The difficulty — and opportunity — in diagnosing psychosis in young people
It can be a challenge to diagnose young people with serious mental illnesses like schizophrenia. But since 2017, Maricopa County’s safety-net hospital, Valleywise Health, has been working to flag and treat young people as soon as possible after the onset of psychosis.
It’s called the First Episode Center, and it’s located in Avondale. Demand is so high, Valleywise is now opening a second center in Mesa. They estimate they’d need 12 throughout the Valley to meet the real need in the Phoenix area.
The First Episode team includes psychiatrists, recovery coaches and specialists who work together to make a plan for each member, helping them get back on their feet and live with schizophrenia.
The Show spoke more about the work with Dr. Aris Mosley, medical director for the First Episode Center. She runs the center in Avondale, and she really talks about mental illness differently. She doesn’t use the phrase “mental health issues.” Instead, she talks about “brain health conditions.” Because, she told The Show, it’s all about the brain.
DR. ARIS MOSLEY: For myself, in my clinic, we focus on a primary psychotic disorder such as schizophrenia. So, speaking to schizophrenia, specifically the age of presentation is typically around late adolescence. So, kind of, the rule of thumb is around maybe freshman year in college is typically when it presents. So if you bring me say, a 7-year-old, and tell me he has schizophrenia or he's having hallucinations, my first thought is going to be trauma or anxiety.
Does it become much more clear at a certain point when they're at that kind of normal age for these things to present?
MOSLEY: Yes and no. I think that one of the things that makes it more clear is what we call collateral information. So, information from other people, maybe natural supports — friends, family — that kind of stuff. Because they're going to be able to give us information that maybe the individual is not able to express themselves.
Now, of course, if someone is symptomatic — a lot of times you can just tell by speaking with them, talking to them. But a lot of the additional information to make the more appropriate diagnosis is going to come from the collateral information.
Give us some examples. What does this look like?
MOSLEY: So. a lot of our young people who come into the First Episode Center actually come to us from the inpatient side. The inpatient psychiatric hospital. Because with a primary psychotic disorder such as schizophrenia, there is, I'm going to say 9.5 times out of 10, there's going to be something called a prodrome. And that's kind of the leading up point to that first episode of psychosis. And that prodrome often looks like depression. So, while a young person is going through that they may get diagnosed with depression first, right? Because it looks like normal, kind of, adolescent angst ... Kind of withdrawing more, maybe not hanging out with the friend group in the way that they used to. Isolating to their rooms more, not talking. Maybe not, what we call, tending to their ADLs (activities of daily living). So, like, eating the same way, bathing the same way, brushing their hair, brush their teeth, that kind of stuff.
So, that very much looks like depression. So, I often times have families stating well, "Why weren't they diagnosed before?" You know, because the last thing you're going to jump to during a prodrome is, "Oh, this is schizophrenia." Right? You're going to go like Occam's razor. Usually it's the most simple answer is the right answer, right? So you're going to think depression.
...But then things change, there becomes a point where they kind of tip. So, then psychosis can look different for every person. For some people, they do hear voices as clear as you and I hear each other's voices, they hear those voices. But other people can't hear those voices. There could be paranoia, worry, fear that people are after them, fear that their family is no longer their family.
They can have what we call, maybe thought insertion. So they feel that people are putting thoughts into their minds. It's not their own thoughts. Some people might be experiencing special messaging through the television or other electronics. So it can look different for a lot of people. It can be all of those things. It can be one of those things.
That's the point at which the First episode center steps in. It's for outpatient care. What does it look like? How do you treat somebody, and why does it matter to catch it early?
MOSLEY: Right. So that's a really fantastic question. It's so important to catch it as quickly as possible, because you want to get in there early to be in treatment as quickly as possible. Because in the brain, during episodes of psychosis, specifically, there can be an inflammatory process that happens to the brain. So, in a very basic way, kind of like a swelling. Like, if you cut your hand, it gets red and swollen, something similar can happen within the brain. So, then we're running the risk of lasting damage being done to the brain. You want to get in there as quickly as possible.
Also, it's very scary for the individual. It's very scary for the families and natural supports. So, you want to get in there as early as possible, to be able to partner and walk this path with them to try to minimize, honestly, the trauma that can come with this. So, that's why it's most important to get in there early and help the young person and their families and natural supports, to be honest. To help them have what we call insight. Just to help, to better prepare them of understanding what it is that they're experiencing.