Dr. Michelle West is a licensed clinical psychologist with expertise in the assessment and treatment of early psychosis, including first episode psychosis and earlier risk for psychosis. Dr. West currently serves as the Director of the Program for Early Assessment, Care, and Study (PEACS) here in our Department of Psychiatry and the University of Colorado.  

On this episode of Mind the Brain, Dr. West talks to Dr. Neill Epperson about joining the Department of Psychiatry and starting PEACS mid-pandemic, and how to assess for and treat early psychosis.  

 
The difference between first episode psychosis (FEP) programs and PEACS

To start the episode, Dr. Epperson asks Dr West to make the distinction between first episode psychosis programs and PEACS – the first program of its kind in Colorado. Dr. West explains that the distinction is complicated, but often boils down to this: “First episode psychosis is when a young person starts to experience psychosis symptoms that are very acute and intense; for a period of time they lose the ability to doubt what is real or not real, or to check their psychosis spectrum experiences with the external world; and often results in their first hospitalization,” which for a lot of young folks is their first contact with the mental health system. From there individuals are often referred to a first episode program, like the Ascent Program of Colorado.  

 

Dr. West explains that early detection of psychosis symptoms and the work of PEACS is a lot “greyer and messier,” looking for early signs of risk, which typically involves “lighter versions of psychosis spectrum symptoms, often combined with other sorts of clinical concerns such as anxiety and cognitive changes.” The goal of PEACS and early detection work is to intervene prior to first hospitalizations and prior to use of anti-psychotic medications.   

Who is at risk for onset of psychosis?

Early signs of psychosis are more common than people typically believe, and many things can increase risk for psychosis (e.g., family history, stressors, certain styles of thinking, head injuries). Most early risk for psychosis programs, including PEACS, screen and treat individuals between the ages of 12 and 30. However, both Dr. West and Dr. Epperson make it clear that psychosis can onset outside both ends of that age window. Dr. West mentions that it is much harder to screen younger individuals, as they have different ways in which they think about and relate to their worlds and internal experiences.  Although Dr. West believes that early screening is important even for younger children (including around the age of 12), it must be done with caution, “without jumping to conclusions based on limited information, or over -labeling things that you don’t know yet.”   

 
Screening individuals who aren’t seeking – and might be resistant to – treatment

Dr. West discusses concerns with mental health treatment of children and adolescents in Colorado generally. She believes that it is important to decrease mental health stigma and increase comfort discussing mental health symptoms, including psychosis, in the community. For example, she believes that bringing screening methods into pediatricians’ offices would be beneficial. To do that, however, Dr. West asserts that it is important to adapt messages about screenings to the audience, in a way that values the over-burdened roles of pediatricians while teaching specific strategies to increase pediatricians’ comfort and willingness to provide such screenings.  

 

Dr. West confirms that, while connecting individuals whose screenings raise concerns with follow-up treatment can be difficult, even just engaging these individuals in conversation is useful and impactful. Further, the more and more that pediatricians and other primary care physicians in Colorado become aware of the PEACS program as a resource for early psychosis, the more likely they will be to participate in giving screenings—because they will have a place to refer patients to.  

 

The role of outreach and training 

Dr. West continues in her distinction of PEACS and FEP programs by highlighting the role that outreach and training must play in early assessment and detection. While at the time of a first episode it often becomes clear what is wrong, prior to that episode it might not be. Therefore, there is a much greater weight put on outreach and training of individuals who are most likely to see early signs – pediatricians, parents, and teachers. PEACS has delayed outreach to some groups in the context of the current pandemic due to concerns about over-burdened health and educational systems. Dr. West offers a few key insights into what teachers and others might look for as symptoms of psychosis in a young person, and how to help get them treatment.

Look for Changes: a change in ability to pay attention, change in mood, increased difficulties organizing writing, or describing new and confusing thoughts or experiences 

Encourage students to seek help and talk to people: many early signs and symptoms of psychosis are internal, so one important thing that teachers can do at baseline is encourage students to talk to trusted adults about what’s going on with them internally. Some internal signs and symptoms that students might voice to these trusted adults include whispering sounds, strong and odd new thoughts, etc. 

Use outside institutions as resources: many schools might not have adequate resources to provide students with care. Luckily, institutions like the Department of Psychiatry here at the University of Colorado have many programs for children and adolescents which can support structures in place at the school level.  

 

The role of the family 

Dr. West mentions that one of the key predictors of a young person’s likelihood to acquire and stay in treatment for psychosis is family involvement. Many clinicians who are treating individuals with psychosis have not had experience working with children, and are not used to involving or speaking directly to family members. She has several suggestions for working with young people and their families: 

Include families in the process as early as possible: gathering initial information in referral screenings from families, involving families in evaluation, and involving families in treatment 

NAMI group: a family-to-family non-profit group to support one another amidst mental health challenges. Dr. Epperson steps in to reassert that peer support is crucial.  

 

A little bit of hope  

Dr. West closes the episode on a hopeful note, saying, “I definitely see this field as being a very hopeful one, and that’s one of the reasons why I love it so much – you can catch folks when they’re starting to struggle, and you can really see [them] changing and doing so much better with not necessarily all that intensive work.”  

She continues, “there is research suggesting that folks who get early treatment in this risk phase have less chance or less risk of developing a first episode.” 

---

Listen to the episode:  Dr. Michelle West on Early Assessment and Care for Psychosis 

For additional support, explore all of our mental health resources.

 

Mind the Brain CME Information: 
CME Survey for the July 28, 2020 Edition

The University of Colorado School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Colorado School of Medicine designates this internet enduring material activity for a maximum of 1 AMA PRA Category 1 Credit^TM. Physicians should claim only the credit commensurate with the extent of their participation in this activity.