Dr. William McFarlane (Guest): Absolutely. We’ve been through this before with cancer and so there’s a good prognosis for the field in general, but it is still a problem for young person and their family to see signs of psychosis, particularly, or any major mental illness, and decide to seek treatment in time to really have the best outcome. Yes, it’s still an issue. I’m happy to say also I think it’s probably diminishing in young people, which is good to see.
Melanie: The stigma is diminishing or mental illness is diminishing?
Dr. McFarlane: The stigma. Mental illness is still with us and I think will be for quite a long time.
Melanie: What are some of the signs and symptoms? Whether we’re talking about younger people, adolescents, or adults that their loved ones can really look at, red flags, Dr. McFarlane, that would signal somebody needs some help?
Dr. McFarlane: Well, the general ones are just unexplainable mysterious changes in functioning: A young person whose grade point average starts dropping off even though they’re trying to do the work, signs of withdrawing from their friends and then even from family members. But the real tipoffs are the classic signs of psychosis, in other words, hallucinations and odd ideas that are usually suspicious or persecutory in nature but not nearly as severe as you’d find in a full-blown psychotic episode. For instance, young people might say they hear their name occasionally and they know nobody is saying that or they hear music when there is no music being played. Or they feel that somebody might be following them and they might even hear a footstep or two, but when they look there’s nothing there. It’s really subtle, not a gross paranoid delusion as you might see in the emergency room or a psychiatric hospital.
Melanie: Would they tell their loved ones about these feelings, about these paranoias, the feeling that someone is following them or the music that they might hear? Do they vocalize that to somebody?
Dr. McFarlane: Well, ideally yes. Many of the best outcomes have occurred in cases where somebody raised the issue with a family member, usually a parent who then sought help from a pediatrician who would then refer to a specialized program like the Portland Identification and Early Referral Program. That’s what we are currently re-establishing in Portland right now. Unfortunately, the usual pathway is it’s picked up by somebody else, often a teacher, a family member who is noticing pretty serious changes and deterioration in outward signs of functioning. Then on interview questioning, the person says, “Oh, yes, I’m hearing this odd sound. I can’t sleep very well. I feel like people might be in the room when there’s nobody there,” things like that. That would often trigger, or should trigger for sure, referral to a specialized program.
Melanie: Do you think sometimes, Dr. McFarlane, that the family might resist seeking that early intervention for shame or fears? You say the stigmas are starting to lull just a little bit, but do you think that maybe some parents might think if it’s their teen, it’s a result of bad parenting, so they’re not as likely to seek help for their teen, thinking they can take care of the situation?
Dr. McFarlane: Well, unfortunately, that’s pretty common, particularly in the United States as opposed to Europe and the Far East. There’s been a tradition of sort of blaming mental illness, particularly schizophrenia, on parenting. The current research shows that there’s almost no basis for that, other than having a child, there’s a huge genetic influence. I think the general assumption is if your son or daughter seems to be developing a major illness, it must be something you’ve done. We’ve tried to dispel that as quickly as possible by actually reversing it, saying a parent who brings a young person in an early stage is manifesting real care and real intelligence as a parent. Sometimes, people resist. Sometimes, because these illnesses are often hereditary, people resist because they think, “Oh, this is going to be like Uncle Harry and look what terrible things happened to him.” Other families would have exactly the same situation and say, “Well, we certainly don’t want that to happen with our son, so let’s speak out now.” It varies a lot. What we’re trying to do in Portland is get the word out that: a) these things are identifiable early; and b) they really can be prevented if we get there early enough, just like in cancer or early identification of heart disease, very similar.
Melanie: How does early intervention help, Dr. McFarlane? What do you do when somebody brings in their teenager or their 20-something or an adult and says, “I think something’s really going on with me,” or a spouse brings somebody in? What’s the first thing you do to identify the level of mental illness that they might be experiencing?
Dr. McFarlane: The first we do, of course, is a very careful assessment. There’s a structured interview that we use now to determine if the person is at risk or perhaps already in a phase of psychosis. Then, if they are found to be a risk or already having an episode, we start treatment immediately, as quickly as possible, and that can vary from some degree of pharmacologic intervention, but the primary focus of our program is on helping the family understand what’s going on and then provide a certain degree of support protection and stress reduction, such that the basic level of neurological arousal in the young person starts to diminish so that some of these symptoms starts going away. If that doesn’t work, or if they’re farther along, we would then offer antipsychotic medication in very low doses. Many of these young people are already in the midst of a mood episode, either manic or depressive. We would also offer medication and specific treatment for that. The program after that really then focuses on getting a person to function better in their natural environment, whether at school or work or with their friends and with the family, again, with a lot of involvement of the family in supporting that, guiding the family to help doing that. The family almost becomes part of our team, in a way.
Melanie: When does it become an inpatient situation?
Dr. McFarlane: Well, at any sign of danger: suicidal ideas, any actions in that direction, or if the person is so impaired and so symptomatic with psychosis that they really can’t function and are not able to do much of anything that they would be expecting or would like to do. We try to avoid hospitalization, but that’s not an absolute thing. If somebody really needs it, we have excellent services in our community anyway for getting people re-stabilized and back on their feet, fairly quickly actually in most cases.
Melanie: In just the last minute, if you would, Dr. McFarlane, give the listeners your best advice on the importance of identifying these signs you’ve spoken of, early intervention for mental illness and why they should come seek their help at Maine Medical Center.
Dr. McFarlane: Well, I think the upshot of all of these is that if there’s anything that parents or people in school or pediatricians, others in the community should be aware of is that first, these early symptoms are fairly subtle. It’s important that they get assessed by somebody who is really trained to assess them, but to do so quickly because just like in many other chronic conditions, the earlier you get there, the better the outcome. As we’ve seen in our research, almost everybody avoids having an episode of psychosis if we get there before it’s really gotten serious. We’ve actually reduced the number of people with schizophrenia and other major psychotic disorders in the Greater Portland Area by about a third by doing this. The stakes are pretty high. As we like to say, if you take it seriously, it will not become serious. It’s sort of a paradox there, but that’s the way it works.
Melanie: Thank you so much. It’s great information. You are listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening.