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TEDx Talks
Published: 2017-09-13
Source: https://www.youtube.com/watch?v=ws-N4gGSER0
close your eyes and I want you to think about the image that comes to mind when you hear the terms psychotic schizophrenic schizophrenia go ahead and open your eyes perhaps the image was of heath ledger's joker in the dark knight perhaps if you're another generation of Batman fans it was Jack Nicholson's joker in the first Batman maybe it was Jack Nicholson's character in one flew over
the cuckoo's nest maybe it was an image that hits closer to home something like this one image that I bet that it wasn't is this image young people hanging out maybe they're at school maybe there had not the college maybe they're at a work retreat well I'm hoping by the end of this talk is that when you heard here the term schizophrenia that maybe this image
could come to mind schizophrenia is a very complex condition it is so complex that researchers have argued over the past century on what causes it some say it's biological some say it's genetic some states cultural some state psychological some state social sums it caused by trauma will probably continue to argue that for another century but we can all agree on is the catastrophic causes but a
catastrophic results of schizophrenia and the terrifying symptoms that the individuals who suffer from this ailment half some of those symptoms include hearing things that aren't really there but it feels real it'll sound is realism I voiced you right now don't believe something that may not be in touch with reality maybe a paranoid thought that the government has a tracking device it's under their skin and they
will believe it so much but don't try to dig it out how common is this condition there are a hundred thousand new cases of schizophrenia each year in the United States one out of a hundred people will experience schizophrenia sometime in their lifetime there are about one hundred people in this audience right now look around in Douglas county we can expect fifteen to thirty new cases
each year you might think around fifteen thirty that's on a huge number two should we really pay attention to this let me show you a huge number a hundred and fifty five billion that is the annual economic impact of skits for its of schizophrenia that the United States suffers from each year this is a combination of cost this could be treatment costs this could be hospitalization
costs in the state of Oregon individuals who experience the first episode schizophrenia hospitalized fifty nine percent of the time it could be costs associated with loss of income according to the World Health Organization schizophrenia's D. eight leading cause of disability applications between the ages of fifteen and forty four staying on the trend of employment Wellfleet eighty percent of individuals with schizophrenia are unemployed and one in
five he's homeless doesn't have to be this way schizophrenia is a slow moving condition with the symptoms Deval up over a period of time with that we actually have the opportunity to catch it sooner if we can identify those symptoms early and move people into treatment let me show you a diagram that spells this out a little bit more detail the three phases of schizophrenia the
first as a pre morbid face this is a very very early and very startled subtle stage pays it's important know that schizophrenia strikes between the ages of fifteen and twenty five wears doesn't exist in childhood and where does it exist in later alter starting later old adulthood in his pre morbid stage it skin symptoms are so subtle it may look like concentration problems maybe a little
bit of depression we can't catch it here we don't have the science the next phase of schizophrenia is the at risk for aids this is where we can actually capture schizophrenia it's in this phase with the individual's functioning starts to decrease significantly that's that line right there then they're experiencing mild but not fully psychotic symptoms now the definition of psychotic is that the person can no
longer tell the difference between what is real and what is not the next stage is the active states that is the stage whether individual then loses track touch with reality I refer to this stage as the stage with the illness now owns the person and subsequently it owns all of us because of the amazing cost that we end up paying if we can catch it in
the at risk face the person still has the opportunity to own the condition and get much better outcomes it's another look the point I want to pay attention to this tiny white line although looks tiny on my screen it actually represents seventy four weeks we referred to that time period has the duration of untreated illness and that is the point where the individual moves from the
at risk space whether symptoms are subtle and they can still control them they still have insight into them too late active phase so the moment they hit the active phase to the moment with a first receive treatment seventy four weeks this white line is essential in our field the longer the white line the worst the outcomes early identification and intervention is going to be most effective
if we can catch in the at risk face or the early active face illustrate my point I'm gonna tell you about two of my favorite people the first person I talked about is Edward Edward was a twenty two year old man who I was asked to go to his home now you may say well why did you go to his home when you come to your
office do you see I've been doing this work has approved around seventeen eighteen years and I have never actually had a young person come to my office was get Freddie and said Hey doctor Milton I have schizophrenia in fact if they did they probably did have schizophrenia so I had to go to Edwards but Edward wasn't even leaving his attic much as was gonna leave his
house the only reason he would leave his addict with each and to draw right words on the floor of his kitchen and his walls and the words that he wrote were fief trader and he wrote those words because that's what he believed his mom was if he believed that his mom was involved with the mafia and they were conspiring to steal millions of dollars from him
