Friday Factoids Catch-Up: Binge-Eating Disorder



We have all heard or used the phrase “binge eating” or “binging.” It is a phrase that gets thrown around often, especially during the Thanksgiving and Christmas holiday seasons.  Most of us use it to describe eating more than normal portions at a meal or continuing to take a few more bites because it tastes so good!  However, true binge eating can be a psychological disorder.


Binge-Eating Disorder (BED) is a new diagnosis added to the category of Feeding and Eating Disorders found in the DSM-5. It is the most common eating disorder in the United States. The number of those suffering from BED outnumbers individuals experiencing anorexia and bulimia combined by more than three times. Current estimates suggest that 3.5% of women and 2% of men suffer from this disorder. While the estimated number of people experiencing BED might not initially seem large, when calculated it comes out to be 2.8 million American adults. That puts it into perspective.


So what exactly is BED? It is considered to be, “Eating in response to something other than physical hunger in an attempt to numb unwanted or uncomfortable emotions that goes beyond emotional eating or compulsive overeating,” (Binge-Eating Disorder, 2016).  During these binge episodes, individuals have uncontrollable and unstoppable urges to eat.  They will even eat to the point of discomfort and/or actual pain.  Additionally, during an episode, a BED sufferer may consume several thousand calories which can be very unhealthy. Afterwards, they often feel shameful and guilty. Many desperately try to hide their binge eating from others.


The DSM-5 lists the following official criteria for a BED diagnosis:

A.            Recurrent episodes of binge eating characterized by both 1.) Eating in a discrete period of time an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances 2.) a sense of lack of control over eating during the episode

B.            The episodes are associated with three or more of the following 1.) Eating much faster than usual 2.) Eating to the point of discomfort or pain 3.) Eating large amounts of food even though you are not physically hungry 4.) Eating alone due to embarrassment resulting from the large amount of food consumed 5.) Feeling guilty, shameful and/or disgusted after the episode.

C.            Increased stress due to binge eating

D.            Experiencing binge eating episodes at least once a week for three months

E.            Binge eating is not followed by unsuitable, compensatory actions (such as bulimia) and does not occur in concurrence with anorexia or bulimia nervosa.


While approximately 30% of individuals with BED fall within normal weight categories for their height, 70% are considered overweight. Bullying, shaming and stigmas surrounding weight can often trigger more intense and/or more frequent episodes of binge eating as well as additional emotional distress. Some additional, common psychological issues that those who suffer from BED experience are OCD, anxiety, and depression. Common physical health issues also experienced are type 2 diabetes, heart disease, sleep apnea, high blood pressure, and osteoarthritis.


Individuals suffering from the symptoms of BED often feel like they are out of control. Through repetition of binge eating, their brains have actually been altered to respond to food in a very comparable way to that of the brain of a substance user/drug addict.  Unfortunately, though, they can’t just stop eating. Therefore, the goal of treatment for BED is a reduction or complete cessation of binging episodes. Treatment teams consisting of an individual’s PCP, psychologist and dietician have proven to be more effective then utilizing one of the services alone.  Support groups for individuals suffering from BED as well as additional resources can now be found online.


Works Cited
“Binge-Eating Disorder.” Binge-Eating Disorder. N.p., n.d. Web. 02 June 2016.


“Binge-eating Disorder.” Overview. N.p., 2016. Web. 03 June 2016. – 37k


“Eating Disorders: About More Than Food.” NIMH RSS. N.p., n.d. Web. 03 June 2016. trifold/index.shtml


“Info about Binge-Eating Disorder in Adults.” Binge-Eating Disorder. N.p., n.d. Web. 02 June 2016.



Crystal Bray
WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged , , , | Leave a comment

Friday Factoids Catch-Up: Understanding Naltrexone

Unfortunately, in the world we all live in today, most of us know someone who is suffering from opioid and/or alcohol addiction. That or we are struggling with it in our own lives. Regardless of the initial purpose behind using either substance, finding a true cure for those who have become addicted to these substances has become vital, and even more urgent. Enter Naltrexone.


