Early Intervention in psychosis

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Exercise!. 5 minutesIntroduce yourself to neighbourThink together about a case familiar to you involving possible psychosis. Layout of session. Brief overview of service15 minute case scenario discussion in groupsDiscussion of issues raised by casesHandout checklist for psychosisTime for burni

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Early Intervention in psychosis

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1. Early Intervention in psychosis What you really need to know! Brigitta Bende, Julie Clitheroe, Dave Hedges, Kate Wood Mersey Care NHS Trust

2. Exercise! 5 minutes Introduce yourself to neighbour Think together about a case familiar to you involving possible psychosis

3. Layout of session Brief overview of service 15 minute case scenario discussion in groups Discussion of issues raised by cases Handout checklist for psychosis Time for burning questions

4. Why? The quicker you treat the better the outcome – evidence based Stronger emphasis on recovery and psychosocial techniques Policy Implementation Guide (politics!) Reduced burden on economy in long term for psychosis (controversial)

5. What and where? 3 teams covering Liverpool and Sefton Based in Wavertree, Aintree and Southport For example, South team: Consultant Psychiatrist, Psychologist, Team Leader, Mental Health Nurses, STaR workers, Pharmacist, PT spR, Staff grade doctor, Secretary

6. Who? Referral Criteria: Age 14 to 35 First presentation of psychosis Or within first 3 years of treatment Also see people at high risk of psychosis (prodromal symptoms)

7. How?

8. What do we actually do? Comprehensive holistic assessment involving carers: Use of formal assessment tools Mental state Social network Occupational needs Carers’ needs Psychological formulation – early experience relating to what’s happening now Risk to self, others, vulnerability and of neglect

9. What do we actually do? cont Regular medical review including medication needs Psychosocial interventions Family work, safeguarding children Relapse prevention Use of STaR workers for specific time-limited pieces of work Strong emphasis on recovery

10. Case scenarios In groups of 6, discuss the case and try to answer the questions. Presenters will be available to facilitate 15 minutes only! Nominate a person to summarise the case in a few sentences for your colleagues

11. Case Scenario – Janet At what points were there opportunities to refer to Early Intervention? What would make you reluctant to refer to Early Intervention?

12. Case Scenario – Janet 1. At what points were there opportunities to refer to Early Intervention? ?direct from school tutor via mental health link worker, from GP, from AED Crisis team 2. What would make you reluctant to refer to Early Intervention? Stigmatisation, patient choice, insurance, employment

13. Case Scenario – Ryan What signs and symptoms would lead you to suspect early stage psychosis? What areas need to be assessed? What risk factors can you identify here and what would be an appropriate management plan?

14. Case Scenario – Ryan 1.What signs and symptoms would lead you to suspect early stage psychosis? What areas need to be assessed? Biological, social, psychological Predisposing, precipitating, perpetuating What risk factors can you identify here and what would be an appropriate management plan? Suicide, stalking, assault, weapons, vulnerability

15. Case Scenario – Anthony What opportunities can you identify where Anthony could have been referred to EIS earlier? What factors would you consider before using the Mental Health Act with younger people presenting with psychosis?

16. Case Scenario – Anthony 1. What opportunities can you identify where Anthony could have been referred to EIS earlier? Parents, GP, college tutors (X2), Housing officer 2. What factors would you consider before using the Mental Health Act with younger people presenting with psychosis? Health, risk to self and others, vulnerability

17. Case Scenario – Bob What factors increased the likelihood of Bob developing a psychotic illness?

18. Case Scenario – Bob What factors increased the likelihood of Bob developing a psychotic illness? Biological, social, psychological Predisposing, precipitating, perpetuating

19. The future? Spreading the word about early detection and intervention: Primary care- Gps, school nurses, counsellors CAMHS Secondary Schools - mentors Colleges Universities Mental health Link workers within education Connexions – careers advise YPAS, The Door, Engage (voluntary sector) Criminal Justice System Drug and alcohol services

20. Psychosis checklist

21. Psychosis checklist If score 20 or more, refer If any * scored, refer even if less than 20 Take away and use it If in doubt, ring us and/or refer There are now 50 EI services across the country Seek out your local team Remember: Early detection and treatment means better outcomes

22. Thank you for listening Any questions?? [email protected] [email protected] [email protected] [email protected]

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