Mental Health Matters Winter 2018

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WINTER 2018

Psychosis: new research on early treatment

BY KATHRYN QUINN JOHNSON, MA, DO, AND CHRISTIAN NEAL, MD, MPH

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hree out of every 100 people will experience psychosis at some point in their lives. Although the warning signs of this serious mental illness—the most common of which is schizophrenia—are experienced during late adolescence and early adulthood, people often wait months or even years before seeking treatment, leading to a lifetime of disability.

In recent years, there has been a focus on detecting the warning signs of psychosis in their earliest stages and intervening with the goal of preventing the disorder and increasing the chance of recovery.

Although the underlying cause of psychosis is not fully understood, changes in the brain’s development may at first manifest in deterioration in everyday functioning, such as memory issues, social withdrawal, changes in mood and uncharacteristic behaviors.

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This so-called “prodromal” period is followed by more acute symptoms that can include disordered thoughts and speech, hallucinations, delusions, and paranoia. Because the earliest stages of psychosis can be difficult to recognize, not only for the person affected, but also for family and friends, it is often not until the “first break” or “first episode” of psychosis that there is contact with a mental health professional. According to the National Institutes of Health, approximately 100,000 adolescents and young adults in the United States experience first-break psychosis every year. continued on page 2 Kathryn Quinn Johnson, MA, DO, and Christian Neal, MD, MPH, are psychiatrists with Centra Medical Group Piedmont Psychiatric Center. For additional information about Centra Medical Group Piedmont Psychiatric Center, please call 434.200.5999 or visit CentraHealth.com CENTRA |

Psychosis

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Psychotic disorders are degenerative illnesses, leading to atrophying of the brain (a loss of one percent of brain mass with each psychotic episode). Researchers point out that a lack of access to mental health services and treatment in early psychosis and schizophrenia is associated with slower or less complete recovery as well as increased relapse and poorer outcomes in ensuing years. As the illness becomes more persistent and severe, there are increasing visits to emergency departments and hospitalizations as well as societal effects including loss of relationships, unemployment, interruptions in education and poor management of day-to-day activities.

Research over the past decade has shown that intervention within the first five years of a psychotic event—considered the critical period—helps preserve brain function and can lessen the severity and trajectory of the illness.

Mental health practitioners are now making a concerted effort to educate resident physicians, primary care providers and the public about the importance of early symptom recognition, diagnosis, intervention, and treatment of psychotic illnesses.

Early intervention methods include: • First break psychosis teams in emergency departments help identify people who are not already undergoing treatment but may be having their first psychotic episode.

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Long-acting injectable antipsychotic medications, which were once reserved as a last resort, are now a first line of defense based on their efficacy and convenience.

Although antipsychotic medications may cause metabolic/endocrine/cardiac abnormalities or

neurological disorders, data has shown that long-acting injectables result in an overall decrease in side effects, hospitalizations, relapse rates, and overall medical costs.

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First break and early psychosis clinics based on the Assertive Community Treatment (ACT) model offer access to clinical providers with specialized training in first episode psychosis on a consultation or outpatient basis. ACT recipients receive the multidisciplinary, round-the-clock staffing of a psychiatric unit, but within the comfort of their own home and community.

ACT team members are trained in the areas of psychiatry, social work, nursing, substance abuse, and vocational rehabilitation. ACT clinics use very low-dose antipsychotics to help prevent treatment resistance and minimize side effects.

In addition to antipsychotics, research supports additional assistance for first break psychosis, including individual or group psychotherapy based on cognitive behavioral therapy principles. Also important are family support, employment/education services to help clients return to work or school, and case management to assist clients with problem solving and coordination of social services.

The new focus on early intervention is already showing results. When intervention and treatment occur during the critical period, 25 percent of those diagnosed with firstbreak psychosis have achieved complete remission without relapse. Although a small percentage of patients may never fully recover, the majority of patients are more able to handle underlying symptoms and challenges and go on to live healthier and more productive lives.

Autism resource fair

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entra Autism & Developmental Services is sponsoring its second annual Central Virginia Autism Resource Fair on Saturday, April 21. The fair will be held from 10 am to 1 pm at the Centra Alan B. Pearson Regional Cancer Center.

There will be children’s activities, resource and information booths, child care (one hour maximum, additional time subject to availability), and refreshments. The fair is free and open to the public.

