Dr. Oyewumi's Lecture on Early Detection


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EARLY DETECTION AND EARLY INTERVENTION IN PSYCHOSIS:A Focus on the Prodromal Phase of Psychosis By: Dr. L. Kola Oyewumi Professor of Psychiatry and Pharmacology &Toxicology, Chair, Neuropsychiatry Division, Director, Southeastern Ontario Early Intervention in Psychosis Program, Queen’s University, Hotel Dieu Hospital Kingston, Ontario Canada K7L 5G2 October 7, 2009

Objectives : 

Dr. L. Kola Oyewumi 2 Objectives At the end of this presentation, participants will: - Be familiar with the concept of Psychosis and its different forms, particularly schizophrenia. Be aware of the different phases (stages) of a psychotic illness. Recognize the factors that contribute to the development of psychosis. Be familiar with the early warning signs of psychosis. Recognize the importance of early detection and early intervention in schizophrenia. Learn about the scope and activities of the HEADS UP: Southeastern Ontario District Early Intervention in Psychosis Program

What is Psychosis? : 

Dr. L. Kola Oyewumi 3 What is Psychosis? A mental disorder in which the thoughts, feelings, ability to communicate and relate to others are sufficiently impaired to interfere extensively with the capacity to deal with reality. Schizophrenia is the Prototype Psychotic Disorder.

Psychotic Disorders : 

Dr. L. Kola Oyewumi 4 Psychotic Disorders Psychosis Schizophrenia Brief Psychotic Disorder Schizophreniform Schizo-Affective Delusional Disorder Substance-Induced Psychosis Shared Psychotic Disorder Mood Disorders With Psychosis Psychosis due to General Medical Condition Other Psychotic Disorders

Schizophrenia: Epidemiology : 

Dr. L. Kola Oyewumi 5 Schizophrenia: Epidemiology Affects 1% of World population (prevalence) Over 300,000 Canadians affected Annual cost in Canada is $2.35 billion (‘96) Hospitalization costs account for 50% of annual costs (Goeree et al. 1999) Costs are disproportionately high in first episode population 40% attempt, while 10% complete suicide

Schizophrenia: Epidemiology : 

Dr. L. Kola Oyewumi 6 Schizophrenia: Epidemiology Onset prior to age 12 is rare (0.1-1% of all schizophrenic disorders) 4% of all schizophrenic disorders occur prior to age 15 Rate of onset increases sharply during adolescence Peak age of onset is 15-30 years Prevalence increases in relatives of affected individuals.

Schizophrenia: Epidemiology : 

Dr. L. Kola Oyewumi 7 Schizophrenia: Epidemiology 10 to 15 new cases per 100,000 population per year (Incidence) 65 to 120 new cases per year in our Catchment area 150 to 225 new cases per year in Eastern Ontario 800 to 1200 new cases per year in Ontario

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Dr. L. Kola Oyewumi 8

Burden of Psychosis in Canada 2004 : 

Dr. L. Kola Oyewumi 9 Burden of Psychosis in Canada 2004 Direct healthcare and non-healthcare costs: $2.02 billion CDN Indirect: lost productivity, morbidity and mortality $4.83 billion CDN Estimated annual cost of treatment in Canada $6.85 billion CDN Cost to families and clients: IMPOSSIBLE TO MEASURE Goeree R, et al. The economic burden of schizophrenia in Canada in 2004. Current Medical Research and Opinion. 2005;21(12):2017-2028.

