Spotlight on Early Intervention in Psychosis

OK, so it’s been around a while now, but Early Intervention in Psychosis is still one of the more modern approaches towards treating psychotic illnesses.

An EIiP team is made up of care co-ordinators, psychologists, psychiatric nurses and psychiatrists who deal specifically with people who have experienced their first episode of psychosis. They typically work with people within a certain age range (such as 14 – 35 years old) and typically work with the service user for 3 years.

Their function is to facilitate recovery from psychotic episodes and illnesses. As studies have shown that the longer a psychosis goes untreated the worse the prognosis is, the aim of the team is to intervene as soon as possible and provide treatment in the form of assessment, medications, psychological services and social care. They will also support a return to normal social function, such as returning to work or education.

Here in the UK the EIiP team is a part of major service reform in treating mental illness. The guidelines state that as well as working with 14 – 35 year old for the first three years of their illness, they should aim to employ one care co-ordinator for every 10 to 15 clients, with each team taking on a caseload of 120 to 150 cases.

I’ve been under the care of the Surrey EIiP team for coming up on three years (we’ve just started to talk about where I’ll be signposted next), and my experiences with them have been great. Unfortunately the team I’m with seems to have a high turnover of care co-ordinators – I’ve had six in three years, some changes were due to circumstances such as a change of work location and a house move though – but despite the regular change of staffing, I’ve had the same psychiatrist throughout. I’ve also found that every care co-ordinator has taken the time to read up on my notes and get a thorough understanding of my case before meeting me for the first time.

As part of my treatment plan with EIiP I’ve spent time attending sessions with a psychologist. The EIiP approach is holistic and looks to solve underlying issues as part of the treatment of the illness. Therapy involved a lot of talking and examining patterns of behaviour as a result of learned beliefs, which is typical of the CBT (cognitive behavioural therapy) approach.

Getting referred to an EIiP team was a speedy process for me as I was in crisis at the time of my referral, but typically a referral can take up to 21 days. Whilst in crisis, the team works hard to keep the service user out of hospital. This can mean involving the Home Treatment Team (who make daily home visits to monitor the client’s state-of-mind and can refer on to inpatient care if necessary), or making use of Crisis Beds in mental health care homes.

Studies have shown that within two years, people who have used EIiP services have fewer relapses, less admission to hospital and have less severe symptoms. Feedback from service users suggest that EIiP teams are effective and have been rated highly for the support they provide.

My personal experience has been positive, and I am not looking forward to moving on from the support I’ve received whilst under their care. I can highly praise the team for what they have done for me in the last three years.

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Spotlight on Early Intervention in Psychosis

So Why Me?

It’s a question anyone with any health issues has asked at some point – why me?

When it comes to mental health, the short answer is that there kinda isn’t one. Lots of research has been done over the years to try to determine why people’s brains do what they do, but it seems no conclusions have been reached. Here’s a run-down of the major theories.

Genetics:

  • There is a school of thought that supports the idea that mental health issues run in families. There have been many studies that look into the genetic make-up of families that have more than one person with mental illness. Within the general population, occurrence of bipolar is roughly 2-3% of the population; when looking at the offspring of a parent with bipolar the risk rises to 15%. If both parents are bipolar, this goes up again to 50%. [NSW Government Health Facts – Fact Sheet 58]. Twin studies have shown that genetics seems to play a major part in the development of schizophrenia too – there’s a 41% – 65% chance of the occurrence of schizophrenia in a twin who’s sibling has the illness [American Journal of Medical Genetics, Vol 97, Issue 1]. However, Peter R. Breggin states that normally you would expect to see a 100% occurrence in genetically identical twins in order to support a genetic causality.

Nurture:

  • Going against the argument for genetics, the nurture argument suggests that one’s upbringing is responsible for mental illness. In families where the children were adopted and had no genetic relation to their adoptive parents, a study saw a correlation between the occurrence of bipolar in both generations. A 40-year study in Finland looked at the nurture causality in-depth, and found that children with a genetic predisposition to developing schizophrenia (that is to say they had the genetic markers identified by studies) saw their risk reduced by up to 86% by a protective family environment. In this study, 36.8% of high-genetic risk adoptees living in a dysfunctional family environment were found to have developed a schizophrenia-spectrum disorder, compared to only 5.8% of those in a healthy family environment.

Trauma:

  • Stress has been shown to trigger the illness in those already susceptible to it. High-stress, traumatic situations such as sexual abuse seem to show a link. Jim van Os at the University of Maastricht, the Netherlands, ran a study comparing self-reported childhood trauma and the prevalence of schizophrenia in young Germans. There was a dose-response relationship, that is that as the frequency of traumatic events in childhood increased so did the proneness to developing the illness.
So Why Me?

