This document discusses psychosis and psychotic disorders in youth. It begins with an overview of psychosis, defining it as a serious disturbance in reality testing that affects thinking, perception and behavior. It then reviews the prevalence of psychiatric disorders in adolescence compared to childhood, noting increases in conditions like depression, bipolar disorder and psychosis during the teen years. The rest of the document outlines various psychotic symptoms like hallucinations, delusions, and cognitive and mood changes. It also discusses the importance of early identification and treatment of psychosis in youth given the disabilities and poor long-term outcomes if untreated.
Presented by: Michael R. Peterson MA LAMFT
Executive Director
Steve M. Wickelgren MA MFT
President
Minnesota CIT Officers Association
Jane Marie Sulzle, RN, CNS, MS
PrairieCare
A 2015 presentation by Victoria Costello, science journalist, author and mental health advocate, demonstrating how lay advocates can access and incorporate scientific evidence into their family and community advocacy for mental health for all. References Victoria Costello's memoir, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness, published by Prometheus in 2012. Presented on May 29, 2015 at the annual meeting of Parent Professional Advocacy League in MA. Website: http://www.mentalhealthmomblog.com
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Children are at high risk of emotional disorders. These have become the most common reasons for their visits to the psychiatrist.
They include mood disorders, anxiety disorders, and trauma and stress-related disorders.
This slide explains each of these in details.
Enjoy
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This is the slide set to the lectures I provided to the medical staff of Child and Adolescent Behavioral Health in Canton, OH during the Fall-Winter of 2018
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
Anxiety: mood state characterized by strong, negative emotion and bodily symptoms in which an individual apprehensively anticipates future danger or misfortune
Attention deficit Hyperactivity Disorder (ADHD) (justpsychiatry)Waleed Ahmad
A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit:
https://psych.thinkific.com
My question bank:
https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych
Presented by: Michael R. Peterson MA LAMFT
Executive Director
Steve M. Wickelgren MA MFT
President
Minnesota CIT Officers Association
Jane Marie Sulzle, RN, CNS, MS
PrairieCare
A 2015 presentation by Victoria Costello, science journalist, author and mental health advocate, demonstrating how lay advocates can access and incorporate scientific evidence into their family and community advocacy for mental health for all. References Victoria Costello's memoir, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness, published by Prometheus in 2012. Presented on May 29, 2015 at the annual meeting of Parent Professional Advocacy League in MA. Website: http://www.mentalhealthmomblog.com
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Children are at high risk of emotional disorders. These have become the most common reasons for their visits to the psychiatrist.
They include mood disorders, anxiety disorders, and trauma and stress-related disorders.
This slide explains each of these in details.
Enjoy
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This is the slide set to the lectures I provided to the medical staff of Child and Adolescent Behavioral Health in Canton, OH during the Fall-Winter of 2018
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
Anxiety: mood state characterized by strong, negative emotion and bodily symptoms in which an individual apprehensively anticipates future danger or misfortune
Attention deficit Hyperactivity Disorder (ADHD) (justpsychiatry)Waleed Ahmad
A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit:
https://psych.thinkific.com
My question bank:
https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych
Mental health includes a broad range of factors, from emotional and psychological well-being to the ability to handle stress and adapt to life's challenges. It's essential to acknowledge and address mental health concerns just as we would with physical health issues. Seeking help, support, and treatment when needed is crucial for individuals to lead happy and productive lives.
The stigma surrounding mental health issues is slowly decreasing, which is a positive step toward encouraging people to talk about their mental health and seek assistance without fear of judgment. Remember, taking care of your mental health is not a sign of weakness; it's a sign of strength and self-awareness. It's also essential to support others in their mental health journeys, as we all have a role to play in creating a more compassionate and understanding society.
Absolutely, mental health matters greatly. Mental health is a fundamental aspect of our overall well-being and quality of life. It affects how we think, feel, and act, and it plays a significant role in our ability to cope with stress, build and maintain healthy relationships, and make choices that lead to a fulfilling life.
Mental illness and mental retardation pptSmriti Singh
Mental illness and mental retardation should not be used interchangeably.
It can be understood as a condition where the individual has a lower IQ and have difficulty in coping with the realities of day to day life.
