Early Attention to Life Circumstances and Relationships Improves Outcomes for Psychosis

Coordinated care with employment support and family therapy leads to superior outcomes for those diagnosed with psychotic disorders.

Peter Simons
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A new study found that early-intervention services (EIS) significantly improve outcomes compared with treatment as usual (TAU). Early-intervention services are designed to provide supports such as employment assistance, while conventional treatment consists of medication and sometimes psychotherapy. The research was conducted by a large team led by Christopher Correll at the Zucker Hillside Hospital in New York.

“The results of a 2013 meta-analysis suggested that, during the last 5 decades, recovery from schizophrenia remained low (median, 13.5%), without significantly improving,”  Correll and the team of researchers write. “Furthermore, individuals with schizophrenia die on average 15 to 20 years prematurely, with an increasing mortality gap.”

Photo Credit: Pixabay

Despite numerous new medications being promoted and prescribed in the last 50 years, recovery rates have not improved. They remain so low that only about 1 in 10 recovers. Additionally, people diagnosed with schizophrenia die younger now, compared to people without that diagnosis, than they did 50 years ago.

This new study, published in JAMA Psychiatry, found that EIS was superior to treatment as usual in all 13 outcomes measured by the analysis. EIS was associated with the following: being less likely to relapse, more likely to have remission of symptoms (significant improvement), more likely to recover from symptoms, less likely to be hospitalized, while also having having greater subjective quality of life, greater global functioning, fewer hospitalizations, shorter stays in the hospital, less severe overall symptoms, fewer and less severe positive and negative symptoms of psychosis, more participation in work and school, and lower likelihood of dropping out of treatment.

The study examined ten randomized, controlled trials that compared EIS to TAU. The total participants numbered 2176. The participants were defined as having either first-episode psychosis or a diagnosis of early-phase schizophrenia spectrum disorder.

EIS is a more holistic treatment being offered in the early stages of psychosis—just after first diagnosis. These early intervention services (EIS) are designed to help ease reintegration into society. According to the authors of this study, in addition to pharmacotherapy and psychotherapy, EIS includes such features as “supported employment and education, and family support,” while treatment as usual is unspecified, but usually includes medication and possibly psychotherapy. A coordinated team provides EIS. TAU, even if it included some of these other elements, would be conducted through a long, arduous referral process to outside providers.

Greater involvement with work and school was associated only with those EIS interventions that provided support for employment and education. Likewise, global functioning was significantly better just in those EIS interventions that provided family therapy.

Unfortunately, the studies examined here only lasted up to 2 years—so it is unclear if these improvements will last beyond that period. Nonetheless, it is striking that medication and psychotherapy alone did not increase global functioning and work/school involvement. Instead, supporting employment and education had a specific effect, as did family therapy.

The researchers write that although EIS is more expensive than TAU, it may be more cost-effective if it reduces the likelihood of the financial cost of worsening psychosis. The researchers conclude:

“These findings should provide further impetus for the widespread implementation and funding of EIS in the United States and across the world.”

 

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Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M. . . . Kane, J. M. (2018). Comparison of early intervention services vs. treatment as usual for early-phase psychosis: A systematic review, meta-analysis, and meta-regression. JAMA Psychiatry, 75(6), 555-565. doi:10.1001/jamapsychiatry.2018.0623 (Link)

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

29 COMMENTS

  1. “… it is striking that medication and psychotherapy alone did not increase global functioning.” This shouldn’t be surprising, since the schizophrenia “medication” can create both the negative and positive symptoms of schizophrenia. Here’s how:

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome (negative symptoms)
    https://en.wikipedia.org/wiki/Toxidrome (positive symptoms, like “psychosis,” are created via anticholinergic toxidrome. A toxidrome is a form of poisoning.)

    And psychotherapy is nothing more than picking out and making up flaws about a person, then defaming the person to their family and as many as the therapist possibly can, with scientifically invalid and stigmatizing DSM disorders.

    Of course, defaming and poisoning a person is going to harm that person, not “increase global functioning.” And defamation and poisoning people are technically illegal behaviors for good reason. It’s a shame the “mental health professionals” are not being held accountable for their criminal behavior.

  2. As for “early attention to life details and relations”. It improves the outcomes for life, too, I would imagine. Intervention? Stop drugging people, and calling them “psychotic”. As with other military psychiatric maneuvers, I’m for intervening in the intervention.

  3. I’m curious about something. Is there an inherent difference between “psychosis” as caused by unclear sources, as in what is labeled as “schizophrenia,” and hallucinations (or visions – choose your word) caused intentionally in people taking drugs such as DMT or ayahuasca? Or is the difference more a matter of attitude, i.e. the latter experiences are more often seen as “positive” and the former as “negative”? It seems strange to me that I am hearing about increasing numbers of people seeking the drug experience while people are being encouraged or even forced to medicate the “psychosis” experience away.

    A bit of a tangent, but if anyone has any insight, I’d like to know. Thanks!

    • msmonique, I’ve never tried DMT or ayahuasca, however I do have some insight into different types of “psychosis.” And one of those types seemed to be similar to what I’ve read, about the experience of people who’ve taken those drugs.

      The antipsychotics can create “psychosis,” as I mentioned above. An antipsychotic anticholinergic toxidrome induced “psychosis” is about evil, incessant voices, spewing inane, insane, and disgusting commentary. It was grotesque and highly annoying. I had to keep really busy just to keep the voices at bay. But anticholinergic toxidrome also causes hyperactivity, which made staying busy easy, so I survived.

      But when one is weaned off the antipsychotics, you may also suffer from what’s known as a drug withdrawal induced super sensitivity manic psychosis. This type of “psychosis” may be similar to the DMT or ayahuasca experience, except it lasts for months. Likely because it takes months for your brain to heal, and come back to homeostasis, after the prior poisoning. The “manic” part of it means you have tons of energy, or “godspeed,” is what it felt like to me at the time. There was tons of dancing, gardening, biking, rehabbing my home, volunteering, running my children around. I actually experienced this type ‘psychosis’ twice, once in 2006 and once in 2009.

      For me this type of “psychosis” functioned as an awakening to my dreams, and an introduction to the concept that there may exist a “collective unconscious.” It was like my entire life was part of a gigantic musical. Like I was living in a movie, and all of humanity was connected, watching, and listening. I’d drive around, trying to mentally come to grips with what was happening, and my thoughts would end up coordinating with the music playing on the radio, as well as the street signs and the vanity plates of people driving by. It was a serendipitous beyond belief trip, with countless signs of God and the connectivity of all of humanity everywhere.

      One song example, “Let’s waste time Chasing cars Around our heads,” was playing on the radio, only I was “chasing cars” in real life. “Show me a garden that’s bursting into life,” and my garden was “bursting into life” in real life as well. God supposedly claimed, “We’ll do it all, Everything, On our own. We don’t need, Anything, Or anyone.”

      The serendipity and feeling of connectedness with all of humanity and nature was beyond staggering. It was bizarre, and a bit scary because the doctors hadn’t forewarned me about a possible drug withdrawal induced “psychosis,” but it was absolutely amazing. It also kind of functioned as a love story, since I was trusting in God throughout the entire bizarre experience, a love story presumably between Him and I. “Some people want to fill the world With silly love songs.” “Strumming my pain with his fingers, Singing my life with his words. Killing me softly with his song, Killing me softly with his song. Telling my whole life with his words, Killing me softly with his song,” is what it seemed like.

      As my family was white water rafting down a river in Washington state, a character within the collective unconscious, who my subconscious self called “Mr. Pope,” chimed in. A character who was supposedly Pope Benedict, the pope at the time. He and I chatted a bit within the collective, supposedly via mental telepathy, not spoken words. He supposedly decided to play Benedict Arnold and betrayed the Catholics, by handing over the ‘eye of God’ to me, a Lutheran. Supposedly because there were choirs of Lutherans within the collective singing, “of course she looks like mother Mary.”

      A couple weeks later a letter that one of my neighbors wrote to the pope landed in my mailbox. I returned it unopened to the post office. I did have an ethical pastor tell me, “Some people can’t pray in private.” Within the collective, the queen of England even supposedly gave her blessing (Why was this needed? I don’t know, as I’m an American). And a blessing for what, I didn’t understand at the time.