Myths & Misconceptions about Psychosis : 

Dr. L. Kola Oyewumi 10 Myths & Misconceptions about Psychosis Poor parenting Weak willpower Split personalities Dangerous In Fact: More likely to be withdrawn, isolated & the victims of violence and crime

Features of Schizophrenia : 

Dr. L. Kola Oyewumi 11 Features of Schizophrenia Positive Symptoms: Delusions Hallucinations Disorganized speech Catatonia Negative Symptoms: Affective blunting Alogia Avolition Anhedonia Social withdrawal Social/Occupational Dysfunction: Work Interpersonal relationships Self-care Cognitive Deficits: Attention Memory Executive functions (e.g. abstraction) Mood: Dysphoria Demoralization Insight Suicidality Comorbid Substance Abuse Attributes "taken away" from the personality by the illness Behaviours "added to" the personality by the illness

Stages of Development in Psychosis : 

Dr. L. Kola Oyewumi 12 Stages of Development in Psychosis Premorbid Stage: The predisposing factors Prodromal Stage: (2-5 yrs): Change in premorbid functioning Psychotic Stage: - Acute vs. Gradual - The positive and negative symptoms Treatment Stabilization Stage: Biological, psychosocial Maintenance Phase: - Symptom control; Residual symptoms - Remission; Functional recovery

What Causes Psychosis? : 

Dr. L. Kola Oyewumi 13 What Causes Psychosis? MANY THEORIES, ++ RESEARCH BEING DONE Understood to be induced by a combination of: Pre-existing genetic vulnerability Likely the result of a number of genetic factors and not caused by one particular gene Probably a combination of biological and genetic factors + stress

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Dr. L. Kola Oyewumi 14 Biology of Psychosis & Diagnostic Issues R. J. Bell, 2001, adapted from EPPIC (1997) Psychoeducation in Early Psychosis: Manual 1 in a Series of Early Psychosis Manuals. Melbourne: EPPIC Statewide General Medical Condition Schizophrenia Schizo- phreniform Brief Psychotic Disorder Bipolar Disorder Substance Induced Schizo- affective Major Depression Brain PSYCHOSIS Delusions Thought Disorder Hallucinations (dopamine) Normal amount Abnormal Process neurotransmitter neuron Delusional Disorder

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Dr. L. Kola Oyewumi 15

Early Warning Signs for Schizophrenia : 

Dr. L. Kola Oyewumi 16 Early Warning Signs for Schizophrenia Genetic vulnerability Any enduring change in behaviour social withdrawal and loss of interest decline in functioning at work or school neglect of self care suspiciousness Uncharacteristic outbursts of emotions Depression and anger Lack of motivation Sleep disturbances Unusual perceptions Difficulties in thinking Unusual beliefs

Case Study - Ezra : 

Dr. L. Kola Oyewumi 17 Case Study - Ezra Ezra: 22 years old, single, undergraduate female, Asian-Canadian Presentation: Three months history of gradual withdrawal from friends Poor sleep, inability to concentrate at school Low energy, lack of interest in sports that used to give her pleasure Suspicion that the government agencies are spying on her in order to prevent her from publishing her poem about the President She now believes her life is in danger She could hear people discussing her situation outside of her door She believes the President wants her dead so that her organs can be used to save the world

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Dr. L. Kola Oyewumi 18 An only child, born prematurely at 28 weeks gestation Had febrile convulsions at age 3, was shy at school About a year before this index episode, parent and teachers had noticed some behavioural changes with decline in her marks at school Both parents alive and supportive Mother diagnosed with schizophrenia, and stabilized on olanzapine. Has no other health concerns Ezra had accused her boyfriend eight months ago of plotting to kill her. She claimed she heard him discussing the plot with his friends every night Reassurances from her boyfriend and others did not convince her. She broke her engagement with him Ezra smokes cigarettes (one pack/day) and has used marijuana since age 16, but more heavily in past year. No other street drugs or alcohol Ezra quit university this year to work as a dish washer in a restaurant Parents are worried she has become a loner Case Study - Background

Advantages of Early Detection and Treatment of Psychosis : 

Dr. L. Kola Oyewumi 19 Advantages of Early Detection and Treatment of Psychosis Reduction of trauma to patients and families Mitigate interruption of school work and social functioning Avoid possible destructive behaviors associated with onset of illness REDUCE duration of untreated psychosis (DUP) and its consequences for outcome

Symptom-Disability Gap in Early Psychosis : 

Dr. L. Kola Oyewumi 20 Symptom-Disability Gap in Early Psychosis Disability Symptoms

