Early care for psychosis catches on, raises questions

Early treatment for serious mental illness makes sense, advocates say: "With heart disease, we don't wait for the heart attack to do something."

For years, Lisa Halpern says she was able to explain away and conceal the early warning signs of psychosis. When she hid in her college dorm room, with towels stuffed under the door and black paper over the peephole, she was just "antisocial." Later, when she was a Harvard graduate student who became unable to read, shower or leave her apartment, she thought she might have a brain tumor.

She didn't tell the neurologist who scanned her brain - and found no tumor - that she was also hearing voices.

Halpern says it took at least six years to get the right diagnosis: schizophrenia. While her story is ultimately hopeful - at age 40, she is doing well with the help of her family, her therapist and medication - it does illustrate a problem: The early stages of psychosis often go unnoticed, are mistreated or not treated at all.

But that may be changing, even as experts debate exactly who needs help and what kind of help to provide.

"There is now a national movement to think about intervening earlier to get better outcomes," says Kenneth Duckworth, a Harvard University psychiatrist and medical director of the National Alliance on Mental Illness.

The hope is to lessen the impact of psychosis — a loss of contact with reality that can be a passing event or part of a lifelong mental illness such as schizophrenia or bipolar disorder. People with psychosis have hallucinations, such as hearing voices; they also suffer from delusions - false beliefs, fears and suspicions. Research shows that the longer psychosis goes untreated, the harder it is to control.

Approximately 100,000 adolescents and young adults in the USA experience a first episode of psychosis every year, according to the National Institute of Mental Health.

"Our best bet to limit the effects of the illness is to identify people early," says Jeffrey Lieberman, a psychiatrist at Columbia University in New York and president of the American Psychiatric Association.

Among new or growing efforts:

• In a first-of-its-kind program, New York City hospitals may soon start contacting the city's health department when anyone ages 18 to 30 is admitted for a first episode of psychosis. The department hopes to send counselors to visit patients and link them with outpatient services, says Adam Karpati, deputy commissioner of mental hygiene. The city board of health will vote on the proposal in December.

• In a few clinics around the country, researchers have been developing comprehensive "first episode" programs. The clinics offer not only medication, but psychotherapy, peer support groups, family support and coaching to help patients return to or stay in school and work after a first psychotic episode. Now, some state and federal agencies are showing interest in funding such clinics on a larger scale, Lieberman says: "This is ready for prime time."