For more information, contact Jill Goughnour at jill.goughnour@centrahealth.com or 434.200.4447.

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Journey to a new me

BY MIRANDA BREIT, Ph.D. Licensed Clinical Psychologist

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motional and psychological issues are often major factors in obesity and are particularly common among patients seeking or undergoing bariatric surgery. One such issue is codependency, a dysfunctional pattern of relating to others characterized by extreme focus outside of oneself, an extreme dependency on the approval of others, and the simultaneous ignoring of one’s own needs in favor of attending to the needs of others.1

People who are codependent appear strong and controlling, but are actually controlled and dependent themselves, often by an illness or disorder, such as alcoholism, substance abuse, or overeating. What has been found to run through codependency and food addiction is a sense of shame, which manifests in low self-esteem, people pleasing, and the neglect of one’s own needs.2 The following is the personal story of an actual patient who turned to food to help combat her depression, family stress, and anxiety.

Anna has always been a caretaker. As a child, she babysat; as a teen, she was the teacher’s assistant; and as an adult, she turned to nursing as a career. She had learned at an early age that if she managed responsibilities well, she earned praise from her often-critical mother. Later, working, married, and with four children, she took care of everyone’s needs but her own. It was a rare occasion when she took time for herself. Something as simple as having her nails done was almost an imposition on the time she felt she needed to spend helping others.

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Anna coped with her stress by eating. At 5 foot, 3 inches tall, she weighed 261 pounds, almost 120 pounds over a healthy weight.

“The more responsibilities I took on, the more weight I gained,” Anna said. “I just wanted everyone else to be happy, and I didn’t want to disappoint anyone. Food was my ‘go-to’ way of feeling better about all of the stress. I’m such a caring person that it sucked me dry. I lost myself.

“In therapy, I was learning to let go of some of the responsibility for others, expecting them to do more for themselves. As I did so, I was able to focus more clearly on the ‘elephant in the room’ that I was not addressing: my own self-neglect and obesity,” she said. “This was not the person who I was or wanted to be. I felt burdened, heavy with responsibility, and weight. I was literally and figuratively carrying around an extra person. I was finally ready to look more squarely at myself. With encouragement from Dr. Breit, I attended an informational session about Centra’s bariatric surgery program.”

Bariatric, or “weight loss,” surgery is a procedure in which a patient's stomach is reduced in size, thereby reducing the amount of caloric intake that is possible. This surgery, combined with a lifestyle that includes healthy eating and exercise, can minimize excess weight and many of the complications that go along with it. continued on the back

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Journey

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Bariatric surgery is not for everyone, nor does everyone qualify. Anna did. “I had been heavy for so long,” she said. “The surgery was my last ditch effort.”

Integral with the bariatric surgery program is a patient’s commitment to weight loss. Determined to do something for herself, Anna lost 36 pounds prior to surgery. After the surgery, she lost another 64 pounds. The weight loss resulted in other health benefits as well. Anna no longer takes medications for blood pressure, sleep, or urinary infections, and she has been able to decrease her psychiatric medicines.

Psychologically, Anna realized how her need to be a caregiver had taken over her life. Now, she was committed to sticking with her food plan, meeting with a Centra nutritionist, exercising at the gym, continuing her regular therapy sessions, and attending the bariatric program’s monthly support group.

“When I went to the meetings, I heard stories about people being codependent,” Anna said. “I never realized I was that codependent. But it was me in a nutshell.

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“I’ve had to learn to take care of myself. I’m losing weight and giving up the burdens,” Anna said. “I’m like a horse with blinders. I know that all of the needs are still there, but now I let everyone else take care of themselves. It’s enlightening to see myself now,” she said. “I don’t even recognize myself in photos from two years ago. My goals are to keep the weight off and keep myself in a good place.

I’ve learned that I can’t take care of everyone.”

But Anna hasn’t given up all of her need to care for others. “I’m telling my story to encourage others,” she said. “I want someone else to benefit from what I’ve learned on this journey.”

Miranda Breit, PhD, is a licensed clinical psychologist, certified marriage and family therapist, and certified sex therapist. She specializes in relationship issues, couples, families, and sexuality in her private practice at Centra Medical Group Piedmont Psychiatric Center.

Resource: 1.2. www.Altamirarecovery.com/blog/common-thread-food addiction-codependency

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