Early intervention in psychosis: K EEP THE BODY IN M IND ! Dr David Shiers GP advisor & National lead on Early Intervention in Psychosis Programme RCGP Annual Conference. Nov 5 th 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) o39% either had no friends or had met none o 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 oLifetime suicide risk 10%; 2 / 3 within first 5yrs, esp around the first presentation  66% are premature deaths from physical causes o2-3x rate of CVS, Respiratory or infective disorders oLifestyle adverse factors: smoking; diet; activity oUp to 5x rate of diabetes oPoorer health care

A widening health inequality Difference between general population and in- patients with schizophrenia in prevalence of:  Rising prevalence of obesity % % Reist et al (2007)  Rising prevalence of diabetes parallel trends % 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 services 1. 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 life ahead both for the young person and their family

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