Understanding the Schizophrenia Prodrome and Early Intervention for Psychosis

In this episode Rachel discusses her career in treatment and research of schizophrenia, and particularly, her research at the University of California, San Francisco, studying the prodromal phase of schizophrenia, which refers to early signs and symptoms, in an effort to detect and prevent the development of a full blown disorder. She explains the differences between prodromal symptoms and the Clinical High Risk Syndrome (CHR), and how there are three main aspects: the presence of delusions and hallucinations, the level of the individual's conviction that the delusions or hallucinations are real, and the level of distress or impairment. She points out that only 25% of people develop psychotic disorders within 2.5 years after diagnosis of the CHR syndrome. She discusses the Coordinated Specialty Care Model that involves medication, Cognitive Behavioral Therapy for psychosis, family support and psychoeducation, case management, and supports to keep the individual on track with school or work. She talks about the advancements in psychiatric medication and discussed elements of CBT for psychosis. She talks about the role of the family and supporting the family through this process, and how the concept of Expressed Emotion and past theories about families with schizophrenia (e.g., refrigerator mother), have done damage in the conceptualization of working with families. She discussed the need for psychoeducation, as well as understanding the interactional patterns that happen between family members as there is a great deal of fear, helplessness, and shame. She discussed how clinicians in practice who are unfamiliar with psychosis should manage their own reactions of fear or overwhelm, as expressing these reactions may lead their client to shut down or avoid seeking support for their symptoms. She reassured that working with psychotic symptoms is very similar to working with other issues in therapy. We discussed validating the client, being curious about their experience, and getting consultation, as many clinicians are unfamiliar with psychosis, or only received training in intensive situations like hospital settings, so have a fatalistic view of these diagnoses. What the clinicians don’t see is that generally, 1/3 of clients recover on their own, for 1/3 medication works, and its only 1/3 that struggle with severe, chronic psychosis. Many people may live with symptoms their whole life, but be happy, healthy and functioning, so the reduction of symptoms may not be the main goal of treatment. Rachel Loewy, PhD, is a clinical psychologist currently working as a Professor of Psychiatry at the University of California, San Francisco. Along with teaching, Rachel has developed clinical programs to diagnose and treat early psychosis, and has led many research studies, primarily focused on early identification and intervention in schizophrenia. Currently, she is a co-investigator on a research project dedicated to building a California early psychosis network that would input thousands of patients' data into one network hoping to create a better system that allows for improved intervention effort. Alongside her research, Rachel has many publications regarding her work that have all been compiled at https://profiles.ucsf.edu/rachel.loewy. These publications focus on various studies regarding schizophrenia and psychosis, such as evidence-based practices for early intervention in psychosis particularly in community settings.