This document provides a summary of the 2010 annual year in review presentation conducted by Dr. Stan Kutcher, the Sun Life Financial Chair in Adolescent Mental Health, on February 10, 2011
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
The school environment is an ideal place to begin the work of addressing mental health needs. Not only does the school offer a simple and cost-effective way of reaching youth, but it is also a convenient place where mental health can be linked with other aspects of health, such as physical health and nutrition, and with learning.
The term ADHD refers to Attention Deficit Hyperactivity Disorder, a condition that makes it difficult for children to pay attention and/or control their behavior. Learn more about about the causes, diagnosis and treatment of ADHD.
“Mental health is as important as physical health to the overall well-being of individuals, societies and countries. Yet only a small minority of the 450 million people suffering from a mental or behavioural disorders are receiving treatment” (The World Health Report 2001, Chapter 1).
The adolescent brain is best described as a work in progress. Our brains are about 90-95% of their maximum size by the time we are 6 years old, but they are definitely not finished changing! Massive changes continue to occur over the next 15-20 years, as connections within the brain are strengthened and refined. Adolescent brain development can be divided into three processes: proliferation, pruning and myelination.
Adolescence is a time of growth and maturation in the brain, and it is also a time when many new behaviours begin to emerge (most of which irritate and frustrate parents!). These changes include changes in attention, in motivation and in risk-taking behaviour. Surprisingly, many of these behaviours are a direct result of brain changes, and are completely NORMAL!
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
1. Sabina Abidi MD FRCPC
Child/Adolescent Psychiatrist
Assistant Professor Dalhousie University
IWK Youth Psychosis Team
Nova Scotia Early Psychosis Program
2. Objectives
Review the history of psychosis and psychotic
disorders, current definitions and symptoms.
Know the markers that help identify youth at
risk for psychosis and psychotic disorders.
Discuss the importance of early identification
and treatment of youth with psychosis and
psychotic disorders.
4. “So…let’s talk about psychosis…”
What IS IT? Who knows?
Definition
Cases
5.
6.
7. Psychosis is a brain disorder.
A medical illness - affects more
than 8% of Canadians at any
point in time
a serious disturbance in an
individual’s reality testing
A process whereby the senses are
distorted, making it difficult for
the person to distinguish
between real and unreal
Affects a person’s ability to think,
perceive and act
Thinking, feelings, perception
and behavior affected
10. Onset of Psychiatric Disorders in Adolescence
Prevalence in Prevalence in
Childhood Adolescence
Depression (1-2%) Depression (6-8%)
Bipolar Disorder (rare) Bipolar Disorder (1%)
Psychosis (rare) Psychosis (1%)??
Anxiety Disorders (6-8%) Anxiety Disorders (10%)
Anorexia Nervosa (rare) Anorexia Nervosa (0.2%)
Total (7-10%) Total (15 – 20%)
11. Prevalence of Psychotic spectrum disorders per 1000
children/adolescents
In males particularly, psychotic disorder(s) is
Boys
8 a major disorder of adolescence
Girls
Hits adolescents in their prime – leads
6 to a disruption in education-attainment,
career building, employment
Alters relationships, family interactions,
4 Alters sense of self, esteem, (Reprinted) Spady et al. Prevalence
of Mental Disorders in Children
productivity Living in Alberta, Canada, as
Determined from Physician Billing
Data. 2001.Arch Pediatr Adolesc
Med. 155: pp.1156.
2
0
Age
0 3 6 9 12 15 18
15. Hallucinations
Hallucinations can affect all senses:
Sensory perceptions that occur in the absence of any
real stimulus but appear to be the result of faulty
messages in the brain.
Hearing (auditory)
Seeing (visual)
Touch (tactile)
Smell (olfactory)
Taste (gustatory)
16. Delusions
Fixed beliefs created by illness which are held only by the
person experiencing the psychosis.
These can include:
Belief in special abilities of self or others
Belief that physical health is changed
Belief that unusual coincidences have a special importance
Belief that one is being controlled
17. Thought Disorder
Problems organizing thoughts.
Thoughts coming to fast or too slow.
Problems thinking and therefore speaking logically.
Problems keeping on topic.
18. Disorganized or Bizarre Behaviour:
Everyone’s behaviour is a response to how they interpret
what is going on around them.
People with psychosis may behave differently than they
usually do.
may become extremely active or agitated,
may laugh inappropriately or display inappropriate
appearance, hygiene or conduct.
may behave in ways that reflect their thoughts
20. Negative symptoms may include:
Problems getting motivated
Problems taking joy in things
Problems getting words out
Seeming flat and blunted
21. Cognitive Symptoms
Refers to problems with learning and concentration
Find it difficult to focus and pay attention
find it hard to filter out all the various stimuli in their environment.
(may be highly sensitive to sounds, lights and even the regular activities
occurring in their immediate environment.)
Easily distracted
Trouble with working memory
Classroom/Tim’s example
22. Cognitive Symptoms
find the ability and speed in processing information and
reaction time may be slowed
experience difficulties with memory, problem solving ability
and judgement.
find it hard to organize activities in their lives, for example to
manage the time and tasks needed to get their schoolwork
completed.
23. Mood Symptoms
The person can be
Anxious, irritable
Depression
Anger and unpleasant behaviour
Rapid changes in mood
24. Key Point
•Sometimes people with psychosis cannot
recognize that they are ill and believe that
nothing is wrong with them.
•This lack of insight can make it hard to get
the person to accept treatment.
26. The psychosis continuum or
spectrum of symptoms
Psychotic disorder
Psychotic like experiences
(schizophrenia)
(normal variant)
PLEs associated with other disorders
-anxiety
-Depression
-Stress PLEs + markers of risk
-Grief/loss - family history
-trauma - social isolation
- birth trauma
- cannabis exposure
27. Types of disorders which present with symptoms
of psychosis
Schizophrenia
Schizophreniform Disorder
Brief Psychosis
Schizoaffective Disorder
Psychosis NOS
Delusional Disorder
Drug Induced Psychosis
Bipolar Disorder (with psychosis)
Psychotic Depression
Secondary to a medical condition
28. To be normal in adolescence it itself abnormal
Anna Freud
29. Prevalence of children’s mental disorders in
Canada
any disorder
any anxiety disorder
ADHD
conduct disorder
any depressive disorder
substance abuse
PDD
OCD
eating disorder
Tourette syndrome
schizophrenia
bipolar disorder
0 3 6 9 12 15
estimated prevalence %
Adapted from Table 2. Waddell et al. 2002. Child Psychiatric Epidemiology and Canadian Public Policy-Making. The state of the science and the art of the possible. Can J
Psychiatry
31. • Common among prison and •More hospital beds in
homeless populations Canada are occupied
(8%) by people with
• 80% will abuse schizophrenia than by
substances during their sufferers of any other
lifetime medical condition
• 15-25x more likely to
die from a suicide
attempt than the general “Youth’s Greatest Disabler”
population
• 10% or patients die
from suicide most often
in the first 10 years after
World Health Report 2001
diagnosis
(WHO, 2002) schizophrenia
and other forms of psychoses
affecting young people rank
third worldwide as the most
disabling condition
If left untreated, there is a continuing slow increase in impairment for years
32.
33. Epidemiology
Schizophrenia causes massive human and financial
costs
Affects more than 1% of the world’s population
Affects all races, ethnicities, cultures equally
More severe presentation in men
Allow for a more broader definition of psychotic
disorder (include psychosis NOS, brief
episodes, delusional disorder) lifetime rate increases to
2-3%
34. Patients with schizophrenia itself die 12-15 years earlier
before the average population – some quote up to 25
years earlier
Schizophrenia causes more lives lost than cancer and
physical illness
Mostly due to poor medical care, suicide and deteriorating
physical illness
35. The vast majority of psychiatric disorders have their onset
in adolescence
The age of maximum incidence for schizophrenia in males is
15-25 years and 18-35 years in females
If left untreated, there is a continuing slow increase
in impairment for years.
36. Life potential
(social, occupational, financial…)
Onset
Of
illness
Successive illness relapses
17
Age
37. Outcomes of psychiatric illness in adolescence
X – onset of
Attainment – in life
psychiatric
illness
X – onset of
treatment
effort
X – delay in
treatment
12 15 20 effort
Time - age
40. Phases of Illness
Birth
Premorbid
Phase
First Signs of Illness
Prodromal
Phase
Onset of Psychosis
Duration of
Untreated
First Treatment Psychosis
Recovery/Stabilization Phase
Residual/Stable Phase
41. Etiology
Risk Factors
Genetic
Family history of psychotic disorder/bipolar disorder
Environmental
Higher incidence in urban populations
Immigrant ethnic groups - social isolation
Areas of Social defeat
Childhood trauma exposure
Cannabis exposure
Perinatal factors
There is a definite interplay of genes
and the environment
42. Genetics
50% of identical twins with a twin having schizophrenia
will develop the disorder.