      The ducks were all in a row, literally, I watched a family of ducks walk by me in a perfect row. The pigs had flown (it happened during the summer when swine flu was propagandized), but this meant anything was possible now. It ended up with a born again type tale, where I actually chose my next body. (???)

      Then Jesus supposedly called the final judgement. I reminded Him that was God’s job, not His. God asked the collective whether they wanted Jesus to rule the entire world, or whether they wanted to take this world elsewhere (my last name). Jesus proclaimed, “all the doctors are going to hell,” then His soul supposedly popped into my heart. I said I thought there must be some decent doctors. The collective decided they wanted to take this world elsewhere, so it felt like all the souls of the world, the dead first, then all others followed Jesus into my heart.

      At the time this happened, I was lying in Millennium Park in Chicago. Minding my own business, watching the cloud formations, trying to mentally comprehend why I was “living the dream,” and being given this spiritual story. Not to mention, I’d just found the medical proof that the antipsychotics could indeed cause psychosis, so I was trying to come to grips with the magnitude of the medical and religious betrayal, with which I’d dealt. A policeman came and took me to a hospital, for lying in a park, minding my own business, and thinking. Well, we here on MiA know that always ends badly, but at least it only resulted in an “adjustment disorder” stigmatization.

      But what a trip, and what a bizarre story I got from the drug withdrawal induced “psychoses.” That’s just a short synopsis. It’s a bizarre story, but it was infinitely more interesting, serendipitous, and hopeful, than the inane, pointless, and disgusting antipsychotic induced “psychosis.” And there are millions of Americans now “waking up” on the internet these days. Who are finally realizing that the wrong people have been in charge of our country for a long time, and praying for God’s grace and justice. I, too, still pray for the day, and do have faith God will judge all fairly.

      Although I must confess, I do know a lot more about the sins and crimes of the medical community today, than I did in 2009. And I definitely believe repentance, and making proper amends to all those the doctors have harmed, is needed. After all, the doctors are given trust they have not earned because they have malpractice insurance intended to pay for their mistakes. We all pay for that malpractice insurance through higher medical costs, the doctors don’t pay for it. And I did find as I read through the bible, during my spiritual journey, that Jesus tended to always be right. “Don’t say I didn’t, say I didn’t, warn you,” doctors.

      • Someone Else:

        Wow, thanks for taking the time to share your experience. What a fascinating experience, and yes, I agree that the doctors are not being made to be accountable as they should be. (By the way, I did have a bit of the mundane drug induced “psychosis” I guess, as Abilify caused me to hear voices. They were kind of friendly, but boring, too.)

        Thanks again.

        • Your welcome, msmonique. Thanks for appreciating and inquiring into the non-medically acknowledged healing experiences of those of us weaned off the psychiatric drugs.

          Your Abilify induced “voices” were likely the result of the central symptoms of anticholinergic intoxication syndrome, aka anticholinergic toxidrome. And I know getting “voices,” despite the fact they’re created with the antipsychotic drugs, does indeed cause one to question their own sanity.

          https://en.wikipedia.org/wiki/Toxidrome

          I’m glad your “voices” were “kind of friendly,” which I imagine means you were not likely abused as a child, nor was one of your children abused. Thus you don’t have any real serious enemies within the collective unconscious who want to destroy you, if such a collective exists.

          Although covering up child abuse is the primary function of today’s psychiatric and psychological industries, according to their own medical literature.

          https://www.madinamerica.com/2016/04/heal-for-life/

          I’d like to see the massive in scope profiteering off of covering up child abuse, by today’s psychiatric and psychological industries, end. Especially since this is illegal. And this is a systemic problem, because the DSM classifies child abuse as a “V Code,” and the “V Codes” are NOT billable DSM disorders. Which has resulted in the “mental health professionals” en mass misdiagnosing of millions of child abuse victims, with the “invalid” DSM disorders.

          https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

          How do we fix systemic, satanic, societal, child abuse covering up problems? I don’t know, except to shed light upon them. Please pass on my concerns, and God bless.

