Understanding delay in treatment for first episode psychosis

Matthew Dodgson, a 24-year-old University of Western Ontario student was diagnosed with psychosis one year ago. Having suffered from depression throughout much of his teen years, it was not until he realized the voice that he had been hearing inside his head was not his own, that he decided he had to seek medical attention. The disjointed thoughts, constant ‘thinking’, and terrifying suggestions brought him to the breaking point. “Being admitted (into the hospital) was the safest place I could be,” states Matthew.

Prior to being admitted into the hospital last April, Matthew visited the emergency room three separate times, only to be prescribed anti-depressants and told to go home and “sit tight”. Knowing that something was “just not right,” Matt’s father refused to take him home, demanding that he be admitted for evaluation. Matthew was experiencing symptoms typical of psychosis and spent a month in the hospital adjusting.

Psychotic disorders are a group of serious illnesses that affect the mind. These illnesses alter a person’s ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality and behave appropriately. When symptoms are severe, people with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary demands of daily life. However, even the most severe psychotic disorders are usually treatable.

The exact causes of psychotic disorders are not well established, but researchers believe that many factors may play a role. Some psychotic disorders tend to run in families, suggesting that a vulnerability to the disorder may be inherited in some, but not all, cases. Environmental factors may also play a role in their development including stress, drug abuse and major life changes. About one per cent of the population worldwide suffers from psychotic disorders at some point in their lives. In London, 40-50 new cases of psychosis are diagnosed each year. Psychotic disorders strike at a fairly early age, usually in late adolescence or early adulthood. Due to the nature of the symptoms and their early onset, these disorders have a major personal, social and economic impact.

Dr. Ross Norman, Program Leader of the Health Outcomes and Health Services Research Program at Lawson Health Research Institute focuses his research work on psychotic disorders. A lengthy delay often occurs between the onset of symptoms of psychotic disorders and initiation of adequate treatment. Dr. Norman and his colleagues within the Prevention and Early Intervention Program for Psychoses (PEPP) are studying the outcome and benefits of early intervention and whether or not there is a relationship between the speed at which a disorder is treated and the related outcomes.

It is not unusual for individuals to have been suffering from psychosis for long periods of time, often several years, before receiving proper treatment. In order to better understand the delays that often occur between the onset of psychosis and access to appropriate treatment, researchers in PEPP examined the pathway to care of patients. Data were collected using structured interviews not only with patients, but with their families, and clinicians as well. Dr. Norman and his colleagues have concluded that both delay in seeking help and the delay from contact with a helping professional are important contributors to the often-reported lengthy delay in receiving treatment for psychosis. “Individuals who are receiving professional consultation at the time of onset of psychosis may be at particular risk of treatment delay,” states Dr. Norman. This may be attributed to several factors such as the psychotic symptoms being mistaken for a preexisting diagnosis of anxiety or depression.

The findings indicate that in addition to informing the general public about the signs of psychosis, it is also important to educate those individuals who are initially contacted by the patients and families for help. Individuals such as family physicians, emergency room staff and community mental health workers need to be able to recognize possible signs of psychosis and appreciate the importance of early treatment. By reducing the delay between first contact and adequate treatment through identification of the disorders, knowledge of the benefits of early treatment and effective engagement the outcomes for individuals such as Matthew should be improved.

Thanks to his medications, the support of his doctor – Dr. Sandra Northcott, his case manager – Cheryl Taylor, and the staff of the PEPP Program, Matthew Dodgson has not experienced a psychotic episode in over a year. When asked what it is like living day-to-day with a mental illness, Matthew states: “It is like anything else. If you have a headache you take an aspirin, it’s the same for me – I take my medications and I’m okay. Living with psychosis is easier when you know what it is and how to manage it.” As for future plans, Matthew is looking forward to moving to Toronto next year to attend Humber College. He is enrolled in the e-business program, and hopes to start his own consulting business someday. “I want to get the most out of life and I am taking the necessary steps to do so.”