On Friday, June 24, 2016, at McLean Hospital, CLBB will co-sponsor a talk by James H. Austin, MD, Emeritus Professor of Neurology, University of Colorado School of Medicine, and author of the new book, Living Zen Remindfully (MIT Press, 2016).
By Ann K. Shinn, Kirsten W. Bolton, Rakesh Karmacharya, Kathryn E. Lewandowski, Cagri Yuksel, Justin T. Baker, Virginie-Anne Chouinard, Samira M. Pingali, Hilary Bye, Katherine Cederbaum, and Dost Öngür | Early Intervention in Psychiatry | November 29, 2015
Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all comers with first-episode psychosis.
We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare with current diagnoses, calculating the proportion of diagnostic changes.
At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder not otherwise specified (NOS) who do not meet full criteria for either category and two (2.2%) individuals with no psychosis. Although patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients.
Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a transdiagnostic approach to early intervention in first-episode psychosis, treating patients who share many but not all characteristics.
On Thursday, February 19, 2015, CLBB presented a McLean Hospital Grand Rounds titled “Psychosis vs. Psychopathy: Navigating the Risk of Violence in the Clinical and Courtroom.” Clinical and legal experts used case-study to distinguish the on-set, pathophysiology, symptoms and effective interventions for each diagnosis, and characterize the risk of violence.
This Grand Rounds presented case studies and discussion by Joseph Stoklosa, MD, medical director for McLean’s schizophrenia and bipolar program; Judge Roanne Sragow, first justice for the Cambridge District Court; Larry Seidman, MD, neuropsychologist and expert on early psychosis; and CLBB co-director Bruce Price, MD, McLean Chief of Neurology. CLBB co-director Judith Edersheim, JD, MD, forensic psychiatrist, served as moderator.
The Grand Rounds took place from 12-1pm in Pierce Hall, inside the Service Building, at McLean Hospital.
Watch video of the entire “Psychosis vs. Psychopathy” event below, or explore past events on juvenile justice, pain, memory, and criminal responsibility, on CLBB’s Vimeo channel.