Early intervention in psychosis: KEEP THE BODY IN MIND!

Dr David ShiersGP advisor & National lead on

Early Intervention in Psychosis Programme

RCGP Annual Conference. Nov 5th 2009

‘Schizophrenia is like managing

the British empire: the orderly

management of decline’ Anonymous

‘CHRONIC’

My GP ‘journey’

Kraepelin’s Dementia Care Model

Leek

Victoria (Aus) Burden of Disease Study: Incident Years Lived with

Disability rates per 1000 population by mental disorder

Most serious mental disorders first appear in teens / young adults

DANGER AHEAD!!!DANGER AHEAD!!!Pressure wave- trapped

• 12-18m delay was typical

• Crisis response– 73–80% hospitalised– 36–59% Mental Health Act– 45% police involved

• 50% disengage: likely crisis reengagement

…on a path to inequality Excluded

12% with a job In previous 2 weeks (Nithsdale survey)

o 39% either had no friends or had met noneo 50% no interest or hobby other than TV

one in four have serious rent arrears

Up to 25 years less life 33% suicide and injury

o Lifetime suicide risk 10%; 2/3 within first 5yrs, esp around the first

presentation

66% are premature deaths from physical causes o 2-3x rate of CVS, Respiratory or infective disorderso Lifestyle adverse factors: smoking; diet; activityo Up to 5x rate of diabeteso Poorer health care

A widening health inequalityDifference between general population and in-patients with schizophrenia in prevalence of:

Rising prevalence of obesity 1988 +4.7%2002 +14.7%

Reist et al (2007)

Rising prevalence of diabetes1979-1995 parallel trends1996-2001 0.7% increase per year in people with schizophrenia

Basu & Meltzer 2006

76% in FEP smoke tobacco regularly

That’s the problem we are trying to solve

Aims of EI services1. Prevent psychosis in the ultra high risk individuals

– identify and intervene on cusp of psychosis

2. Reduce DUP (Duration of Untreated Psychosis):

– promote early detection & engagement by community agencies– Comprehensive initial mental health assessments & diagnosis

3. Optimise initial experience of acute care & treatment:– ‘Youth friendly’ Acute Home based/Hospital Treatment

4. Maximise recovery & prevent relapse during critical period: – Provide integrated bio/psycho/social interventions – focus on functional/vocational as well as symptomatic recovery– address co-morbidity and treatment resistance early– Support carers and network of community support agencies

Reflection

The hazards can be reduced and ultimately negotiated

• Timely support. • Thorough preparation• Effective use of well

developed evidence-based approaches– for both the young person – and their family.

Celebrate and prepare

• Have learnt something• Have a guide/mentor

– Professional, family, friend or peer

• Alert and ready for a next time?– Take remedial action– Seek help

Supporting GPs’ to do a difficult

job better:

Acknowledgements to:

Dr. Roy Morris Dunedin and Dr Maryanne Freer, Newcastle for contributing the white water rafting metaphor

to Guzer.com for use of their video clips and to Paddy Power for slides 18 & 19

Early intervention is everybody’s business

• EI psychosis services insufficient by themselves

• GPs offer continuity, context and family practice:– Key role in care pathway of

emerging psychosis

– Listen and act on concerns of the family

• Keep the body in mind.– Alongside practice nurses, GPs can

be critical players in improving physical health pathways

Equipped for the Equipped for the life ahead both for life ahead both for the young person the young person

and their familyand their family

You don’t need an engine when you have wind in You don’t need an engine when you have wind in your sailsyour sails Paul Bate 2004Paul Bate 2004