Treating First Episode Psychosis - John Kane, M.D.

John Kane, M.D.:>> In general, the first challenge is to make the appropriate diagnosis to make

sure that there is no other medical condition or substance use that might be accounting

for the psychotic signs or symptoms.

And so, we have to take into consideration, the presence of things like delusions, which

are fixed, false beliefs or hallucinations, hearing a voice when no one is speaking. But

we also have to feel comfortable that those symptoms are present with enough severity,

intensity, and frequency to justify a diagnosis of a psychotic disorder.

We also, will often see that someone has had a deterioration in functioning, either in

school or at work or in terms of their social relationships so all of those things are taken

into consideration and these symptoms need to be present for a certain amount of time

before we would consider the diagnosis of a specific illness.

Unfortunately, when people begin to experience psychotic symptoms, they often go for a long

time before receiving treatment, uh, we call that the "duration of untreated psychosis."

We believe that the longer it goes undiagnosed and untreated, that the more difficult it

is to achieve the outcomes that we like to achieve. And in the data that we've analyzed

so far, from the RAISE study, we did find that those individuals who had a duration

of untreated psychosis longer than 74 weeks, were not as likely to benefit from our comprehensive

care intervention as those patients who had a shorter duration of untreated psychosis.

So we do believe that the timing is important and trying to provide the right treatment

at the right time is really key.

We do believe in, based on our findings so far from RAISE, that coordinated and comprehensive

specialty care can help improve the trajectory of early phase psychosis and early phase schizophrenia.

So we'd like to see it more broadly available

There are many things that need to be available to patients and families that we would put

under the label of "comprehensive care." And what we mean by that is individual therapy,

family therapy, family education, supported employment, supported education to help someone

get back to work or back to school.

We can't emphasize enough the importance of the team-based approach

Having those people available but also working very closely with each other is key so that,

an aspect of treatment that's being conducted by a family therapist is also shared with

an aspect of treatment that's being conducted by an individual therapist and vice versa.

So, having, having real team meeting where people can get together and discuss, you know,

all the information, um, whatever challenges there are etc., and basically working on those

problems together with the patient is very important. And all of that should be tailored

to the specific needs and goals of that individual and his or her family. So, it's, it's a matter

of both gathering information and also doing education, helping a person deal with the

fact that they've experienced the onset of an illness, which can be, which can be serious.

So, promoting, promoting hope and optimism in recovery but also trying to be realistic

about the need for treatment.

We want to make sure that in that comprehensive and coordinated care there's also attention

to, to medical issues to lifestyle issues. We want to help people stop smoking. We want

to help people, um, exercise, lead healthier lives. What we've, what we've seen from data

from many states across the US is that the expected life span of someone with a chronic

and severe mental illness is perhaps twenty-five years shorter than the general population.

And we also want to do something about that.

I think it's very important for people to recognize that, this is an illness that we

can treat. We can help people to achieve the best possible outcome. We need to, to work

with them. We need to discuss their, their goals and their aspirations and try to help

them to achieve those goals. Um. Treatment may go on for periods of time. People need

to stick with it. Um. But, I think, if we can provide consistent, evidence-based care,

coordinated team approach that, that we can help them. And we can help them, um, get back

to leading a normal life in the community. And, I think, it's also important to recognize

that the more we can succeed in, in producing better outcomes, we can also help to reduce

some of the, some of the stigma that people at times associate with mental illness.