Presented by: Steven Adelsheim, MD
Clinical Professor of Psychiatry and Behavioral Sciences
Stanford University Medical Center
June 5, 2014
Psychosis is a serious mental disorder that causes thinking and emotions to become so impaired that the person loses contact with reality and the ability to function in ordinary life. Psychotic disorders such as schizophrenia and conditions like clinical depression, anxiety, and bipolar disease remain some of medicine’s deepest mysteries—and some of its most misunderstood.
Mental disorders are extremely pervasive and have a serious impact on physical, social, and economic well-being—not only for people living with the disorder but also for their families, friends, schools, workplaces, and communities. Depression, for example, is predicted to be a leading cause of disability by the year 2020.
Focus on Teens
These conditions affect adolescents and young adults at a disproportionate rate. About half start showing symptoms by age 14, and more than 75 percent start by age 24. Almost 80 percent do not receive care, whether because of a lack of awareness, family concerns, or the perceived stigma of being different.
“Mental health is a worldwide public health issue,” said Steven Adelsheim, MD, a clinical professor of psychiatry and behavioral sciences, who spoke at a presentation sponsored by the Stanford Hospital Health Library. “We do not do enough to address the concerns of young people.”
Schools need to be key contributors to mental health education, said Dr. Adelsheim, who works closely with community high schools in developing mental health education programs geared to teens. Taking an approach that parallels how the public is taught about obesity can help to increase awareness, offset the stigma, and point to warning signs and early interventions.
Psychosis rarely appears out of nowhere. Most often family, friends, teachers, or the individual recognizes that something is not quite right about their thinking, feelings, or behavior before an illness appears in its full-blown form. This early stage, before symptoms really start to show, is called the prodromal stage. “It’s like feeling the symptoms of a cold before you are completely sick. You know something is starting to develop,” he said.
Multiple studies have shown that the shorter the duration of untreated psychosis, the better the outcome. That is, patients respond best to treatment when the symptoms are recognized and treated early, showing improved social skills five to 10 years later. One long-term study, called PACE 400, showed that early intervention reduced incidence and severity of episodes, improved function, and extended the length of time between episodes.
“Recognizing early symptoms really matters and has a huge, positive effect on outcomes,” Dr. Adelsheim said. “The more time goes by, the higher the rate of developing problems.”
Without intervention, 33 percent of young people with symptoms go on to develop full-blown psychosis; with intervention, only 10 percent experience psychosis. However, currently the average time between the time symptoms start and getting treatment is one to two years, often because the changes are gradual or because people think some unusual behaviors are a normal part of teenage behavior.
Dr. Adelsheim is a strong advocate of reorienting community and school mental health programs to establish new models of care for early intervention. He points to an Australian program called headspace that sponsors numerous free clinics focused equally on physical, mental, and sexual health. The messaging is young and hip, and designed to remove any embarrassment about getting support for one’s psychological well-being.
Similar national programs are being developed in Ireland, Canada, and the United Kingdom. A prototype program in Oregon focused on early intervention for prodromal symptoms and early psychosis has demonstrated reduced hospitalizations due to psychotic episodes and improved performance in school. The target for all these efforts, he said, is to bring in young people for early support.
Dr. Adelsheim has helped develop innovative programs locally to improve teenagers’ understanding of mental health and to strengthen peer networks. The programs encourage kids to identify signs of mental illness, seek and offer help, and expand their social connections. Other efforts are designed to link families to share experiences, improve communication, and educate kids and families about early warning signs.
“It’s about creating a climate change, so that it’s not only OK to get help for a friend, but it’s cool to do so,” he says. “The goal of early detection and intervention is to build emotional health and address the mitigating effects of mental illness.”
About the Speaker
Steven Adelsheim, MD, is a clinical professor of psychiatry and behavioral sciences and director of the department’s community partnership programs. A specialist in developing community mental health partnerships, Dr. Adelsheim focuses on developing early detection programs for children and young adults at risk for psychosis. He received his MD from the University of Cincinnati College of Medicine in Ohio and did his residency and fellowship at the University of New Mexico School of Medicine. He is Board Certified in child and adolescent psychiatry and in psychiatry by the American Board of Psychiatry and Neurology.
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