Preventing the First Episode of Psychosis William R. McFarlane, M.D., Director, National Program Office Early Detection, Intervention and Prevention of Psychosis Program Robert Wood Johnson Foundation Maine Medical Center Research Institute Portland, Maine Tufts University School of Medicine
Preventing the First Episode of Psychosis. William R. McFarlane, M.D., Director, National Program Office Early Detection, Intervention and Prevention of Psychosis Program Robert Wood Johnson Foundation Maine Medical Center Research Institute Portland, Maine - PowerPoint PPT Presentation
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Preventing the First Episode of Psychosis
William R. McFarlane, M.D., Director,National Program Office
Early Detection, Intervention and Prevention of Psychosis ProgramRobert Wood Johnson Foundation
Maine Medical Center Research InstitutePortland, Maine
Tufts University School of Medicine
Early detection and prevention in another illness
“If you catch cancer at Stage 1 or 2, almost everybody lives. If you catch it at Stage 3 or 4, almost everybody dies.
We know from cervical cancer that by screening you can reduce cancer up to 70 percent.”
---Lee Hartwell, MDNobel Laureate, Medicine
President and Director, Hutchinson Center
New York Times MagazineDecember 4, 2005, p. 56
2-3%
Proportion of youth who develop schizophrenia or a severe, psychotic
mood disorder
75%
Proportion of people who have one psychotic episode and schizophrenia
and then develop disability
12-15%
Proportion of people with schizophrenia or a psychotic mood
disorder who commit suicide
$61 billion
Annual U.S. costs for schizophrenia
Functioning as an effect of
number of psychotic episodes
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6Number of episodes
Fu
ncti
on
ing
(G
AF
)
Portland Identification and Early Referral
(PIER)
Reducing the incidence of major psychotic disorders in a defined
population, by early detection and treatment
Professional and public education
• Reducing stigma
• Increasing understanding of early
stages of mental illness and
prodromal symptoms
• How to get consultation, specialized
assessments and treatment quickly
Family practitioners
Pediatricians
General Public
Mental health clinicians
Military bases and recruiters
Clergy
Emergency and crisis services
College health services
EDIPPP Team
Advertising
School teachers, guidance
counselors, nurses, social
workers
Employers
Family-aided Assertive Community Treatment (FACT)
• In-depth assessment of symptoms of risk
• Rapid initiation of treatment
• Psychoeducational multifamily groups
• Supported employment and education
• Key intensive case management methods
Early Detection and Intervention for the Prevention of Psychosis
(EDIPPP)
A national multisite effectiveness trial
Reducing the incidence of major psychotic disorders in a defined
population, by early detection and treatment
Early Detection and Intervention for the Prevention of Psychosis
• Effectiveness Test at six sites:– Portland, Maine– Glen Oaks and Queens, New York – Ann Arbor, Michigan – Salem, Oregon – Sacramento, California– Albuquerque, New Mexico
• Large, nationally representative sample• PIER community outreach and identification
systems• Sponsored by RWJF: $17 million
Outcomes
Early identification across cities
SITE PopulationAge-corrected
rate**, at 25/100,000*
Years of community
outreach
Maine 323,105 63% 8Michigan 344,791 37%Oregon 631,853 29% 2.5California 466,488 26%New York 557,725 17%
1.5New Mexico 662,564 12%Total 2,986,526 27%
** Proportion (69.2%) of ages 12-35 population represented by ages 12-25 population *Rate for Nottingham, U.K., in Kirkbride, et al., Arch Gen Psychiatry. 2006;63:250-258