Early-Onset PsychosisEARLY:Early Assessment andResource Linkage forYouth
May 15, 2008
Signs of prodromal psychosis
A clustering of the following:
•A significant deterioration in the ability to copewith life events and stressors
–Decrease in work or school performance
–Decreased concentration and motivation
•Withdrawal from family and friends
•Decrease in personal hygiene
•Depression or anxiety
Signs of prodromal psychosis
Marked changes in behavior, thoughts andemotions, such as:
Unusual perceptual experiences
Heightened perceptual sensitivity
Magical thinking
Unusual fears
Disorganized or digressive speech
Uncharacteristic, peculiar behavior
Reduced emotional or socialresponsiveness
Functioning as an effect of repeatedpsychotic episodes
Effects of multiplerelapses
Adapted from Lieberman, J., et al., J Clin, Psychiatry, 1996; 57: 5-9
Cognitive
Deficits
Affective Sx:Depression
Social
Isolation
SchoolFailure
Biological Vulnerability: CASIS
Brain
Abnormalities
Structural
BiochemicalFunctional
Disability
Social andEnvironmentalTriggers
Increasing Positive symptoms
Early Insults
e.g. DiseaseGenes, PossiblyViral Infections,EnvironmentalToxins
After Cornblatt, et al., 2005
Effects of family expressedemotion (EE) and medication onrelapse in schizophrenia
Bebbington and Kuipers, 1994
Biosocial treatment of theprodromal state
•Rapid, crisis-oriented initiation of treatment
•Psychoeducational multifamily groups
•Case management using key Assertive Community Treatmentmethods
–Integrated, multidisciplinary team; outreach PRN; rapid response;continuous case review
•Supported employment and education
•Collaboration with schools, colleges and employers
•Cognitive assessments used in school or job
•Low-dose atypical antipsychotic medication
–10-20 mg aripiprazole, 2.5-7.5 mg olanzapine, 0.25-3 mgrisperidone
•Mood stabilizers, as indicated by symptoms:
–SSRIs, with caution, especially with aripiprazole and/or a familyhistory of manic episodes
–Mood stabilizing drugs: lamotrigine 50-150 mg, valproate, 500-1500mg, lithium at therapeutic doses by blood level, 0.6-1.2