    • One thing is that drug experiences tend to be bad when drug users are secretly given hallucinogens, so they don’t know what’s going on, in the same way “real” psychotics aren’t aware what’s going on when they begin to suffer perceptual distortions and disturbances.

      • despondent –

        Thank you for your reply. However, I’m not sure what you are saying seems naive? Taking the psychedelic drugs? It’s confusing to me, too, but I am hearing more and more people saying that it was a good (mystical, even!) experience for them. (And occasionally someone saying “Meh, not so much” or even that they got addicted to the drugs.) I hope my first post doesn’t imply that I think someone should or should not take those drugs, as I’m totally on the fence about that.

        Part of what I was trying to say, though, is that maybe reframing the experience of “psychosis” (not drug induced) to something more informative (to be learned from) and less medicalized might be helpful. For instance, in my struggles with depression, I think it’d have been much more useful for me if someone told me “yes, this is very painful, but you can get through it. You need to find your own path” rather than what I was told:”this is a chemical imbalance for which medications are the answer.” Or do you think that is naive as well?

        • I agree, it’s up to the person experiencing psychosis or depression to make sense of it themselves. Or to go beyond it. But it’s different to those people who go to an ayahuasca retreat for a week in the Amazon. That’s why I thought the comparison was naive. Especially when I see all the videos on youtube.

        • That is what 99% of the people I’ve tried to help really needed to hear. There is HOPE and you can DO SOMETHING ABOUT IT. Whereas the bio-psych message is, you can’t do ANYTHING about it, and the ONLY hope is trying out more drugs and accepting that your life will not be what you want it to be.

          • Thank you Steve. You are spreading a great message! I am fortunate to have figured it out, but it took me way longer than it needed to. Some people never figure it out and often die way younger than they should have because of this.

            I’m also suggesting that maybe there is a more specific message in a person’s struggle, be it with “psychosis,” depression, anxiety, or whatever. For instance, I think the main message of my depression was that I was trying to live my life the way other people wanted me to instead of what is right for me.

            Anyway, that’s what I was trying to get at in my original post. I do think it’s probably obvious to some, but then again, others still insist that the “meds” are the solution. *sigh*

  4. Since it’s clear that the lifespans of those diagnosed with “schizophrenia” have significantly declined since the beginning of the drug era, and since it’s clear that social outcomes do NOT improve as a result of “TAU,” why in the hell is “TAU” even considered “treatment?” Especially when you combine this with the WHO cross-cultural studies showing massively higher recovery rates in “developing” countries that use less drugs, any real scientific reading of the data says we need to reduce the use of these drugs to the absolute minimum or eliminate them altogether.

    Of course, we know the answer. “Follow the money.” Sigh…

  5. “…in addition to pharmacotherapy and psychotherapy, EIS includes such features as “supported employment and education, and family support,” while treatment as usual is unspecified, but usually includes medication…”

    When talking about IES the term ‘pharmacotherapy’ is used, when talking about TAU the term ‘medication’ is used, why not use the same term for drugs and make the article clearer?

    It seems bloody obvious that if you help someone who’s in a shitty environment to get out of that shitty environment then they will feel better about themselves.

  6. I am tired of the fact that theologians/inquisition in medical disguise, ARE MAKING SATAN/EVIL AND HUMAN MAIN ENEMY FROM THE NECESSITY TRAITS OF HUMAN PSYCHE. AND THAT THEIR PREYING ON THE PSYCHE IS CALLED —-JOB OR PROFESSION, science, theology, law (apolonian traits)

    And that HUMAN psyche is supposed to be an effect of trauma or other BS.
    Psyche is psyche, apollonian ego perception is only one of the many many others possible modes of perception. Abslolutely disagree with assumptions that PSYCHE and its main mode of perception called -psychosis is an effect of trauma or poverty ———BS———-MADE FOR MONEY, AND MONEY AND DRUGS ARE THE MAIN FETISH OF soulless APOLLONIANS WHO PREYS ON PSYCHOLOGICAL MAN TRAITS.

