Like the “golden hour” of trauma care that increases the odds of a person’s survival, some clinicians are now applying that philosophy to the treatment of schizophrenia, one of the most puzzling mental health disorders.
Diagnosis and treatment of schizophrenia isn’t a frenetic medical emergency, but quick, comprehensive response at its onset may have a profound effect on limiting its severity and progression. The University of Alabama at Birmingham’s First Episode Schizophrenia Clinic, which has opened to treat patients with a new diagnosis, is the only such clinic in Alabama and one of the few in the country, according to its director, Adrienne Lahti, M.D., professor in the UAB Department of Psychiatry and Behavioral Neurobiology.
“There is growing evidence that schizophrenia can be managed better, and that complications associated with schizophrenia can be lessened if aggressive, comprehensive treatment is begun shortly after the first diagnosis is made,” says Lahti.
One element of comprehensive treatment is that the patient should not do it alone, says Lahti, who is encouraged when family members come to clinic.
Schizophrenia often is first observed during teenage years. Boys usually are 16 or 17 years old, girls perhaps a little older. Frequently the first signs are nebulous – changes in school behavior and worsening grades. A child might display odd behavior and lose long-time friends. A downward spiral can be rapid, and complications ranging from obesity to smoking and drug use are common. It can be a devastating diagnosis for the whole family.
“It’s very hard on parents,” Lahti says. “They have to come to grips with the fact that many of the dreams they had for their child no longer are viable options. They may not go to college, be able to hold a regular job or marry and have a family.”
Family is an integral part of the treatment mix at the First Episode Clinic, Lahti says, because these ties play a primary role in helping the schizophrenic patient cope and manage their disease. But there are barriers that families and patients must overcome.
In a study in Psychiatric Services, Ruth Gerson of the Cambridge Health Alliance reported that family members said entry into the mental health system frequently occurred during a crisis, with African-American families specifically reporting police involvement. Follow-up care was described as fragmented, and issues arose with insurance coverage.
“The goal of the First Episode Clinic is to address some of those issues, to help patients and families understand that there is help available and that a comprehensive treatment plan can be beneficial,” Lahti says.
Lahti says the First Episode Clinic will monitor the use of medications, establish a support system with family and stress that family members must become an advocate for the patient.
“These children are lost, and their whole future is in peril,” says Lahti. “We want to establish a relationship with family that does not assess blame and works to maintain normalcy as long as possible. Studies have shown that patients do better the longer they can maintain normal function and remain involved in work or school.”
Lahti says the focus on family involvement differs from the way most mental health services are delivered.
“Research has shown us that patients with schizophrenia often display symptoms long before they seek or get help,” Lahti says. “First Episode Clinics may be a means for reducing that delay, and helping patients — and families — learn to manage their disease.”