In the seventh grade, 13-year-old Christine Frey and her two best friends loved soccer, but then Christine suffered a serious leg injury and was forced to quit. Her friends played on, leaving Christine to feel increasingly left out and alone.
By the eighth grade, it was almost unbearable. She would experience sudden fits of uncontrollable weeping. She went to counseling. She was treated for depression. Nothing helped. Least of all the voices in her head.
“The way I describe it is like being in a hostage crisis,” says Christine, now 15. “You feel like you have to do something or something bad will happen. The guys in my head would tell me to run away from school or leave home and it was something I just could not ignore.”
Her friends had no clue about what was going on. Her parents, teachers and doctors were flummoxed. Christine was clearly in psychological crisis, but exactly what sort of crisis? Was it schizophrenia? Bipolar disorder? A mood disorder? Something else?
A clinical diagnosis of mental illness is invariably difficult. Accuracy is critical to determining effective treatment. The challenge is particularly pressing when patients are young, when conditions like adult deficit/hyperactivity disorder (ADHD), autism or simply the vagaries and rigors of evolving childhood can confuse, complicate and confound.
“It’s really important to handle things correctly, to get the diagnosis right,” said
Kristin Cadenhead, MD, professor of psychiatry at UC San Diego School of Medicine and director of Cognitive Assessment and Risk Evaluation, or CARE, a program that focuses upon recognizing and treating early psychosis.
“Sometimes people think that young kids are just getting into trouble, doing things that are typical for their age, when in fact, they may be on the cusp of serious mental illness. This is when you want to catch and treat the problem before it profoundly disrupts their lives.”
The incidence of mental illness is rising in the United States, most alarmingly in the suicide rate, which disproportionately hits men aged 45 – 64 and girls aged 10 – 14, according to the Centers for Disease Control.
An estimated 1 in 10 American children between ages 5 and 16 suffer from a diagnosable mental health disorder. That works out to roughly three children in every classroom. More than half of adults with mental health problems were diagnosed in childhood, though less than half received treatment at the time.
Christine and her family eventually discovered Cadenhead and the CARE program, where Christine received an assessment and began treatment. She was diagnosed as having a psychotic disorder. Psychosis covers a range of conditions that involve altered thinking or perception. It’s characterized by hallucinations (seeing or hearing things that are not real), delusions (false beliefs) or some other loss of contact with reality. Psychosis can be a part of a biological illness, such as schizophrenia, bipolar disorder or depression. It is also important to rule out causes of psychosis, such as illicit drugs, medical or neurological conditions with a complete medical work-up.
Christine’s therapy involves not just medication, but individual and group therapy. She’s embraced the challenge, even posting a video to family and friends that described what was happening in her head and how best to interact with her. It went semi-viral.
And these days, she’s looking and feeling much better. Her eyes sparkle. She smiles easily. She’s an advocate of the Strong Minds Project http://strongmindsproject.org/, a support group for young people recovering from mental health struggles.
“I’m not necessarily smarter now, but I feel more focused. I’m getting good grades. I’m happy.”
Christine’s future appears bright, though she will likely need to continue treatment into adulthood and perhaps beyond. No worries, she says. She plays the guitar and writes songs. Her life seems full of songs.
More about CARE
The primary goal of the CARE program is to identify and assess adolescents and young adults, ages 12 to 30, who may be experiencing early psychosis, then develop a treatment or intervention that might help delay or prevent the onset of serious mental illness and decrease the severity of current symptoms.
Participants, who may also be involved in CARE-sponsored research programs, are selected based on two different types of criteria:
- The low-grade symptoms group includes changes in behavior, thoughts or emotions, such as hearing voices, seeing visions, changes in how objects are perceived, social withdrawal, sleep disturbances, reduced concentration or attention, development of odd beliefs or ideas and deterioration in school or work functioning.
- The family history group includes individuals who have a close family member with schizophrenia, such as a parent or sibling, and a recent deterioration in their ability to cope with life events and stressors.
Outpatient treatment is intense, with meetings three times a week for five hours at a time, involving group therapy, individual sessions with a psychiatrist and family participation.
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Early Psychosis Treatment