Naltrexone is a prescription drug that is predominantly used in the management of opioid and alcohol dependence. It is sold under the legal trade names of Revia, Depade, and Vivitrol (a once-monthly, extended-released, injectable formulation).  Naltrexone is also being used to help save the lives of individuals who have overdosed on opioids. EMS units, ER’s, and even pharmacies carry it for this exact purpose. It literally reverses the effects of opioids within minutes, but how does it work for addiction?


For opioid addiction, naltrexone acts as a blocking agent. It attaches itself to opioid receptors in the brain. It then prevents the receptors from up-taking any the substance which in turn prevents the pleasurable feelings caused by the opioids.  However, it does not prevent good feelings that come from other naturally pleasurable activities.  This action makes it very beneficial, along with therapy, to assist with opioid relapse prevention.


For alcohol addiction, scientists and doctors are not certain how Naltrexone works but do know it decreases the cravings for alcohol. It is hypothesized that, as with opioid addiction, it works as a blocking agent and prevents the pleasurable feelings drinking alcohol promotes because it partially prevents the uptake of endorphins associated with euphoric inebriation.


Whether taken for alcohol or opioid addiction, Naltrexone does have serious side effects. These include confusion, auditory and/or visual hallucinations, blurred vision, severe vomiting and/or diarrhea, and liver damage. The less severe and more common side effects are nausea, difficulty falling or staying asleep, increased or decreased energy, drowsiness. muscle or joint pain, rash, vomiting, stomach pain or cramping, mild diarrhea, constipation, loss of appetite, headache, dizziness, anxiety, nervousness, irritability and/or tearfulness.


Any individual interested in obtaining a prescription for Naltrexone would need to consult with their medical doctor and be undergoing outpatient/inpatient therapy for substance abuse treatment.


Work Cited
Naltrexone: MedlinePlus Drug Information. (n.d.). Retrieved May 30, 2016, from   


VIVITROL® Official Site | VIVITROL® (Naltrexone for extended-release injectable       suspension). (n.d.). Retrieved May 30, 2016, from


Crystal Bray,
WKPIC Doctoral Intern



Posted in Blog, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged , , , | Leave a comment

Friday Factoid Catch-Up: Yeast Infection Linked to Mental Illness


Candida albicans is a yeast-like fungus naturally found in small amounts in human digestive tracts. Symptoms cause burning, itching, thrush, and genital yeast infections. In its more serious forms, it can enter the bloodstream. Most Candida infections can be treated in their early stages, and clinicians should make it a point to look out for these infections in their patients with mental illness. Decreased sugar intake and other dietary modifications, avoidance of unnecessary antibiotics, and improvement of hygiene can prevent Candida infections.


Johns Hopkins researchers focused on a possible association between Candida susceptibility and mental illness. There has been growing evidence suggesting that Schizophrenia may be related to problems with the immune system. For the study, researchers took blood samples from a group of 808 people between the ages of 18 and 65. This group was composed of 277 controls without a history of mental disorder, 261 individuals with Schizophrenia and 270 people with Bipolar Disorder. The researchers used the blood samples to quantify the amount of immunoglobulin G antibodies to Candida, which indicates a past infection.


The research group found that a history of Candida yeast infections was more common in a group of men with Schizophrenia or Bipolar Disorder than in those without these disorders, and that women with Schizophrenia or Bipolar Disorder who tested positive for Candida performed worse on a standard memory test than women with these mental health disorder who had no evidence of past infection. The researchers caution that their findings and do not establish a cause-and-effect relationship between mental illness and yeast infections. This may support the role of lifestyle, immune system weaknesses and gut-brain connections as contributing factors to the risk of psychiatric disorders and memory impairment.


The study found no connection between the presence of Candida antibodies and mental illness overall in the total group. But when the investigators looked only at men, they found 26 percent of those with Schizophrenia had Candida antibodies, compared to 14 percent of the control males. There was not any difference found in infection rate between women with Schizophrenia (31.3 percent) and controls (29.4 percent). Men with Bipolar Disorder had clear increases in Candida as well, with a 26.4 percent infection rate, compared to only 14 percent in male controls. The researchers found that this association could likely be attributed to homelessness. However, the link between men with Schizophrenia and Candida infection could not be explained by homelessness or other environmental factors. Many people who are homeless are subjected to unpredictable changes in stress, sanitation and diet, which can lead to infections like those caused by Candida. The data provided support to the idea that environmental exposures related to lifestyle and immune system factors may be linked to Schizophrenia and Bipolar Disorder.