Spotlight on Anxiety

Let’s talk about anxiety. As a headline mental illness this is something a lot of people know a bit about. The feeling of panic that can be so overwhelming is fairly common in our western world.

I am inclined to split anxiety into two classes. There’s the anxiety that warrants its own diagnosis (for example, Generalized Anxiety Disorder or Social Anxiety Disorder), and there’s anxiety coexisting with another mental illness. I’ve experienced a little Generalized Anxiety Disorder (GAD), but mostly anxiety has been as a by-product of psychosis.

GAD is defined by excessive and irrational worry about events and activities, to a point where it interferes with daily life. The gold standard test for diagnosing this disorder is the GAD-7, which rates daily experiences of anxiety and assigns a score. Essentially, the more anxiety affects your functioning in life, the higher the score is. People with GAD often struggle to remember the last time they felt relaxed.

Anxiety is also a primary symptom of many psychiatric conditions; notably phobias and post-traumatic stress disorder. In these cases the anxiety is less generalised – it tends to relate to specific circumstances that trigger the panicked feelings.

Alongside the diagnosis of anxiety disorder often comes depression. Comorbidity of depression and anxiety exists in between 5% and 10% of the population each year (based on those seeking primary care services for these issues). The existence of these disorders together is probably the most common presentation, but not the only one. Bipolar mania can cause a state of agitation and worry that is uncomfortable. Psychotic symptoms such as paranoia can also manifest in a specific anxiety about given situations, as I’ve touched on elsewhere on the site.

The symptoms of anxiety are not just mental. It affects the body in many ways. Stomach upset, heart palpitations, headaches, dry mouth, sweating and more are common presentations of anxiety, as well as the general feeling of fear and tension. Interestingly, as a nurse explained to me, many of these symptoms come down to the flight-or-fight response. As she explained it, the body begins to divert key resources (such as oxygenated blood) to key areas in preparation for flight – as well as the increased adrenaline that floods the system.

Treating anxiety comes down to personal choice. Anti-anxiety medications such as benzodiazepines can be very helpful in the short term when taken as needed. They have a sedative effect on the mind and body that helps with finding calm and relaxation. Unfortunately benzodiazepine medications such as temazepam and diazepam (Valium) can be highly addictive and are a stop-gap solution that deals with the immediate effects of the anxiety.

In the long term, treatment of anxiety with talk therapies can be very productive. CBT (cognitive behavioural therapy) seeks to understand ones’ thoughts (cognition) and re-program the behaviours that result from the pattern of thinking. CBT uses exercises to identify and change key thought processes, and those exercises can be used outside of the therapeutic setting. For example, STOPP is one such exercise, and one I’ve found personally very helpful.

I would welcome comments and questions below, on Facebook or via Twitter (@dontsayimcrazy).

Spotlight on Anxiety

Citalopram And The Doctor From Hell

When I first became unwell it was the anxiety that sent me to see my GP. At this point I wasn’t truly psychotic or manic, but it had started to creep in (if only I knew the warning signs back then!). I hadn’t been sleeping because I was so afraid that if I slept, my husband and I would be murdered in our bed by the neighbours. On top of the paranoia I was also ‘running fast’; I wasn’t able to slow down enough to shut off. I was having anxiety attacks every night over this fear and have experienced them before so thankfully I was able to at least identify; ‘yes this is anxiety’.

I booked an appointment to see the doctor to see if I could get some help dealing with the fear. My regular doctor wasn’t available, so I took the first free appointment with a locum. In I went, my heart beating in my chest with the anxiety of having to talk to someone about what was going on. When she asked why I had come in to see her I broke down. I spilled my heart out and told her everything – that I wasn’t sleeping, couldn’t calm down and was having anxiety attacks. I probably only talked for a minute but it felt like forever. She listened and made reassuring mhmm noises as I spoke; but when I was done she came out with the least helpful statement a doctor has ever made:

“I don’t know what you want me to do about it. You’ll have to sleep sometime.”

I was shocked. Worse still, I didn’t have an answer. I didn’t know about asking for referrals to talk therapy (in this area of the UK there is a very good telephone counselling service, as well as the opportunity to take up six face-to-face sessions), and I didn’t know about anti-anxiety or sleep medications. She had knocked the wind out of my resolve to get this sorted and I had no idea how to respond.

After a moment of silence she started to talk about the link between depression and anxiety. She suggested that I was in fact depressed and it was manifesting itself as anxiety. That’s not to say it doesn’t happen; that’s just not what was happening with me. She wrote me a prescription for citalopram (which is an SSRI anti-depressant) and sent me on my way.