    IT IS A MAIN TASK OF PSYCHE TO CREATE PSYCHOSIS, AND NORMALCY IS AN EGO APOLLONIAN FUNDAMENTAL ASSUMPTIONS/ FANTASY ABOUT HUMAN PSYCHE. THEY DO NOT ACCEPT PSYCHE, THEY HAVE ONLY THEIR CRUEL INHUMAN CLAIMS TOWARD STH THEY REJECT FROM THE BEGINNING. HOW CAN YOU HELP SOMEONE IF YOU HATE HIM FOR WHAT HE REPRESENT?

    IT IS NOT HELP, IT IS CHARACTER ASSASINATION.It is an anti psychological inhuman terrorism.

    Apollonian ego along with the theology made HUMAN PSYCHE a main enemy OF THE theological, (and EGO APOLLONIAN) state and made those kind of people starving and left them on the streets. YOU HAVE STOLEN THEIR PSYCHOLOGICAL REALITY for building AN EGO UTOPIA FOR YOUR OWN PURPOSES, SO THEY ARE HOMELESS.

    AND NOW YOU ARE PREYING ON THEM,AND BLAMING THEM, THAT THEY REMIND YOU OF THE PSYCHE YOU HAVE DESTROYED…….

    Give back psyche its PROPER meaning, you AUTHORITARIANS who have stolen it and still are preying on psychological man. You are imapired, not the psyche.

    RE -VISIONING PSYCHOLOGY.
    AND BEWARE OH HADES. YOU REALLY OUGH TO.

  7. “Early Attention to Life Circumstances and Relationships Improves Outcomes for Psychosis”

    All of this seemingly sophisticated gobbledygook can never prove that there is such a thing as “psychosis” in the first place. People take it for granted that there is such a thing as “mental illness” and “mania” and “psychosis,” as if we were discussing concrete reality. Several decades ago, people used to be interested in the real questions: “What is mental illness?” “What is psychosis?” “Who came up with these notions?” “Why did they come up with these notions?” “Where the people who developed these notions honorable and trustworthy individuals or charlatans?” “Do these notions correspond in any way with reality?” A bit of careful study reveals that so-called “mental illness” with all of its attendant psycho-babble, is a myth, and that psychiatry is a pseudo-scientific system of slavery that thrives on the perpetuation of these myths.

    Wake up people. You’ve all been had.

    • there is such a thing as mental illness in the sense of it being a hypothetical/metaphorical narrative that attempts to explain what mania and psychosis and depression and so on is – when the cause remains so far unknown.

      there are lots of other causes of mania and psychosis and depression and so on that are known. for instance, brain tumours, kidney failure, alcoholism…

      mania and psychosis are not invented things. they point to actual lived experiences that manifest in the world.

      i know, i know, you and oldhead insist that if science can’t examine it directly and if language can’t narrow it down with exactitude then for you it has no basis in reality whatsoever.

      which is why you must also think that love is a lie. after all, science cannot examine love directly and who invented this ridiculous word love anyway? it means different things to different people and is therefore meaningless.

      no-one is going to take you seriously if you persist with claiming that mania and psychosis don’t exist. other than other flat-earthers, of course.

      • Just as my once favourite psychiatrist said,, some people would never have fallen in love if no one had told them love exists, today I read about how many develop anorexia only because they have had the condition ‘marketed’ to them, an inadvertent consequence of some good intentions.

  8. Peter, please go and immerses yourself in some critical psychiatry/psychology texts at least. The first sentence evokes the taught – they would say that wouldn’t they! ‘Early intervention’ meaning treating people before they become ‘ill’, you can’t argue with ‘prevention is better than cure’ can you? Well actually if you treat people for a condition they don’t have, (regardless of if it’s an imaginary disease or not) then lo and behold after treatment they still don’t have this condition (usually).
    A verifiable miracle cure is it not? Who determines if these predictions are correct, after all doctors can’t even agree on who has these conditions independently of each other more than 50% of the time and that’s when a person is troubled or troubling in their behaviour.

    I think your doing good work here, some of the best work on these problems comes from journalists. But please get with the program already. Be critical, assume every claim is wrong for starters.