Vancouver/Richmond EPI
Early Psychosis Intervention

WHAT CAN FAMILY AND FRIENDS DO

PRODROME

If you live in the Vancouver/Richmond region call our Early Psychosis Intervention program at . We will provide you with referral information and answer any questions you may have.

Have the person assessed by a family doctor or mental health team.
Encourage the person to refrain from using any street drugs or alcohol as these may make their problems worse.
Try to keep an open line of communication with the troubled individual.
Be supportive and non-judgmental.
Avoid using critical comments.
Focus on the specific problems that the person acknowledges, e.g. difficulties with sleep, concentration, appetite, taking the bus etc.
If conversation seems to agitate the person, sitting together quietly may be helpful. Follow their cues.
This whole episode is probably frightening for the person. Offer comfort and reassurance, provide hope, and offer information that you know is accurate.
Try to decrease current stresses and lower the stimulation in the household. This might mean keeping television, stereo, or radio volume low, limiting the number of people in the home, lowering the lights, etc.
Behaviour problems such as neglecting hygiene, arguing, not complying with household rules etc. should be dealt with, perhaps one at a time. Set clear limits around
acceptable behaviour and be clear about your expectations. Decide on consequences that are fair and related to the behaviour. Make sure that you enforce them. Be firm. Avoid arguments that will only escalate difficult behaviours. Remember that young people with mental health issues continue to require structure and limits, and a calm, predictable environment.
The troubled young person should be taught about how to manage stress. See the stress management section of the web site.

ACUTE PSYCHOSIS STAGE

If your family member or friend is showing signs of psychosis (hallucinations, delusion, thought disorder) it is best to contact their psychiatrist or mental health worker. If they are not yet connected with a professional you have several choices. You may want to bring the person directly to the emergency department of your local hospital. Or, if you feel they can wait, call the mental health team in your region or your family doctor.

HOW TO APPROACH SOMEONE YOU FEEL NEEDS HELP:

Individuals developing a psychotic condition will often not reach out for help. If you are concerned about an individual, you may have to approach him/her first.
Approach the individual you are concerned about in a caring and non-judgmental manner.
Specifically state why you are concerned.
It is often best to state your concerns in behavioural terms.
For example, "I have been concerned because you don't seem to be spending any time with your friends anymore."
Do not speculate on what their diagnosis might be. For example, do NOT state, "I am concerned that you might be getting psychotic."
Arrange to talk to the individual in a private setting.
If the individual is unwilling to talk with you, let them know that you will be available if they would like to talk with you in the future.
Ask if their family has expressed concern. Ask if they think it's okay for you to talk to the family.

Some helpful hints for preparing for and attending an interview:

Write down exactly what has been happening and what you have observed. Include what actions you may have taken up to now. Bring this with you.
Write down questions you may have (you'll probably find that you have more during the interview). Be persistent in asking your questions.
Take paper and pen with you to write down what is said so you don't have to rely on your memory afterwards.
Be realistic in your expectations. This is an initial meeting and more meetings may be scheduled. Change happens slowly.
Be sure to get a sense of when you will hear back about test results, followup, etc.

Keep a list of who you see, when, why, what they say and what happens. It will give you the confidence to be sure that you have your thoughts in order when dealing with people who may not have the whole picture.

WHAT WILL HAPPEN DURING AN ASSESSMENT for the individual concerned

Whether you see your family doctor, a mental health clinic or a psychiatrist, it is likely that a range of information will be gathered. All mental health clinicians as well as physicians are guided by the rules of confidentiality. That means that whatever you discuss will remain confidential within the treatment team unless you agree to share the information with others such as a family member.

A full history might include:

Physical illnesses
Developmental information
School history
Problems related to social environment or family environment
Occupational history
Housing problems
Economic problems
Legal problems
Addiction problems etc.
Is there a family history of mental illness? How was it treated?

The interviewer will ask more specifically about the presenting problem:

When did it start?
What was going on in the person's life at the time?
How did it affect their daily functioning (e.g. school/work, social life, family life)?
They will likely want to zero in on specific symptoms and ask about the presence of others not mentioned.
You may not be able to tolerate a full interview. Information can also be gathered more slowly over time.
If you agree, a family member may be asked to sit in on the interview at some point to help clarify information. This would be with the consent of the individual concerned.
A physician might then make a formulation of what appears to be happening and suggest treatment. It should also be suggested that the person have a complete physical examination.
It may not be clear that you have a psychiatric illness. Treatment may not be recommended. Instead, the physician or mental health worker might want to work with you to help you to deal with some of the issues that are troubling you.

Help for family members:

Organizations such as B.C. Schizophrenia Society and the Mood Disorders Association of B.C. are organizations that provide support, advocacy and education to family members. Use their resources and others listed in the resource section of this web site.
Recognize your stress level. Follow some of the hints in the stress management section of this web site.E.G. follow a nutritious, well-balanced diet, exercise regularly, try to get enough sleep. If you're calm, it will help to reduce stress in the household.
Educate yourself
Continue to connect with your friends and family. Let them support you and help ease the burden. Remember, psychosis is a brain disease, a physical illness manifesting itself in a psychological way. You are not to blame.
Continue to enjoy activities and hobbies.

Managing Symptoms at Home

HALLUCINATIONS (sensory experiences not shared by others)

Possible Signs:

Pacing
Restlessness
Increased social withdrawal
Increased preoccupations
Irritability
Talking to oneself

Coping Strategies:

Work with the person to develop a strategy of what is helpful for them Identify and reduce what is causing them stress. See the doctor or mental health worker if necessary Help to provide distraction by:

Provide Activity e.g. a walk, card or board games, simple chores Encourage the person to have conversations with others
Relaxation e.g. stress management tape
Exercise
Work
Provide competing stimuli e.g. portable stereo, tv, radio. Movie

What Doesn't Work:

Attempts to reason or debate with the voices

DELUSIONS (fixed, false beliefs: e.g. the person thinks they are Queen Elizabeth, or, that the radio is sending messages just to them; or that the RCMP is plotting against them)

Possible Signs:

Fearfulness
Suspiciousness
Preoccupation
Refusal to maintain routine/activities
Irritability

Coping Strategies:

Avoid debate, reasoning
Acknowledge person's distress
Avoid collusion
Avoid interpreting the meaning of the delusion
Speak about how the person is feeling, eg. Anxious and how to manage that anxiety (see stress part of website) or perhaps they are losing sleep and discuss how to manage that.
Perhaps say: I can see that those thoughts are making you feel very anxious (worried, upset, irritable etc). Let's work together to help you feel more relaxed.

Delusions are part of illness. Try to avoid emotional responses. Try to empathize with the fear, anxiety and distress.

THOUGHT DISORDER (thoughts seem confused, disorganized, speeded up or slowed down)Possible Signs:

Incoherence
Illogical
Inappropriate emotional responses (e.g.laughs at very sad news)
Pacing
Restlessness
Irritability
Preoccupation

What Helps:

Structured routine
Limits to behaviour
Simple words, short sentences
Ask the person to repeat the instructions you gave them
Lower the stimulation around them e.g. turn off radio, tv when speaking with them
Do not provide too many choices-too confusing

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Vancouver/Richmond Early Psychosis Intervention Program

Vancouver, BC, V5N 5P9

Tel: