Schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are diagnoses laden with stigma, and they can sound downright frightening.
Child psychiatrist Perihan Esra Guvenek-Cokol, MD, an expert in psychotic disorders, doesn’t dispute their seriousness. But she knows that with the right care, people with these diagnoses can go on to live happy, fulfilling lives.
“As with many illnesses, the earlier we intervene, the better the prognosis, and it’s so true with psychotic disorders,” said Guvenek-Cokol. “Our greatest efforts should be applied to prevention and early intervention—giving young people the tools and skills to be empowered to manage whatever comes their way.”
Early intervention is the founding principle of the one-year-old Support, Treatment, and Resilience (STAR) Program, which delivers top-quality outpatient care to young people ages 14-25 who are at risk of developing psychotic illnesses.
Patients with full-blown versions of these disorders experience disruptions in their thoughts and perceptions, making it difficult to judge what is real and what isn’t. Some may suffer from hallucinations—seeing, hearing, or even smelling things that don’t exist. Psychotic symptoms often begin between ages 18-20, although some people experience them later. About one in 100 people suffers from a psychotic disorder.
Donor support has been critical to STAR, as a novel clinical program with limited reimbursable services. Nicholas Zeppos, McLean trustee and chancellor emeritus at Vanderbilt University, seeded the new clinic with a philanthropic gift in 2019 because he found its goals so compelling.
“A program like STAR can make a tremendous difference in the trajectory of a young person’s life at a critical time in their development.”
– Nicholas Zeppos, STAR donor and McLean trustee
“As someone who spent a good portion of his career working with college students, I have seen how devastating psychiatric illnesses can be,” he said. “A program like STAR can make a tremendous difference in the trajectory of a young person’s life at a critical time in their development.”
A 2020 gift from the Gildea-O’Keefe Family Foundation, a longtime supporter of the hospital, fortified the program further. “Between the pandemic and the social and political upheaval, it’s an especially fraught time for many of us, and the stressors are exacerbated,” said foundation Trustee Ann O’Keefe. “Supporting mental health causes, especially ones like STAR that are trying to intervene earlier in a disease’s trajectory, is more important than ever.”
The adolescents who are treated through STAR often have symptoms that may seem like depression or anxiety—a loss of interest in things that once gave them pleasure, neglect of personal hygiene, trouble concentrating. But layered on top of those changes are symptoms that point to possible psychosis down the line.
“They may hear their name called when it hasn’t been, see shadows out of the corner of their eye, become more preoccupied with religion, or begin mistrusting people,” explained Guvenek-Cokol. “Sometimes they’re just feeling something odd that they may not be able to articulate.”
The STAR Treatment
Patients treated through STAR see therapist Sarah Burke, LICSW, who is also the program director, at least weekly. The sessions are tailored to the young person’s specific symptoms, and Burke may incorporate tools such as cognitive behavior therapy, dialectical behavior therapy, behavioral activation, and motivational interviewing—all commonly used with other psychiatric illnesses.
“Our program puts a lot of emphasis on building skills, resilience, and routine. Good sleep, hygiene, eating well, and abstaining from substances—marijuana, most commonly—is key,” explained Burke.
There is a strong correlation between heavy cannabis use and psychosis, so some patients are also referred to addiction treatment programs. One STAR patient who was a heavy cannabis user received care in McLean’s substance use residential program. “His paranoid thinking cleared up when he maintained sobriety from cannabis,” reported Guvenek-Cokol.
When needed, patients may also be prescribed medication by Guvenek-Cokol, but she tries to limit this to cases where symptoms are severe and impeding the progress of talk therapy. “It’s like physical therapy (PT),” she explained. “If you have severe back pain, you may need pain medication in order to get to the point where you can engage in PT.”
Medication can be particularly helpful with what’s called mental rigidity, when a patient lacks the cognitive flexibility to recognize that a delusion may be just that. “We never want to invalidate a patient’s experience and their suffering, but we do want them to consider whether there may be other explanations for what they’re experiencing.”
Getting families involved in treatment is also critical.
“Child psychiatry is family psychiatry,” said Guvenek-Cokol. “Young people live in the same home as the parents, so we would like families to understand and support our interventions and also understand what their child is going through. We bring families in during intake, and Sarah stays in close communication with them.”
Patients and their families learn what’s called emotional labeling—the language of feelings—so they are better able to talk about their feelings using common terms. STAR is in the process of developing a more formalized family therapy program.
Dost Öngür, MD, PhD, chief of McLean’s Division of Psychotic Disorders, says while preventing patients from ultimately experiencing psychosis is important, that’s not the end goal of STAR. “Ultimately, our goal is what we call in the field ‘functional recovery’—teaching the coping skills that allow people to have meaningful, fulfilling lives.”
McLean is grateful to all the donors who have supported the STAR Program and the Division of Psychotic Disorders more broadly. To learn more or make a gift, contact Keith Raho at 617.855.3421.
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