medication) recommended only when psychosocial treatment is ineffective. This opens the door for a central role for psychologists in clinics like FYPP, given their high degree of training in such interventions.
Furthermore, neuropsychological assessment – the use of mental ability testing to make inferences about brain function – has also shown promise in predicting who is most likely to develop psychosis. This can assist in assigning increased care to individuals who most need it.
I joined FYPP in February 2014 as a postdoctoral research fellow under the supervision of Dr. R. Michael Bagby, a senior psychologist who provides clinical and research consulting to FYPP. My role in FYPP is to conduct research and to provide psychological assessment and treatment. Lauren Drvaric, M.Sc., also under Dr. Bagby’s supervision, provides clinic co-ordination, research, and clinical services. Dr. Shauna Kushner, another psychology postdoc, joined the clinic in November and provides research and psychotherapy services. Our clinic is led by Dr. Romina Mizrahi, an experienced clinical researcher and psychiatrist.
The psychology team at FYPP has embarked on several novel research projects, including a trial of a new group therapy designed to increase resilience and stress coping in CHR youth; studies of cognitive functioning across the schizophrenia spectrum, including the CHR state; and studies of personality factors that may impact the risk of having a psychotic episode. Through research, we hope to both improve the accuracy of early prediction of psychotic episodes and to improve our ability to intervene with novel psychosocial treatments.
Another important function of FYPP is community outreach. Given that psychotic episodes and experiences are relatively common, I’m often surprised when I speak with CHR youth to find that they are unaware of what psychosis is, or that their distressing and often alienating experiences are shared by many others. The psychology team plays an integral part, providing outreach talks in schools, youth shelters, and other places where youth congregate. We engage in psychoeducation and de-stigmatizing efforts to encourage youth who are in distress to seek help, and provide staff with referral information so they know where to send youth who are at risk.
Dr. Thomas Insel, director of the National Institutes of Mental Health in the US, wrote of this new approach to psychosis intervention, stating “…now that we have the tools available for predicting risk, we can get serious about preventing psychosis and enabling these young people to engage in, rather than withdraw from life.”
As someone who’s working to do just that, it affirms the work we do at FYPP. We’re serious about preventing psychosis, and I am proud to be a member of the psychology discipline, helping fulfill this goal.