Occupational Therapy for First Episode Psychosis

Transcription

1 2018 International OT Conference Occupational Therapy for First Episode Psychosis Ms. Yeung Sau Fong, Odelia Occupational Therapy Department Kwai Chung Hospital HKSAR

2 Early intervention Stage specific intervention Keys Specialized Occupational Therapy Outcomes

3 Early Intervention Shortening the duration of untreated psychosis (DUP)

4 Early recognition & intervention Duration of untreated disorder Duration of untreated prodromal phase Duration of untreated psychosis (DUP) Start of negative symptoms Start of positive symptoms Start of treatment Premorbid phase Prodromal phase Psychotic symptoms Initial treatment Long-term phase First non-specific indications Start of illness Start of episode End of first episode

5 Poor cognitive performance (Penttila et al., 2014) Social impacts (Penn et al., 2005) Attention Stigma Memory Executive function Unemployment Social isolation Prolonged DUP Avolition Anhedonia Apathy Poor longterm functioning Severe negative symptoms (Morgan et al., 2006)

6 Enhancement of knowledge of mental health in community Community-wide initiatives to fight stigma Formation of a team of primary healthcare professionals Shortening DUP Quick access Interphase with NGOs, private practitioners and schools User-friendly easy access to mental health service Commencement of treatment prior to the crisis Involvement of families Initial treatment location should be in clinic or home Better prognosis

7 Stage Specific Intervention Going through the recovery journey

8 Four-step process infographic First 3-5years ADD A post DESCRIPTIVE diagnosis STATEMENT may constitute HERE a critical period in shaping long term outcome (Crumlish et al., 2009). Intensive intervention is provided in a stage specific basis (International Early Psychosis Association Writing Group, 2015). 1 Acute stage of FEP - Engagement - Pharmacological intervention 2 Early recovery (remission) - Insight instillation - Functional assessment 3 Early recovery (maintenance) - Relapse prevention - Self management 4 Late recovery (functional recovery) - Life functioning enhancement - Life role establishment - Illness management - Life adjustment - Family support

9 Specialized Occupational Therapy Adding perspective into multi-disciplinary service

10 Medication compliance and its importance Side-effect monitoring and education Complexity of contributing factors Symptom management Supportive intervention & empowerment Treatment planning Roles during recovery journey

11 Explanatory model of illness Acknowledgement of recovery journey Cognitive function Daily living independence Vocational capacity Matching the value, functioning and actual life Reengineering the expectation Shaping the life roles

12 Self-esteem adjustment Stress management Occupational lifestyle redesign Explanatory model of stress-vulnerability Potential causes of relapse Relapse implication on brain Early warning signs Crisis management plan

13 Life role identification Return to work / school programs Functional rehabilitation Social cognition and skill training Pre-vocational programs

14 Core aspects to look into - 1) Cognitive Functioning Cognitive impairment of FEP (Profile of MATRICS Consensus Cognitive Battery MCCB) Normal population (n = 300) First episode psychosis (n = 105) Schizophrenia (n = 176) Indication of T-score 50 = average 40 = lower average 35 = borderline McCleery, A., Ventura, J., Kern, R. S., Subotnik, K. L., Gretchen-Doorly, D., Nuechterlein, K. H. (2014). Cognitive functioning in first-episode schizophrenia: MATRICS Consensus Cognitive Battery (MCCB) profile of impairment. Schizophrenia Research, 157,

15 Core aspects to look into - 1) Cognitive Functioning Prospective memory (Zhou et al., 2012) Attention (Milev., 2005) Work skills (Bowie et al., 2006) Employment outcomes (Velligan et al., 2000) Cognitive impairment Prediction Poor prognosis Treatment adherence (Robinson et al., 2002) Treatment effectiveness (Chen et al., 2005) Verbal learning (Censits et al., 1997) Social functioning (Green et al., 2004) Executive function (Heinrichs, & Zakzanis, 1998)

