First contact: Early intervention key in diagnosis and treatment of serious mental illness

April 16, 2012

Early symptoms of major mental illness can be subtle personality changes. Therefore, initial warning signs can often be missed, or even ignored due to conventional wisdom that suggests it's better to wait for true behavioral deterioration and prolonged patterns of abnormality before diagnosing and treating a mental illness. But experts warn that waiting until someone is so ill that the psychological sickness is unmistakable can be detrimental and can lead to long-term health concerns. In an effort to end the waiting game, Northwestern Medicine behavioral health experts from the Stone Institute of Psychiatry at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine have launched First Contact, a program aimed at preventing the onset of long-term disability due to severe mental illness by increasing awareness of signs and symptoms and encouraging people to seek help earlier.

"Oftentimes, waiting is tragic," says Will Cronenwett, MD, a psychiatrist at Northwestern Memorial and instructor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. "The first time subtle changes emerge is the best time to get an evaluation. By the time someone is so ill that it's resulted in their first hospitalization, they've already started to fall away from the trajectory that their life would have taken."

Cronenwett notes these subtle changes include odd thoughts, changes in mood, behavior or personality. Depression and isolation can be a sign, as well as strange experiences like hearing things that other people can't hear. "What really makes these things clinically significant is if the patient, family, or school thinks the young person's level of functioning is changing," said Cronenwett. "If grades drop, or the person misses days at work or changes, or if he or she gives up friends, or stops relating well to family members, these are all serious signs."

First Contact focuses on identifying the first stages of mental illness, even before a definite diagnosis is made. This is possible because mental illnesses like schizophrenia and bipolar disorder have very similar biological profiles, so the symptoms can be the same. When appear, diagnosis is not necessary to begin early treatment that is very low risk, such as teaching people about psychiatric wellness and how to monitor themselves for signs of illness.

Cronenwett explains that those who suffer from mental illness experience deterioration in or difficulty maintaining vitally important connections. They either lose or can't form important relationships, their productivity and performance drops and they often struggle to start a career or maintain stability such that their lives spiral out of their control.

"We don't want to wait until someone gets hospitalized before we begin treatment," said Cronenwett. "We want to intervene early to see if we can prevent that loss of milestones. This program gives people a place to go when they are concerned about a friend or loved one."

If someone is concerned about in a family member, they can call Northwestern's Stone Institute for more information. Stone offers inpatient and outpatient care for adults, as well as outpatient care for adolescents ages 12󈝾 through its Warren Wright Adolescent Center. If the patient is over the age of 18, they will receive an evaluation at First Contact. Patients under the age of 18 are evaluated at Warren Wright. The evaluation might include psychological testing in addition to a standard psychiatric interview. Treatment services are available for all mental health conditions, including substance abuse, depression and ADHD.

"Whatever age in life the illness begins to strike, we can treat adolescents or adults to prevent disability and keep them on track with the rest of their lives," said Cronenwett.

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