Psychosis Early Treatment: Dr. Carrie Bearden & Gayle Ayres

I truly believe that early intervention gives the best chance for a young person with a psychotic disorder to recover. It has worked for me! In this inspiring Brain Waves "double feature," two women will present their perspectives on the early treatment approaches offered at the IMHRO-funded CAPPS/ABBRC psychosis prevention/early intervention clinic at UCLA. First, Dr. Carrie Bearden, Director of the center, describes some of the core and emerging treatments offered to its young clients. Next, Gayle Ayres, mother to Anna, a 2012-2013 ABBRC client, provides her impressions of the program and of how it has benefited Anna.

If you like what you learn of this IMHRO-funded program, please feel free to donate to IMHRO. Support from people like you enables it to happen!

-Brandon

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Good morning to all of you visiting the IMHRO site today!
I hope you enjoy the video- I personally found it very inspiring to hear from Gayle about her experiences with her daughter's illness and road to recovery, and I'm so happy that our program at UCLA (CAPPS/ABBRC) was part of that recovery process. Please tune in to hear more about early intervention for psychosis - and I will be happy to take your questions over the next few days. I look forward to hearing from you!
best,
Carrie
 
Carrie E. Bearden, Ph.D.
Associate Professor, Departments of Psychiatry, Psychology and Brain Research Institute
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles
Cbearden@mednet.ucla.edu

Good morning and thank you for joining us.
It is such an honor to participate with Dr. Bearden and Brandon and I look forward to answering any questions about our positive experience with the CAPPS/ABBRC program.
Dr. Bearden's interview provides a beneficial road map for parents of adolescents who are navigating this challenging yet manageable terrain.
We have been blessed with a dedicated and compassionate Cognitive Behavioral Therapist (Dr. Jayne Kading) and psychiatrist (Dr. Andrea Sorensen) during Anna's journey.  Together with the CAPPS/ABBRC program, our daughter is thriving.
Our daughter was acutely ill and all but lost.  Know it does get better. 
I look forward to hearing from you, Gayle

Thank you for sharing your stories of success and hope. Gayle, how did you learn about the program? Can you share a bit about how to manage the side effects of medication? 
 
Carrie, are you considered a first episode clinic?  How do you spread the word do parents, pediatricians, college counselors, etc. of your existence?
 
Are you aware of any new medications or non-pharmaceutical treatments that are effective and recently made available?
 
Thank you both for your participation, and to Brainwaves for bringing you to us,
Warm regards.

Hi-Anna's psychiatrist researched various research studies and felt CAPPS/ABBRC was the best fit for Anna.  She started the process for us and then Anna participated in a phone interview that lasted about an hour and a half to determine if she qualified (a phone interview so we didn't have to travel to Los Angeles).  We familiarize ourselves with the side effects of the medications and familiarize ourselves with symptoms of her illness (sometimes they overlap). I keep a daily journal of her well-being.  We can usually adjust dosages within a couple of days of any serious side effects. I highly recommend keeping a daily journal.  I only write a paragraph or so daily but it has helped us manage her illness.  Anna's psychiatrist and cognitive behavioral therapist also appreciate a running log.  I've also printed them out for her neurologist and rare visits to the ER.  Anna is well aware of everything recorded and often contributes.
I hope this helps, Gayle
 

 

hi, to answer your question about our program - we have two clinical research programs, CAPPS (http://www.semel.ucla.edu/capps) - for youth experiencing prodromal or subthreshold symptoms, and our ABBRC program, for 12- 17 year old youth who have already experienced a psychotic episode. While most have a recent onset, we are not exclusively a first episode clinic. For individuals over 18 who have experienced a recent onset of psychosis I recommend the Aftercare program at UCLA directed by my colleague Dr. Keith Nuechterlein. Regarding our outreach, one of our team members frequently gives talks out in the community (at schools, community mental health clinics, etc)  regarding early warning signs of psychosis. We also have program brochures and a newsletter which are mailed out to clinics, schools and other treatment providers  around Southern California with information about the program. 
i hope this helps!
 
best,
Carrie

I have a question regarding the family sytem. How do you educate and stress the importance of the caregiver "thinking outside the cultural norm" while raising their child and caregiving for mental illness which requires compassion and a uniqueness of the individual and what they need, while caring for themselves in all the changes and stress that occures? I am so thankful for the program and all the care that is given. sharon