16 Core aspects to look into - 1) Cognitive Functioning Cognitive remediation is promising to improve cognitive function of people with FEP (Fisher et al., 2015; Lee et al., 2013) Drilling through computer assisted cognitive training Promoting learninginduced neuroplasticity Improving cognitive function

17 Core aspects to look into - 2) Life Functioning Negative symptoms in FEP Avolition Anhedonia Asocial Apathy Disruption in occupational engagement and lifestyle Not able to establish life role with poor life functioning

18 Core aspects to look into - 2) Life Functioning Goal setting Life coaching Leisure Life Social Life Successful experience Work Life Domestic Life Life functioning Occupational lifestyle redesign program

19 Outcomes Acknowledging the recovery

20 Suggested Outcomes Administrative outcomes: - Number of referrals - Number of family involved - Number of treatment provided - Waiting time of the service Clinical outcomes: - Duration of untreated psychosis - Relapse rate - Concept of illness management - Mental wellbeing, perception of hope, life functioning, functional outcomes Subjective appraisal: - Satisfaction of the service - Self-perception on recovery oriented practice

21 References Hill, M., Crumlish, N., Clarke, M., Whitty, P., Owens, E., Renwick, L., O Callaghan, E. (2012). Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12years. Schizophrenia Research, 141(2-3), Penttilä, M., Jääskeläinen, E., Hirvonen, N., Isohanni, M., & Miettunen, J. (2014). Duration of untreated psychosis as predictor of longterm outcome in schizophrenia: Systematic review and meta-analysis. The British Journal of Psychiatry : The Journal of Mental Science, 205(2), Morgan, C., Abdul-Al, R., Lappin, J. M., Jones, P., Fearon, P., Leese, M., Murray, R. (2006). Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study, 189(NOV.), Penn, D. L., Waldheter, E. J., Perkins, D. O., Mueser, K. T., & Lieberman, J. A. (2005). Psychosocial treatment for first-episode psychosis: A research update. American Journal of Psychiatry, 162(12). International Early Psychosis Association Writing Group (2015). International Clinical Practice Guidelines for Early Psychosis. British Journal of Psychiatry, 187(48), Zhou, F. C., Xiang, Y. T., Wang, C. Y., Dickerson, F., Au, R. W. C., Ungvari, G. S. (2012). Characteristics and clinical correlates of prospective memory performance in first-episode schizophrenia. Schizophrenia Research, 135, Censits, D. M., Ragland, J. D., Gur, R. C., Gur, R. E. (1997). Neuropsychological evidence supporting a neurodevelopmental model of schizophrenia: a longitudinal study. Schizophrenia Research, 24, Heinrichs, R. W., Zakzanis, K. K. (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology, 12,

22 References Green, M. F., Kern, R. S., & Heaton, R. K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research, 72, Bowie, C. R., Reichenberg, A., Patterson, T. L., Heaton, R. K., & Harvey, P. D. (2006). Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry, 163, Velligan, D. I., Bow-Thomas, C. C., Mahurin, R. K., Miller, A. L., & Halgunseth, L. C. (2000). Do specific neurocognitive deficits predict specific domains of community function in schizophrenia? Journal of Nervous and Mental Disease, 188, Robinson, D. G., Woerner, M. G., Alvir, J. M., Bilder, R. M., Hinrichsen, G. A., & Lieberman, J. A. (2002). Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder, Schizophrenia Research, 57(2-3), Chen, E. Y. H., Hui, C. L. M., Dunn, E. L., Miao, M. Y. K., Yeung, W. S., Wong, C. K., Tang, W. N. (2005). A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients. Schizophrenia Research, 77. Fisher, M., Loewy, R., Carter, C., Lee, A., Ragland, J. D., Niendam, T., Sophia, V. (2015). Neuroplasticity-based auditory training via laptop computer improves cognition in young individuals with recent onset schizophrenia. Schizophrenia Bulletin, 41(1), Lee, R. S. C., Redoblado-Hodge, M. A., Naismith, S. L., Hermens, D. F., Porter, M. A., & Hickie, I. B. (2013). Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients. Psychological Medicine, 43(6),

23 Q & A