To determine whether infection with Candida affected any neurological responses, all participants in the study were assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Form A to measure immediate memory, delayed memory, attention skills, use of language and visual-spatial skills. Results showed that the control group had no measureable differences. However, the researchers noticed that women with Schizophrenia and Bipolar Disorder who had a history of Candida infection had lower scores on immediate and delayed memory than the controls.


The data showed that some factor associated with Candida infection, and possibly the organism itself, plays a role in affecting the memory of women with Schizophrenia and Bipolar Disorder. The researchers are investigating whether pathogens, such as bacteria or viruses, may contribute or trigger certain mental disorders.


Yolken, R., Gressitt, K., Stallings, C., Katsafanas, E., Schweinfurth, L., Savage, C.,…Markus, F. (2016). Candida albicans exposures, sex specificity and cognitive deficits in schizophrenia and bipolar disorder. Nature Paper Journals. doi:10.1038/npjschz.2016.18


Jonathan Torres, M.S.
WKPIC Pre-doctoral Intern


Posted in Blog, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged , , | Leave a comment

Congratulations, Dr. McNeill!


WKPIC is thrilled to announce that former intern Danielle McNeill has completed licensure in the State of Kentucky! She’s all official now!





<You are now free to recruit minions of your very own.>


Posted in Announcements, Former Interns, Social, Uncategorized | Leave a comment

Friday Factoids Catch-Up: Controversial Illnesses–Morgellons Disease


Morgellons Disease is a controversial and poorly understood condition in which unusual thread-like fibers appear under the skin. The patient may feel like something is crawling, biting, or stinging all over. Some medical experts say Morgellons is a physical illness, while others suggest it is a type of psychosis called “delusional parasitosis,” in which a person thinks parasites have infected their skin. Patients with delusional parasitosis often present pieces of clothing lint, skin, or other debris and place them in plastic wrap, on adhesive tape, or in matchboxes. They typically state that these contain the parasites; however, these collections have no insects or parasites.


Symptoms that are typically associated with Morgellons are unpleasant skin sensations, feeling like bugs are crawling all over the skin, burning or stinging sensations under the skin, intense itching, skin sores that appear suddenly and heal slowly, sores that leave very red scars, and reports thread-like fibers stuck in the skin. People with Morgellons sometimes complain of other symptoms which may include extreme fatigue, hair loss, joint and muscle pain, nervous system problems, tooth loss, sleep problems, and short-term memory loss. Doctors often tell patients that this is an “unexplained dermopathy,” which means a skin condition that occurs without a known reason. Other medical professionals have called the condition a “fiber disease.”


In the past, few doctors had heard of Morgellons. But in response to scattered reports, the Centers for Disease Control and Prevention (CDC) worked together with several other health care agencies to investigate this condition. Most reports come from California, Texas, and Florida, although patients have been seen in all 50 states. A CDC study found that Morgellons is most likely to affect middle-aged white women. Oddly enough, delusions of parasitosis also occur primarily in white middle-aged or older women.


The question of whether Morgellons is a disease or a delusion has prompted debate and new research in recent years. The CDC states that the condition is not caused by an infection or anything in the environment. The CDC study also included a lab analysis of skin fibers in Morgellons patients. The analysis showed that these fibers were mostly cotton, such as typically found in clothing or bandages. From a 2012 study, neuropsychological testing revealed a substantial number of study participants who scored highly in screening tests for one or more co-existing psychiatric or addictive conditions, including depression, somatic concerns, and drug use.


Others researchers say that Morgellons results from an infectious process in the skin cells. Research also revealed that the skin sores seemed to be the result of long-term picking and scratching the skin. Previous case studies have suggested that Morgellons may be linked to Lyme disease. Some patients with signs and symptoms of Morgellons had tested positive for the bacteria that causes Lyme disease. But according to Morgellons researchers at Oklahoma State University, there is no evidence to prove this theory. Likewise, there was no evidence of Lyme infection in any of the people in the CDC study. A 2010 study found a potential link between Morgellons symptoms and hypothyroidism. More research needs to be done to further investigate the findings.