which you didn't have prior to my visit with Edward left speaking with his mom and she told me about five years prior to this event that Edward was becoming quite suspicious of his friends she was starting to believe that they were stealing money from him and he knew that wasn't true but it was bothering him so much you start is cut off more more his friends
to the point where he started isolating but by time I got to at work he was in the full active phase of schizophrenia I sat down with that word I knew better not to challenge his belief system because the moment I did he would throw me out I said Edward Lawson must be really hard if it you believe that your mama stealing from your conspiring with
the mafia I'm sorry about that thinking that I could engage in that way he's a doctor melting heat is could you put your hand on the kitchen table I did I got up he left he came back with some large garden shears and he said you doctor Melton are also part of the mafia and I'm gonna have to remove your hands at that point I terminated
the interview I when they called the police the police picked up at work he was taken to an emergency room he was then taken to a psychiatric hospital he was then committed to the state hospital where he spent the next six months being mandated to treatment execute okay in those six months he was in treatment after he left however he would no longer mandated to treatment
he began a very vicious cycle I'm going back to his beliefs back to the hospital sometimes back to jail on and off of homelessness and to this point today I'm not even sure his mother even knows where he S. the onus owned at heart but there were opportunities early never favor person a mine Andrew and it was a sixteen year old okay student mostly bees some
C. pluses and grades his does average grades were starting to get very significantly they were dipping to the point where they drew attention to his teachers and as teachers I referred him to a school counselor school counselor I was able to and engaging in conversation where Edwards Andrew said well the big problem is I'm I'm so distracted by the fact that I'm starting to believe that
my teachers inserting thoughts into my head and I'm so focused on that I'm missing all of my assignments Kevin gave evidence of this and he'd say no he was trying to talk himself out of it and then you'd see a teacher blinked and it's a no no they aren't in putting thoughts into my head the counselor rightly referred her to prepare for it and you to
me I met with Andrew we were able to engage in a treatment where he could talk about those symptoms we could do a therapy called cognitive behavior therapy we could engage in reality testing with them challenges thoughts six to eight months later his grades improved he later graduated from high school went on to college has a very good job now and living in a city he
always trapped he wanted to live and this isn't new the research around early intervention with schizophrenia now expands two decades and it's very very positive we have employment rates of upwards of eighty percent when people engage in early intervention hospitalization rates according to state of organs data dropped to six percent fifty nine percent of individuals do not apply for disability who receive early intervention for schizophrenia
and then maybe these numbers here if you're worried about cost as many of us are fiscally responsible three thousand four hundred and forty five dollars is the annual cost to treat somebody in an early intervention program if we catch it early the next number nine thousand five hundred and three dollars is the average annual cost to treat somebody it was just standard care who we cut
too late that is the difference the top number represents Andrew the bottom number represents Edward greater cost with Edward worse outcomes a colleague of mine and other early schizophrenia researcher said to me you know if we catch cancer in stage one almost everybody lives if we catch cancer in states for almost everybody dies the same is true with major mental illness if we catch it early
the outcomes are much better any individual can own the condition and own their lives so what's new longer a matter of should we do this that argument is passed the question now is how do we do this sure the ingredients to a good early intervention program for schizophrenia obviously there are some very advanced treatment but what I want to focus on right now my call to
action my more than words action plan for all of you in the audience right now is to become aware of those early warning signs and to help individuals kit to treatment as soon as possible do not wait the longer the duration to worst the outcomes so you play a role by acting in that top pool of early intervention awareness early intervention and treatment does not work
and that's you all are involved and can recognize the symptoms and get people to help as soon as possible there are thirty eight states in this country with fully running early schizophrenia programs and the rest of the states are working on it Jatin portent ticket states are seeing this as a priority if you're in one of those states where you don't have an early intervention program
please get the individual to a mental health clinic or to their primary care doctor or another person that can I think it's important just review those signs are you absolutely aware of all those signs include increased difficulty at school and work we saw this happening with Andrew withdrawal from family or friends this was happening with Edward I wish we would have caught it down for him
difficulty concentrating our thinking clearly we saw this with Andrew suspicious this mistrust of others we saw this bolt with Edward and Andrew cut it at the right time with Andrew kinda too late with Edward changes in the way things look or sound like thinking or behavior emotional outburst lack of emotion poor personal hygiene now you they look at the single jojo wait a minute that looks
like every stinkin teenager Idaho the difference is individuals that are suffering from early schizophrenia this is a big change for them it's causing a significant decrease in functioning and they are much different than their peers take a close look at this list now close your eyes is there somebody you know out there who may be experiencing the symptoms is there somebody who I can't is there