Hi Sharon-As a caregiver, I’ve been fortunate to work separately with Anna’s CBT, who initially guided me through this bewildering terrain until I could eventually stand on my own two feet…a truly transformative relationship. Anna’s psychiatrist has been dedicated to this process as well while refining her medication treatment plan and being especially receptive to any of our concerns. When Anna’s illness presented, I made an effort to talk to people who have learned to successfully manage the same disorder and have read a plethora of  biographies/autobiographies by people who live with her disorder/similar disorders, looking for common denominators in recovery. Dr. Elyn Sak’s book (the first book I read), The Center Cannot Hold, gave me tremendous hope. I understood that before I could do anything outside of the cultural norm or outside of the norm of caregiving for mental illness, it was vitally important to stabilize her with medication and therapies (cognitive behavioral therapy and psychosocial rehabilitation in her case). Cognitive behavioral therapy and psychosocial rehabilitation have helped us manage the changes and stresses that you mention. We are now exploring dialectical behavioral therapy as well. That being said, I served as a volunteer hospital chaplain (specifically with Alzheimer’s/dementia patients) for a few years prior to Anna’s illness presenting. It was during service as a chaplain that I learned the importance of mindfulness so it is something I’ve practiced with Anna during this journey. At that time I became familiar with the writings of Eckhart Tolle and Thich Nhat Hanh which have been especially beneficial. We practice mindfulness through art (i.e. painting, zentangles, mandalas), handwork (i.e. knitting and crocheting) and music (listening to particular genres were very helpful) as well as breathing exercises that she learned from her CBT and psychiatrist. My husband, older daughter and I are able to fully participate in mindful caregiving and it has enriched our lives and extends beyond our home.  In terms of educating, I simply try to model mindful caregiving as I model our healthy relationship with Anna’s CBT, psychiatrist and behavioral healthcare team. Thank you for the great question.

hi Sharon,
what a great question - I certainly can't say anything more eloquent and informative on this topic  than what Gayle has articulated above! I am also a big advocate for mindfulness training, and fortunately there are a lot of resources  and classes at UCLA (http://marc.ucla.edu). I would also add that the therapeutic approach we've found to be very effective in reducing symptoms in youth with prodromal symptoms is Family Focused Therapy, which focuses on improving family communication - i.e., not just treating the individual. It's also incredibly stressful to have a child with mental illness so parent support groups offered by NAMI (http://www.nami.org)  in many areas have also been helpful for many families we've worked with.
best,
Carrie
 

I have a question for Dr. Bearden. I taught gifted and talented education (fifth and sixth grade) prior to becoming and at-home mom (it’s been well over 20 years). Part of my job included going into the community and training teachers how to identify gifted children (as opposed to high achievers). When I would meet with teachers, I would mention some behaviors that might hamper their ability to identify a gifted and talented student. When I look back, I realize that some of these more challenging characteristics of some gifted and talented students are similar to prodromal symptoms. Examples would include lack of organizational skills, poor listening and concentration skills, extreme sensitivity, deficiency in tasks emphasizing memory, perceptual abilities as well as several other characteristics. Have any studies addressed these shared characteristics? Thank You, Gayle

hi Gayle, this is a really interesting observation. There is  evidence that at least some people who later go on to develop psychotic symptoms had earlier indications of some unusual processing , even in early childhood- which could manifest in the form of attentional difficulties, unusual emotional expression, and /or over-sensitivity to sensory stimuli. On average, children who later develop psychosis do not appear to have higher IQ than those who don't, but there are many exceptions to that, on an individual basis- and some people with psychosis have very advanced artistic abilities.  it's hard to know for an individual child whether those traits you mentioned  are predictive of later difficulties  - but my recommendation to teachers would be that if the child seems to be having difficulty functioning in the classroom as a result, a comprehensive evaluation and possibly approrpriate classroom accomodations (extra test time, etc) may be warranted. It's certainly possible that could make a difference for later outcome in terms of decreasing stress in the classroom setting.
best,
Carrie

What a great discussion this time! Thank you, binformed and sharons, for your questions, and hearty thanks to Gayle and Carrie for your helpful answers. Comments are now closed. Stay tuned for Brain Waves next month when we catch up with the ever active Dr. Scott Russo.

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