There is no known cure for Morgellons. Treating any medical or psychiatric problems that occur at the same time as Morgellons may help ease symptoms in some patients. Medical researchers usually recommend that patients with these symptoms should undergo psychiatric evaluation. Some people who suspect they have Morgellons disease claim they have been ignored or dismissed as fakers. It is not uncommon for people who report signs and symptoms of Morgellons disease to resist other explanations for their condition,


Ballatyne, C. (2009). “What is Morgellons Disease? Is it a physical or psychological condition?” Scientific American.  Retrieved from


Pearson, M.L., Selby, J.V., Kenneth, K.A., Cantrell, V., Braden, C.R., Parise, M.E.,…Lewis, B. (2012). Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy. Plos One. Retrieved at
The Morgellon Research Foundation. (n.d.)What is Morgellons Disease? Retrieved from


Jonathan Torres
WKPIC Pre-doctoral Intern


Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged , | Leave a comment

Friday Factoids Catch-Up: Euthanasia for Psychiatric Patients?



At least three countries, the Netherlands, Belgium and Switzerland, allow assisted suicides for people who have severe psychiatric illnesses. Other countries, like Canada, are debating such measures, citing the rights of people with untreatable mental illness. Laws in the United States, passed in five states, restrict doctor-assisted suicide to mentally competent adults with terminal illnesses only, not for psychiatric disorders. In 2002, euthanasia was legalized in the Netherlands for those with “unbearable suffering with no prospect of improvement.” The Netherlands has seen a sharp increase in the number of people choosing to end their own lives due to mental health problems.


Last year 56 people were euthanized in the Netherlands, whereas just two people were euthanized in 2010 due to an “insufferable” mental illness. The criteria for euthanasia in the Netherlands essentially require that the person’s disorder be “intractable” and “untreatable.” Experts worry how these criteria can be measured in patients with dementia or psychiatric illnesses. The most recent controversial case, a woman in her twenties was allowed to go ahead with the procedure as she was suffering from “incurable” posttraumatic stress disorder (PTSD), according to the Dutch Euthanasia Commission. Her conditions included childhood sexual abuse, anorexia, depression, and self-harming behaviors. She was given a lethal injection after doctors and psychiatrists decided that her mental health conditions were incurable. The injection went ahead despite improvements in the woman’s psychological condition after ‘intensive therapy’ two years ago.


Records from cases of doctor-assisted death for psychiatric distress from 2011 to mid-2014 show that 37 of the 66 cases, people had refused a recommended treatment that could have helped. Depression was the most common diagnosis and loneliness was a frequent theme. Most of the patients had a chronic and severe mental illness with histories of suicide attempts and psychiatric hospitalizations. Of the patients included in the study, 70 percent (n = 46) were women; 32 percent (n = 21) were aged 70 years or older, and 44 percent (n = 29) were aged 50 to 70 years. The ratio of women to men was notable in that it is the reverse of the ratio of women to men who commit suicide without assistance in the Netherlands (43 percent women versus 57 percent men). More than half had received a personality disorder diagnosis of Avoidant or Dependent Personality Disorder.


The data also revealed that euthanasia is often granted despite disagreement by treating physicians and psychiatrists over whether cases meet criteria for “unbearable suffering.” Although euthanasia review committees typically defer decisions to the judgment of physicians, that judgment often appears inconclusive. In 24 percent (n = 16) of cases, there was disagreement among consultants; 11 percent (n = 7) of cases were found to have had no independent psychiatric input at all; and one case was found by a review committee to have failed to meet legal due-care criteria. Only 41 percent (n = 27) of physicians administering the assisted suicide were psychiatrists, and among 32 percent (n = 21) of patients, previous assisted suicide requests had been refused. Three of the patients had physicians who later changed their mind, and 18 were granted the assisted suicide from physicians who were new to them. Among those, 14 of the physicians were affiliated with a mobile euthanasia clinic called the End-of-Life Clinic. In 12 percent of cases (n = 8), the researchers found evidence that the psychiatrist involved believed that the criteria for granting a request were not met, but the assisted death took place anyway.