13% risk for children with one parents with schizophrenia.
2% risk for first cousins of a person with schizophrenia
>1% risk for the general population.
43. Stress-Vulnerability Model of Schizophrenia
High
Stress Less severe Psychotic symptoms
-adverse acute Psychotic-like
& chronic life
events Symptoms or
- developmental Prodromal
challenges symptoms
No symptoms
Low
Low High
Vulnerability
-family history of psychotic disorders
-Obstetric complications
44. It is important to remember that
psychosis is not caused by:
Family upbringing.
Problems with other people.
Having a “weak” character.
45. Dopamine in brain function
Dopamine is important in three areas of brain
function:
Mesolimbic-frontal cortex circuits
( psychotic symptoms).
Basal ganglia (control of muscle movement).
Parkinson’s disease; loss of dopamine cells
Hypothalamus-Pituitary (control of the hormone,
prolactin).
47. Duration of Untreated Psychosis (DUP)
Historically youth experience long DUP before coming
into contact with psychiatric services
2-5 years
Long DUPS translate to very poor clinical and social
outcomes
We now know that if this illness is caught
early, prognosis can be very positive with effective
treatment
49. Rational therapy for psychotic disorder
Antipsychotic medication along with therapy/education
are the cornerstone of effective treatment programs when
dealing with a known chronic psychotic illness such as
schizophrenia
50. Antipsychotic Medications
All antipsychotic medications influence
communication between brain cells involving the
neurotransmitter, dopamine.
Each medication may also influence a number of other
neurotransmitters in the brain, but the effect on
dopamine seems to be one common factor in reducing
psychosis.
51. First and Second Generation Antipsychotics
“Traditional” or “First Generation” antipsychotic
medications (1950-1988) (dopamine blockade):
Haloperidol, Chlorpromazine, Thioridazine and many
others.
Second Generation antipsychotics (serotonin-
dopamine antagonism)
“Clozapine / Clozaril (1990)
Risperidone / Risperdal (1992)
Olanzapine / Zyprexa (1996)
Quetiapine / Seroquel (1998)
Ziprasidone / Zeldox (2008)
Paliperidone / Invega (2008)
Aripiprazole (Abilify, 2009)
52. Side effects
First generation (due to Dopamine receptor
blockade):
Extrapyramidal (movement) symptoms (EPS)
Muscle stiffness, restlessness, involuntary movements.
The use of anti-parkinsonian “side effect” meds.
Prolactin (hormonal) elevation.
Ammenorhea and sexual dysfunction
“Dysphoria” (feeling bad).
Difficulty with concentration and memory.
53. Side effects
Second generation antipsychotics:
Sedation (early in treatment)
Sexual dysfunction
Weight gain
Metabolic dysregulation
Dylipidemia
Hypertriglyceridemia
Risk for diabetes
Cardiac dysfunction
Glaucoma
Stroke
Extrapyramidal side effects still a concern
54. General treatment guidelines
Individual basis
Try to treat with one medication at a time.
If there is an insufficient clinical improvement after 3-
6 months, try a different medication.
Use continuous treatment with medication for as long
as possible.
55. Treatment: How Long?
50% of patients who do not take medication in the
first year will relapse
56. Treatment
40-60% with effective treatment
(medicine, therapy, education, rehabilitation) can lead
productive lives achieving life goals had prior to the
onset of illness
57. Key Points
Psychosis is treatable.
Medication is a necessary, but not
sufficient, part of a total treatment plan.
The stress-vulnerability model helps us
understand treatment.
Adherence with treatment, including
medications, is a critical issue.