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Dr. L. Kola Oyewumi 22

Southeastern Ontario : 

Dr. L. Kola Oyewumi 23 Southeastern Ontario

The Regional Service : 

Dr. L. Kola Oyewumi 24 The Regional Service SEODEIP Kingston Prince Edward Hastings Frontenac Lennox & Addington Leeds – Grenville Lanark

Population Served : 

Dr. L. Kola Oyewumi 25 Population Served Individuals between 14 and 35 years of age Counties of Hastings and Prince Edward, Lennox and Addington, Frontenac, Leeds and Grenville, and Lanark Individuals within the first 3 years of a first psychotic episode or Those believed to be experiencing a pre-psychotic stage of illness (prodrome.)

Challenges in the Treatment of Patients with First Episode Schizophrenia : 

Dr. L. Kola Oyewumi 26 Challenges in the Treatment of Patients with First Episode Schizophrenia Illness in the prime of youth (young age) Engagement versus Retention in treatment Sensitivity to Medication (dosing, side effects, etc.) Non-compliance Substance use/abuse Preventing disability Re-Integration versus Re-Habilitation

Marijuana (THC) and Mental Illness : 

Dr. L. Kola Oyewumi 27 Marijuana (THC) and Mental Illness Psychosocial: Euphoria, drowsiness, feeling of calm Feeling that time has slowed Feeling that their senses are heightened, e.g. sound Improved self confidence Increased appetite and thirst

Marijuana (THC) and Mental Illness : 

Dr. L. Kola Oyewumi 28 Marijuana (THC) and Mental Illness Physical: Conjunctivitis (red eyes); strong odour; pupillary dilatation, tachycardia, dry mouth (cotton mouth) Coughing fits

Marijuana (THC) and Mental Illness : 

Dr. L. Kola Oyewumi 29 Marijuana (THC) and Mental Illness Other Effects: Perceptual disturbances. Sensitivity to sound Feeling of oneness with environment Anxiety, paranoia (suspiciousness, hyper alertness) Impaired attention Decreased motor coordination Morning hangover (may interfere with functioning) Impairs transfer of material from immediate to long-term memory

Marijuana (THC) and Mental Illness : 

Dr. L. Kola Oyewumi 30 Marijuana (THC) and Mental Illness Effects of Chronic Use: Amotivational syndrome (i.e. lack of persistence at any task that requires a prolonged attention period, e.g. school work) Apathy; Inertia; Impaired productivity

Dr. L. Kola Oyewumi 31 Cannabis Induced Psychosis Prominent hallucinations or delusions Impaired reality testing Evidence of intoxication Psychosis continues as long as use continues Psychosis can occur up to 4 weeks of abstinence Cannabis Intoxication Individual realizes hallucinations are cannabis induced Primary Psychotic Disorder Persistent symptoms after abstinence Symptoms in excess of expected for cannabis Ongoing use complicates determination

Principles of Management of Schizophrenia : 

Dr. L. Kola Oyewumi 32 Principles of Management of Schizophrenia Early Identification/Recognition • A collective responsibility (Families, Schools, Teachers, Primary Care Workers) • Education • Communication Immediate Treatment • Biological therapies (e.g.: Medications) • Psychological therapies (e.g.: Cognitive therapy) Psychosocial Therapies • Supportive therapy, Functional Adaptive Skill Training (FAST)

Helping the Patient Adjust : 

Dr. L. Kola Oyewumi 33 Helping the Patient Adjust To side effects Effective management of emerging side effects Adequate follow up (Physicians) To improvements (case management) Cognitive Awareness of loss of the years (personhood), education material, self-esteem, skills) The loss of the hallucinations To psychosocial adjustments (case management) Loneliness Reconnecting with family Financial management - Grief: The losses and compromises of their lives with schizophrenia

Psychosis is a Medical Condition : 


Anyone Can Refer : 

Dr. L. Kola Oyewumi 35 Anyone Can Refer For information about psychosis or to learn how we can help please call:     The Southeastern Ontario Early Intervention Heads Up! Program Toll free 1-866-485-2728

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