The importance of early intervention in psychosis

Childhood early warning signs of mild paranoia

I first suffered from very mild paranoia when I was at primary school - as a class we watched a children's TV sci-fi  drama in which, towards the end, a character pointed a device with a wooden handle and three pipes towards a car's exhaust, and it forced the car to stop suddendly with a screech.

I don't think this affected anyone else in my class -- just me -- and it wouldn't later re-emerge until high school when I was 11 or 12 and thought an unusual pen which a schoolmate went round jabbing people's legs with for kicks was some kind of harmful injection.  Of course it was just a pen, but to me, it was more.    My mum thinks I may have seen something on the TV news about the Markov case at the time -- but I think I mainly was unaware of news and current affairs at that age -- I know I'm an experienced journalist (15 years) but I came quite late on to the daily news junkie thing!

Late teenger early warning signs of more pronounced paranoia

It's very common for the onset of paranoia to be late teens and this was a time I became very depressed because of getting ME/CFS at 16.  By 19 I was attending a day hospital and fearing that my meals would be poisoned.  Unfortunately, and I hope this wouldn't still happen today, the psychiatrists at the day hospital didn't react to seeing me eat in the staff canteen instead of with my fellow patients on the ward.  They dismissed it.  Around this time I also lost most of my sense of taste (now restored!) because of my immune system dysfunction and was quite convinved everything I ate publicly was either contaminated or poisoned.  None of it was ...

A uni degree later and five years at work, the psychotic episode!

This is the point at which I feel most let-down by the system, because when I had been working just 5 years after uni, for the BBC at that time, I was rejected by the corporation for 21 consecutive jobs.  I no longer blame the BBC for causing the psychotic episode which those rejections triggered -- it is likely some other life event besides losing my career would've triggered something off before I reached about 35 -- my grandma had schizophrenia like me and I had birth complications -- a 6% risk compounded by childhood early warning signs.

I was already under a consultant psychiatrist and consultant clinical psychologist for depression, and had very good professional relationships -- one bordering on friendship -- with them.  I trusted them completely and so when I told my psychologist I felt I'd been politically blacklisted by spies against working for the BBC, and his honest opinion was that "Ian they have absolutley nothing to fear from you but be careful -- these are powerful people", then his acceptance of my paranoia was really unhelpful.  Worse still, I went through about six months of a prodrome or "prodromal phase" during which my family and mental health professionals should have picked up that I was denormalising and becoming increasingly more anxious, restless, paranoid and depressed.

It wasn't until the month before sectioning that my consultant psychiatrist put me on an antipsychotic.  I looked it up in the BNF -- the medicines bible -- and refused to take it.  OK, it was only 2mg of rispderidone, but with early intervention in psychosis as we know it now, a targeted medication and CBT approach at this stage would have had a fighting chance of persuading me that I was very, very unwell, and needed that medication (higher dose) and a lot of talking therapy.

Early intervention in psychosis - avoiding the pain of sectioning

I'm not going to risk triggering off memories in those of you reading who have been sectioned or had psychotic episodes, but I want to link here to some current thinking and sources of information on early intervention in psychosis.  If you recognise yourself or one of your family or friends or colleagues in any of this blog in any way, please read them carefully as early intervention can really make the biggest possible difference to someone's prognisis.

I regard myself as "in recovery" nowadays -- I was frequently a suicide risk for 7 years, having made 2 attempts, and felt compulsively sucidal over a 3 year period until this past few months -- and my paranoia is really confined now to those "core beliefs" about vetting and "ideas of reference" in public -- this means situations and events which I think happen specially for me but are actually very ordinary everyday events e.g. people waiting on street corners or in cars on predicatable journeys by bus or train are almost certainly not MI5 or the DWP benefits fraud team, but that's probably what will be going through my mind.   I no longer feel victiminsed by the state -- I agree my journalism is quite subversive and my website deliberately reflects that.  There is no way any mainstream TV broadcaster would employ someone whose views are as liberal and pacifist as me.  I take all this on the chin and I have moved on.   I am enjoying working as a mental health and learning disability jouranlist/columnist/blogger and looking at more local forms of 1-1 work to supplement my fairly hectic schedule of work, volunteering and social inclusion.

So how wonderful would it have been to have bypassed several years of the past decade and not been in hospital twice and sectioned, and to have been treated with respect and really listened to by the mental health profession, instead of being pumped full of powerful drugs with powerful side-effects and addictions, and left to fester for 6 and a half weeks in almost isolation in hospital? This, as you'll see, is something I'm very passionate about and really care about.  The technical term is the "DUP" - duration of untreated psychosis -- the shorter this is, the better the prognosis -- that's key to why early intervention is so important.  Also suicide prevention -- although I have been suicidal in the past 3 years, I only ever made attempts on my life during my first untreated acute psychotic episode, and I firmly believe these could've been prevented.

Early intervetion -- resources and further reading

The NHS Conferation in 2011 produced VERY comprehensive overview of early intervention in psychosis and if you are approaching this from a medical person's perspective, it's definitely worth starting off with this:

Personally I would also recommend a number of really useful websites aimed at people who may be suffering from a psychosis prodromal phase, or the family, friends, colleagues etc of those they suspect may be becoming unwell, such as:

(1) RETHINK

rethink.org/about_mental_illness/early_intervention/

(2) WIKIPEDIA

en.wikipedia.org/wiki/Early_intervention_in_psychosis

(3) IRIS INITIATIVE

iris-initiative.org.uk/

And also there is a book available from Amazon.co.uk (and presumably Amazon's other websites around the world if you are not reading this in the UK or Ireland) -- just search for "early intervention psychosis".

Final thoughts ...

The NHS being the creative that it is, many EIS (Early Intervention in Psychosis) teams have been disbanded and their work merged with other staff within CMHTS (Community Mental Health Teams).  This is a matter of much regret and mirrors the dissolution of some AOTs (Assertive Outreach Teams) at the other end of the spectrum who look after the most seriously mentally unwell patients in their areas.

If you come across barriers, your GP is your first port of call and gateway to all NHS services and should have at least some working knowledge of how to refer for a mental health assessment in secondary care.

Thanks for reading, and if this blog helps just one person not go through what I did, it will have been more than worth writing!