58. Challenges to Treatment
Non-adherence
Depression/risk of suicide
Substance use/abuse
Excessive stress/expectations
59. Predictors of Non-Adherence
Denial of illness Support Network
Symptoms of Illness Stigma
Delusions Insight
Depression Distressed by side effects
Cognitive impairment
Drug induced dysphoria
Belief that medications no (feeling bad) or
longer needed (I’m cured). akathisia (restlessness)
Attitudes of family and Cost of Medication
friends
60. Depression
Major depression during course of illness : 60%
Post-psychotic Depression: 25%
Attempted suicide: 25% - 40%
Successful suicide: 10% - 13%
61. Challenges:
Substance Use/Abuse
Substance use is very common in first episode psychosis
Up to 80%
Cannabis and alcohol are most frequently abused
substances
62. Cannabis and Early Psychosis
People with psychotic disorders have higher rates of cannabis use
than the general population
Cannabis use is associated with poorer functional and clinical
outcomes in this population, e.g. greater psychotic symptom
severity the effects of which can last up to 4 years later
Cannabis misuse associated with 4 times the risk of psychotic
relapse
One of the strongest predictors or risk factors associated with the
onset of psychotic illness
There is little evidence that the high rates if cannabis are is related
to self-medication for distressing symptoms or side effects of
meds
63. Common Issues in Recovery
Daily Life Relationships
Lack of Trying to establish independence
structure/disorganization from family
Lack of supports required Loneliness/Separation from social
to return to school or work groups
Negative experiences Increased anxiety in social groups
No plan to help recovery Difficulties in re-establishing
Lack of motivation relationships
Recovery takes time
65. Prevalence of Psychotic spectrum disorders per 1000
children/adolescents
Boys
8
In males
Girls particularly, schizophrenia is a
major disorder of adolescence
Hits adolescents in their prime – leads
6
to a disruption in education-attainment,
career building, employment
Alters relationships, family interactions,
4 (Reprinted) Spady et al. Prevalence
support of Mental Disorders in Children
Living in Alberta, Canada, as
Alters sense of self, esteem, Determined from Physician Billing
Data. 2001.Arch Pediatr Adolesc
productivity Med. 155: pp.1156.
2
0
Age
0 3 6 9 12 15 18
66. Phases of Illness
Birth
Premorbid
Phase
First Signs of Illness
Prodromal
?Primary prevention
Phase
Onset of Psychosis
Duration of
Secondary Untreated
prevention
First Treatment Psychosis
Recovery/Stabilization Phase
Residual/Stable Phase
67. “It is not an easy task to recognize psychosis in the early
stages and motivate a young psychotic person, who
might have persecutory delusions or other delusional
beliefs, to accept psychiatric treatment.”
Nordentoft M et al. Does a detection team shorten duration of untreated psychosis? Early Intervention in Psychiatry 2008;2 :22-26.
68. Challenges in identifying the prepsychotic phase –
The earliest symptoms identified are non-specific:
Sleep disturbance behavioral disturbance
Depressed mood social withdrawal
Anxiety irritability
In youth, changes that occur as part of the normal developmental
continuum can complicate psychiatric diagnoses. Patient
age, gender, developmental stage, identity, culture, belief system
are all significant diagnostic and therapeutic factors
The differential diagnosis for psychosis is widespread in youth
and depends upon a number of environmental factors that must
be examined
40% cases – initial diagnosis has cause to be changed in 3
months
69. Recognition of youth in trouble
Less than ½ of child & adolescent psychiatric
disorders are identified in primary care settings &
only a fraction are referred for mental health
services
70. Recognition of youth in trouble
Direction of help-seeking behavior
Help seeking behavior in adolescents is primarily
directed to friends, family and teachers before
physicians
71. Warning signs
Gradual onset of change in behavior, appearance, attitude etc
“he’s not himself”, “something’s up with him”
Isolation from friends, adopting new/unusual friend group
Decline in grades and overall functioning over time
Poor hygiene
Onset or increase in substance abuse, esp marijuana
Odd or bizarre comments, beliefs, behaviors
Easily distracted, sensitive to noise/light, wearing headphones
often with little eye contact
Appearing to be “out of touch” or daydreaming a lot, staring
Low mood, frustration, irritability, sadness, confusion
Avoiding hallways, crowds, buses
Fatigue during day (poor sleep)
72. How can you help?
Early identification
What do these youth really look like?
Support
Reduce stigma/increase acceptance
Substance use
declining grades/functioning
changes in behavior
Help access service/assessment
73.
74. Studies are now showing with earlier identification there
is a decline in the transition rate to psychotic disorder
in youth at high risk.