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Psychiatry Newsletter - Psychosis Help of EPIC Proportions
Hopkins BrainWise Winter 2010
Psychosis Help of EPIC Proportions
Date: February 1, 2010
Krista Baker, Shannon Barnett and Russ Margolis aim to nip psychosis in the bud.
Social skills were never Daniel Lawson’s* strong suit. He excelled in math, though, and sailed through his high school’s advanced classes. So when Lawson enrolled at Hopkins as a math major, his parents thought he was on track. And he was, until his sophomore year.
One evening when they came to visit, his parents found him sitting in his apartment in the dark, amidst the scattered contents of his tabletops, cupboards and closets. Voices had told him to empty them out so he could hide from the campus police.
Daniel was “deeply into a first psychotic episode when he came here,” says psychiatrist Shannon Barnett who heads the Early Psychosis Intervention Clinic (EPIC) at Hopkins’ Bayview campus. But now, six years later, the young man is finishing up a Ph.D. program. “He’d be the last to admit to anyone outside EPIC that he has schizophrenia,” says Barnett, “but he’s religious about checking in monthly and he’s doing well.”
When the clinic opened, the idea was to marry adult and child psychiatry into a service for young adults new to schizophrenia, bipolar disease or to disorders that overlap the two. “We believe there’s no other focus like this in Baltimore—and, really, only a few exist nationwide,” explains primary therapist Krista Baker, the force behind its start.
Atypically, EPIC staff treat psychosis itself as a target. “Because every psychotic episode harms the brain, it’s especially crucial that patients this age stay on treatment,” Barnett says. “We don’t want kids to have these serious symptoms long enough, even, to find out what their illness is.”
The clinic tries to take advantage of the newness of the illness while there’s a significant chance for change. Otherwise, she says, young adults can get tagged with bipolar disorder or schizophrenia, put on medication and that’s that. “Most adults that I see in my hospital practice have become defined by their illness,” adds Barnett. “Stepping in at this age, we believe, makes that less likely.”
“Stepping in” involves practicing traditional medicine more astutely than usual. It also means tailoring care to a high degree. So when EPIC psychiatrist Russell Margolis interviewed a teenage patient who came to the clinic diagnosed with absence seizures, he instead suspected auditory hallucinations. Margolis, who heads Hopkins adult inpatient schizophrenia program, is a point person on psychosis. A standard antipsychotic took the young patient’s “seizures” away.
When Eileen*, with schizoaffective disorder, found that the very olanzepine that expanded her abilities also brought a weight gain of 40 pounds, staff recognized a threat to the young woman’s stability. They enrolled the 20-year-old in a hospital aerobics program. They also take mile walks at her clinic visits. Now in her own apartment, Eileen cooks healthier food thanks to EPIC-accompanied grocery shopping.
Finally, because patients’ needs are complex, EPIC taps Hopkins’ nearby community psychiatry services. For John*, whose persistent use of amphetamines turned him both psychotic and violent, the staff of EPIC and CODA—a substance abuse program for his age group—mapped out joint therapy. When Lakeisha’s* social anxiety kept her from clinic visits, the Child Mobile Treatment Services came to her door. And the Psychiatric Rehabilitation Program devised incentives that kept her coming.
For information: 410-550-0137.
*For privacy, we’ve changed names and details.