Paulan Stärcke, a Dutch psychiatrist, reported that even children as young as 12-years-old who ask to end their lives should be taken seriously. She stated, “Euthanasia is a good death by the wish of the person who dies and no-one else. It is an execution of the wish of a patient.” Opponents of the law argue that the primary purpose of psychiatric care should be the prevention of suicide, but the opposing argument is that the suffering of some psychiatric patients is as “unbearable” as the suffering of patients with other medical conditions prevailed.


I ask the readers, what’s your view point?


Boztas, S. (2016, May 11). Netherlands Sees Sharp Increase In People Choosing Euthanasia Due To ‘Mental Health Problems.’ The Telegraph. Retrieved from


Melville, N. A. (2016, February 10). Euthanasia for ‘Untreatable’ Mental Illness: New Data. Retrieved from


Jonathan Torres, M.S.
WKPIC Pre-Doctoral Intern



Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged , , | Leave a comment

Friday Factoid Catch-Up: Your Brain on LSD


A Friday Factoid was written by this writer in November 2015 about the research behind psychedelic-assisted therapy. Several studies have shown that positive results can come from short courses or single sessions of psychedelic-assisted psychotherapy.


Until recently, there had been no modern brain images of someone on lysergic acid diethylamide (LSD) to show exactly how this drug affects the brain’s connections.
Researcher David Nutt, a neuropsychopharmacologist at Imperial College London, performed a recent two-day study with twenty healthy volunteers. On one day volunteers got a 75-microgram injection of LSD, and on the second day, they got a placebo. Researchers used three different brain imaging techniques to measure and compare blood flow, brainwaves, and functional connections within and between brain networks in volunteers on the placebo and under the influence of the drug. David Nutt stated about the discovery, “This is to neuroscience what the Higgs boson was to particle physics.” Consider that neuroscientist have waited over 50 years for these images since the drug was banned in the 1960s.


What researchers found sheds lights on how people who have taken psychedelics have reported feeling they are “one with nature” and that the self “dissolved.” The regions of the brain responsible for higher cognition lit up and suddenly become hyper-connected with other networks in the brain that do not normally communicate with one another. The study’s volunteers on LSD reported experiencing their sense of self dissolve, which is what researchers’ call “ego dissolution.” For people, ego dissolution can be a positive experience leading to peace, acceptance, and a new perspective of things.


Volunteers taking LSD appeared to process their visual world in fundamentally different ways from people who were not given the drug. Typically, the activity in our brain flows along specific neural networks. Although the primary visual cortex usually communicates mainly with other parts of the vision system, many other brain areas contributed to the processing of images in volunteers who received LSD. The visual cortex became much more active with the rest of the brain, and blood flow to visual regions also increased, which the researchers believe correlates with the hallucinations reported by volunteers and the emotional experience they can take.


Enzo Tagliazucchi, a neuroscientist who helped lead the study said, “This could mean that LSD results in a stronger sharing of information between regions that deal with how we perceive ourselves and how we perceive the outer world.” For example, LSD appeared to trigger the frontoparietal cortex, which is an area of the brain associated with self-consciousness, and strongly connect it with areas of the brain that process sensory information about the world outside ourselves. That interconnectedness may be creating a stronger link between our sense of self, sense of the environment, and potentially diluting the boundaries of our individuality.


The study found that the increased interconnectedness of brain regions, while on LSD, makes the brain of an adult resemble something like the brain of a baby, which is more free and unconstrained. In the adult brain, networks that control vision, movement, and hearing function separately. LSD lifts the barriers between these networks and stimulates the unconstrained flow of information between them that leads to a hyper-imaginative state of thinking.


Researchers found that communication between the parahippocampus, a brain region important in memory storage and the visual cortex, is reduced when you take LSD. When you hear music the visual cortex receives more information from the parahippocampus, and this is associated with increases in imagery with your eyes closed. Music appears to enhance the LSD experience and might be important in therapeutic settings. This could have great implications in the treatment of depression, addiction, or other mental disorders that emphasize negative thoughts. The improvement of well-being does not appear to subside after the drug has worn off.


Brodwin, E. (2016, April 12). Mind-Blowing New Images Show How LSD Changes The Way Parts of the Brain Communicate. Business Insider. Retrieved from


Sample, I. (2016, April 11). LSD’s Impact On The Brain Revealed In Groundbreaking Images. The Guardian. Retreived from


Schlanger, Z. (2016, April 12). Brain Scans Show Why LSD Makes You Feel One With Nature And Your Self Dissolve. News Week. Retrieved from


Jonathan Torres, M.S.
WKPIC Pre-Doctoral Intern



Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged , | Leave a comment

Behind on Blogging!

I admit it. WE’RE BEHIND.


But, we’re starting our catch-up today! With something very, very, very important.


Former intern Brittany Best (2014-2015) is one step closer to being official!




Posted in Uncategorized | Leave a comment

Friday Factoids: Post-Partum Psychosis


It is safe to say that a good majority of the population has heard of postpartum depression.  Many may even know a new mother who has experienced this condition.  However, far fewer have heard of or truly understand postpartum psychosis, this writer included. 


Postpartum psychosis, also referred to as postnatal psychosis, is very rare. It develops in only 0.1% of all women after they give birth. Women who have experienced the condition previously are said to have a much higher rate of 30% with each additional pregnancy. Those who already have a serious mental illness, such as bipolar disorder or schizophrenia, are also at an increased risk.


Postpartum psychosis can present with a rapid onset of a few days to that of a few weeks following child birth.  A limited number of women do not exhibit symptoms, however, until they cease breast feeding, or until their menstrual cycles resume.  Most all cases develop within two weeks, though. It is important to note that it is a medical emergency and should be treated immediately to help reduce the severity of symptoms.


The most common symptoms of postpartum psychosis include hallucinations and delusions. Secondary symptoms may vary. They can include paranoia, mania, loss of inhibitions, low mood, agitation, restlessness, anxiety, trouble sleeping, loss of appetite and/or severe confusion. Rapidly fluctuating moods can also occur. A minimal percentage of women effected by this condition may even experience mania and depression simultaneously.


Due to the presentation of symptomatology, the psychiatric condition may be a severe emergency that requires admission to hospital for treatment.  When at all possible, it is best for the patient to be admitted with her newborn, into special psychiatric care options referred to as a mother-and-baby units. This helps to facilitate the continued bonding of mother and baby.  Medication management figures largely included in symptom reduction. The medications chosen often consist of a blend of neuroleptic (s), antidepressant(s) and mood stabilizers. Most women who follow medical protocol make a full recovery within several months.


Work Cited
K. K. (2013, October 6). Postpartum Psychosis: What You Might Not Know. Retrieved March 14, 2016, from 


Sit, D., ROTHSCHILD, A. J., & WISNER, K. L. (2011, June 7). A Review of Postpartum Psychosis. Retrieved  March 14, 2016, from doi: 10.1089/jwh.2006.15.352


Crystal K. Bray,
WKPIC Doctoral Intern



Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged , , | Leave a comment

Article Review: Obstacles to Care in First-Episode Psychosis Patients With a Long Duration of Untreated Psychosis


In the field of mental health, both clinical and research efforts have focused on the importance of early detection and intervention in psychosis. Research has shown that this strategy might lead to an increased chance of preventing, delaying the onset of, or reducing problems resulting from psychosis. In addition, treatment delays may add to the burden experienced by the individuals and their family, and may have social, educational and occupational consequences.


Reluctance to accept a stigma-laden diagnosis and fear of mental health services may delay help seeking. Families, friends or the individual’s broader social network might be the first to recognize pathological changesbut may lack the ability to correctly identify these changes as symptoms of psychosis. The aim of this study was to gain knowledge about factors that prevent or delay patients with a long duration of psychosis from accessing psychiatric healthcare services at an earlier stage and their personal views on the impact of ongoing informational campaigns on help-seeking behavior.


In this study, eight patients who experienced duration of untreated psychosis lasing for more than six months were interviewed. Participants included four men and four women who were both students and full-time employees, with age ranging from 17 to 44 years. The patients must meet the DSM-IV-TR criteria for first-episode schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic episode, delusional disorder, drug-induced psychosis, affective psychosis with mood incongruent delusions, or psychotic disorder not otherwise specified. The interview format focused on the following main topics: symptom awareness, help-seeking behavior, family and professional involvement, awareness and feedback. Each topic was introduced with an open-ended question and follow-up questions were asked depending on how much the patient elaborated. The interviews were conducted by the first author and lasted 40 minutes on average.