What a disaster that was. I felt rotten, but relieved that I could at least try these pills and maybe get a break. I didn’t know then about certain anti-depressants exacerbating mania. Pretty quickly, I found out though.

For the first few days I felt no change. A quick search online told me to be patient – 2 to 4 weeks is typical for SSRIs to take effect. My mood was still elevated and I was still terrified to sleep. Gradually, however, the mania took hold. I hadn’t been sleeping more than a few hours a night anyway, but this amount dropped away until I was catching around three or four hours every third night. I was restless, agitated; every night I fantasised about going out for a long walk just to take the edge off. I was raging angry at my husband for every tiny transgression, and I couldn’t focus on my work.

The thing that made me drop the citalopram in the end wasn’t this manic experience though. I am notorious now with my psychiatrist for getting the weird, rare side effects on every medication we’ve tried. In the case of this particular anti-depressant, it was making my food taste rotten. I couldn’t eat a thing unless it was highly flavoured or highly spiced to cover up the taste of the meat. Fatty foods were out; whenever I tried even so much as a sausage it felt as though my tongue was coated in the oil from the meat. It was disgusting, and I was hungry, so I stopped the medication.

From there on in the mania settled a little. Probably back to ‘simply’ being hypomanic rather than full-blown raging mania. It was another month or so before it came back in full and my husband got me to see a different doctor, this time armed with mood charts and trackers.

Even now I’m on a different anti-depressant we are careful of my mood. Sertraline is nowhere near in the same league as citalopram was for triggering mania, but it’s not perfect either. Unfortunately without it I get severely depressed, so it is a case of balancing the pros and cons.

So to wrap up, I suppose the moral of my story is to do your research and never be afraid to challenge your doctor if you’re not sure they are right.

Citalopram And The Doctor From Hell

Things I Would Say to Myself Aged 13

This post is somewhat inspired by the book I posted a review of earlier today (Reasons To Stay Alive by Matt Haig). In the book he has sections like ‘Things you think during your first panic attack’, and conversations between himself now and himself then. It got me thinking – what would I like to say to myself aged 13 if I could.

You are not crazy.

The title of this site is taken from my lifelong fear that I am crazy/abnormal/weird etc. When I first started feeling anxiety and depression I would wonder how long I could last like this before they locked me away. A lot of my fear of seeking adult help stemmed from this belief. I wish I could go back and tell myself that it is going to be OK.

Lean on people.

No, 13 year old Alexandra, your mum is not going to be mad at you. She might get angry, sure, but she loves you and cares about you. Your nan will listen too, if you feel like you can’t talk to mum. So will Aunt Sandy, and you know she’s cool anyway. What I’m saying here is to use the support around you. It will be hard at first but the road is a lot smoother when people are ironing out the bumps.

Please stop hurting yourself.

This is a tough one. I wish I had known how much of a slippery slope this is. Cutting is the most common form of self-harm and it leaves marks on skin and soul that fade but don’t disappear. I know that when I’ve been engaged in it it has been because I literally didn’t know what else to do to cope. Even now that I’ve learned how to utilise healthy coping skills I still find my mind turning back to self-harm. I would tell myself to stick it out with the psychiatrist, learn to use exercises like STOPP and The Butterfly Project and I would ask myself very nicely to chuck out the blades once and for all.

You will make it past 20.

I spent my teenage years acting as though I had a death sentence looming over me. I was convinced I wasn’t strong enough to see it out to reach 20. I’m now 25 and still here, and it’s been well worth the wait. In fact, I can say I started to see the future when I met my now-husband aged 18, so the last two years of my teens weren’t all that bad. Certainly 13 to 17 year old me was hopelessly lost in a depression that hardly lifted, ruined my college years and felt like the end of everything. But here I am, little me, and life now is well worth sticking it out for.

Talk to a therapist or doctor.

Professional help is key to recovery. Perhaps I’d never have developed Schizoaffective if I’d been treated for my depression and anxiety earlier. Or perhaps it is in my genetic make-up. Even if I had been seen in my teenage years and still developed sza, it would likely have been caught earlier, treated sooner and I’d have lost out less. I was so scared of doctors (still am in truth, but I’m better with it now) that I avoided and avoided going unless I was literally falling apart. So if I could I would encourage myself to be open and honest with a medical professional and ask them for help getting through the rough times.

Things I Would Say to Myself Aged 13

Book Review – Reasons To Stay Alive by Matt Haig

It has been a while since I’ve bought a physical, paper-and-ink book but when I saw Matt Haig’s Reasons To Stay Alive in the book shop, I had to have it. A memoir of his battles with depression and anxiety, Matt has crafted a combination of narrative stories and thoughts on depression into a great read. So great, in fact, that I read it in two sittings.

