early intervention in psychosis: k eep the body in m ind ! dr david shiers gp advisor & national...
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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