Based on the results, the authors identified five main themes, which include: failure to recognize symptoms of psychosis, difficulties expressing their experiences, concerns about stigma, poor psychosis detection skills among healthcare professionals, and lack of awareness or understanding of available community resources. The five themes identified suggest participants were unable to recognize or understand the severity of their symptoms. Further, although family members or others sometimes recognized the initial symptoms of psychosis development, these symptoms were attributed to reasons other than psychosis. Participants reported that healthcare professionals also had trouble identifying emerging signs of psychosis. Lastly, information about available resources needs to be carefully tailored to relay information to people who do not consider themselves as currently experiencing signs of psychosis.


The majority of participants reported they failed to understand that they needed help at the time of the onset of their psychosis. Instead, they believed or hoped the symptoms and changes they experienced would eventually pass without intervention. Many participants reported that family and friends were the first to notice changes in mood and behavior. Family or friends attributed these changes to difficulty concentrating, “teenage behavior,” or introverted personality rather than the development of a psychiatric illness. In cases where family members suspected the presence of a psychiatric illness, depression was suspected rather than psychosis. Half of the participants reported having no knowledge about psychosis at the time of onset and attributed their symptoms to depression or an anxiety disorder.


An additional obstacle to seeking treatment was uncertainty about how to ask for help. Many participants had trouble explaining their symptoms to healthcare professionals. When they first entered psychiatric treatment, healthcare professionals initially misinterpreted symptoms as depression or anxiety. One participant reported that although she knew where to go to seek help, she did not know how to express herself. Another reason for not seeking help involved concerns that family and others might consequently find out about the mental illness. Many of the participants reported that they deliberately hid their symptoms due to concerns about the reaction of others.


More than half of the participants reported that healthcare professionals had failed to recognize their symptoms as related to psychosis. One of the participants raised concerns about his symptoms with his general practitioner (GP) on several occasions over a period of 1 year before they were correctly identified. Some participants had sought help repeatedly from their GPs or the school nurse during periods when they experienced troubling symptoms. At times, they received treatment from GPs, psychologists, psychiatrists and school nurses for symptoms of anxiety and depression, but healthcare professionals failed to correctly detect and diagnose psychosis. One participant had described the presence of auditory hallucinations upon admission to an adolescent outpatient clinic. Still, he was not offered assessment for psychosis.


The majority of participants said they had seen mental health treatment ads in newspapers or as posters at school. The majority of participants who had seen the ads, however, did not seek help despite awareness of the programs. One participant mentioned that the ads failed to help him understand the true nature or experience of psychosis. Others did not consider themselves as belonging to the target group mainly due to feeling ‘not sick enough.’ The only participant who did seek help reported that he eventually made contact many years after seeing treatment ads.


At first, he did not think he belonged to the target group. As his condition worsened and he experienced all the symptoms mentioned in one of the ads. One participant believed she was actually too sick to get help and felt treatment was not worthwhile. Participants also stated they did not want to unnecessarily bother mental health staff. Others were worried that making contact might lead to a hospital admission.


Although this study utilized a small sample size, it nevertheless represents many of the fears individuals with first-episode psychosis experience. In our communities emphasis should be placed on having more information and education readily available at schools for students and parents. Students, teachers and school nurses should receive information sessions from mental health professionals about signs and symptoms and how to refer students to available treatments. Additionally, information about mental health should start at an earlier point, for example, in junior high school. National newspapers, journal articles, and the Internet may be beneficial channels for communication of available resources in the community.


Bay, N.; Bjornestad, J.; Johannessen, J. O., Larsen, T. K., & Joa, I. (2016). Obstacles to care in first-episode psychosis patients with a long duration of untreated psychosis. Early Intervention in Psychiatry, 10, 71-76.


Jonathan Torres, M.S.
WKPIC Doctoral Intern



Posted in Blog, Continuing Education, Current Interns, Mental Health and Wellness, Resources for Interns | Tagged , , | Leave a comment