It is full of insight; conversations between then-Matt and now-Matt in which he offers words of encouragement to his past, depressed, self are wonderful – words that can only come with the distance of hindsight. He beautifully sums up the desperation that a depressive feels when they are deep in the pit and can’t see the light (in fact, Matt summarises this situation as akin to being in a tunnel where both ends are blocked; it is dark and you are trapped). And he offers hope to those in that darkest of situations; the book features a list of things he wishes someone had told him at the time, including my favourite: So what, you have a label? ‘Depressive’. Everyone would have a label if they asked the right professional.

That is a powerful statement and oh so true of the way the mind works. When you are experiencing any disturbance of ‘normal’ thought patterns, you feel as though you are the only one in the world struggling through life. The reality is that you are not alone. Statistically one in four people will experience a mental health problem in the course of a year. Being an illness that affects the way the mind works, even more people will be touched by mental health problems through being friends with, family of or co-workers with those effected. Having said that; it doesn’t automatically make it better to know that you are not the only person in the world in the pit. It does, however, give some perspective on your situation – people have come through this and are on the other side living normal, happy and contented lives.

Matt isn’t afraid to tackle the big subject of suicide either. He understands what it is like to be so desperate to feel nothing that one would end their own life. In summarising the depths of feeling, Matt neatly states that zero is worth more than a negative number to the mind of someone suffering depression. The mind doesn’t see the green grass on the other side of the struggle; it just wants to not feel so awful. There is no wishing for happiness, no desire to feel pleasure. Instead there is a need to wipe the slate clean, to get back to ‘zero’. Further chapters on the subject seem to reflect how I’ve felt in the past. The way one is so desperate to feel nothing that they wish they’d never been born, for example. Death is scary, contemplating choosing it is scarier still.

But Matt believes in the power of words. Mental illnesses effect so many people worldwide and yet we still sweep it under the rug like it is a dirty secret – like we should be ashamed that we are unwell. We are making progress by speaking out. Books like Reasons To Stay Alive are starting to break down the stigma associated with those with mental health conditions; and I say let’s add more and more voices to the cause until we are impossible to ignore. I am not afraid to say I have an illness. Are you?

Book Review – Reasons To Stay Alive by Matt Haig

Spotlight on Mindfulness

Mindfulness. It has become something of a buzz-word in the mental health world lately. People, sufferers and not, are jumping on the mindfulness bandwagon – which is testament to just how well it works.

In summary, mindfulness is the non-judgemental acceptance of your current situation. It means that you are fully present in the moment; not fretting about the future or past. Acceptance of the present is a powerful tool in overcoming anxiety especially. So much of anxiety comes from rumination (a contemplation of thoughts where they are allowed to run wild and are obsessed over). Mindfulness means that you can observe your thoughts without becoming emotionally entangled in them.

To practice mindfulness means becoming aware of the world around you in the moment; and becoming aware of your own internal world too. It means paying attention to the detail – how green the grass is, how warm the breeze is, the sound of the birds singing (using an idyllic summer’s scene here – it could equally be the sound of the storm lashing your window panes and the texture of the blanket you are laying under). Turning the practice inwards, perhaps it is about noting (but not judging) the million anxious thoughts going through your head; the trick is learning to observe without getting involved. It can be a highly eye-opening experience to see the patterns of your thoughts.

There are plenty of exercises linked into mindfulness. Some are traditionally meditative and involve soothing music and listening to a pre-recorded track – there are lots of videos on YouTube that you can try out. Others are more interested in observing the world you are present in in detail. A favourite of mine is to do ‘mindful dishes’; an activity that normally sees my mind wandering becomes an exercise in focus. I learned to notice all the little elements of the mundane that normally pass me by – from the temperature of the water, to the smell of the soap and right down to the detail of the bubbles gently tickling as they burst on my skin.

Mindfulness does take practice, but it is well worth it. Meditative mindfulness means that we can learn to see when our thoughts are taking over and takes away their control over our minds. The activity based mindfulness can be a break from roller-coaster emotions and anxieties; learning to find peace in the every day things is like a time-out for the mind. It can reduce stress and improve mood.

Setting aside time for mindfulness is of benefit too. Scheduling ten minutes in the morning can set you up for the day. Ten minutes in the evening can be a chance to unwind and relax before settling for bed. Taking a mindful walk at lunch time is a nice break from the stress of work. Whatever you decide works for you really.

Give mindfulness a try; you won’t regret it.

Spotlight on Mindfulness