Cheryl Martin (Host): You are someone you know may be seeking specialized or comprehensive care for symptoms of mental illness. Here to talk about what they are and our specialty care outpatient clinic is Craig Jones, a licensed certified social worker and the program manager at the UAMS Odyssey Clinic.

This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Cheryl Martin. Craig, so glad to have you here to talk about a great service we provide.

Craig Jones, LCSW: Well, thank you for being here. It's an honor to be able to talk about our program and to give people more information about psychosis.

Host: First of all, what is the Odyssey Clinic at UAMS?

Craig Jones, LCSW: So, the Odyssey Clinic at UAMS is Arkansas first coordinated specialty care program to work with individuals who are experiencing first-episode psychosis. We define that as individuals for our clinic purposes, who are 16 or older, who are within the first two years since the onset of psychosis.

In our program, we implement a protocol known as the NAVIGATE protocol, which came out of a special study that was developed by the National Institutes of Health back in 2008 the RAISE study, the Recovery After Initial Schizophrenia Episode Study that looked at the feasibility and effectiveness of first-episode psychosis intervention programs in the United States. These have been the going on for quite a while internationally. And it was in 2008 that we started looking to see would this work here. And in 2014, the studies were published, indicating not only that it was highly effective, but that people's lives got better as a result of that. And so, in our program, we implement, as I said, the NAVIGATE protocol, which involves specialized forms of individual therapy, family psychoeducation, medication management, and supported education, and employment services as well.

Host: Talk about specifically what are some of the problems that you address. If you can just kind of give a list of symptoms.

Craig Jones, LCSW: Certainly. Psychosis is a bit tricky for folks, especially when we're dealing with first episode. And that's partially because of the nature of psychosis. When we talk about psychosis, we think about psychosis generally occurring in three different phases. There's the first phase, what we call the prodromal phase, which is often kind of quiet. People may begin experiencing small changes that other people may notice, think, "Well, that seems unusual." But they don't really have other context to characterize the behavior. So, they tend to describe it in ways that are non-illness-related. So, for example, you might see somebody becoming more withdrawn, that maybe that person is demonstrating more suspiciousness, or maybe paranoia. They may say something that's kind of unusual, or kind of bizarre in nature. Sometimes folks will also begin experiencing, at that point, hallucinations. Hallucinations are sensory experiences that are internally generated in the brain as compared to those that are externally sourced in the world outside of ourselves.

And so, initially, in this prodromal phase, individuals experiencing psychosis may begin demonstrating these in relatively quiet kind of manners. You may also see more passive kind of changes as well associated with what we ultimately would call negative symptoms. Now, negative here doesn't mean bad, it means privative in nature. And so, when we talk about privative symptoms, we're looking at things such as changes in motivation or volition. We see changes in feelings of interest or pleasure and things that used to be interesting to the person. Sometimes we see challenges in language what we call alogia, which can manifest as a poverty of speech or poverty of content of speech. In the first case, a person doesn't really say much, or they may give some vague answers to questions or responses. And the second, they actually say a lot, but there's not really any substance behind what they're saying. We may also see other negative symptoms, including challenges associated with sociality as well. So again, that withdrawal that sometimes people will demonstrate, or they may as though they don't have much interest in engaging with others.

Host: You mentioned motivation. Are you talking about they are less motivated?

Craig Jones, LCSW: They appear less motivated. Oftentimes the people who are beginning to experience this will begin to seem as though they're not carrying through with activities of daily living. So, for example, if it's a young person experiencing a first episode of psychosis, perhaps they're not attending classes like they were, or maybe their work quality is beginning to decrease, or they have increased absenteeism. Or there may be challenges associated with self-care, a person's becoming more disheveled, their hygiene is worsening, the status of their home is kind of becoming a bit off compared to where it was beforehand. So, their home isn't very clean, things along those lines. So, that's the kind of thing that we would see with that avolitionism. Many times people think, "Oh, well, they're just tired or maybe they're being lazy." It's none of that. It's actually the illness itself manifesting in that way.

Host: What is schizophrenia and who's considered at risk for the mental illness?

Craig Jones, LCSW: And so, as I mentioned, we have the initial prodrome. Again, those are kind of, that's often the first phase of psychosis. And then, we have what I like to call the public eruption, or when a person is really in active psychosis. And what I mean by public eruption is that people become aware that something's going on. And this is often when individuals may first come into care. Families will begin noticing that the strange behaviors they were noticing before are more consistent and more problematic. And when persons enter into care at that point, for us as clinicians, we go through and assess how long do we think that these things have been going on.

So, we start gathering reports from family and persons, from our clients. We start looking for signs, maybe, for example, grades or attendance, things that would show us that things were happening. And so, if we see those symptoms lasting for longer than six months, then that would be the first criteria to meet for schizophrenia is we have to see the presence of what we call the positive symptoms, which are again, are not good symptoms. In this case, we're talking about excessive symptoms, so looking at those hallucinations, those sensory experiences, most commonly auditory hallucinations, but followed up by visual hallucinations. But some people do also experience tactile hallucinations, taste hallucinations, or olfactory hallucinations. We may also see delusions, which are problematic beliefs oftentimes that are pretty resistant to change. There may also be a lot of disordered thinking as well as disordered or disorganized behavior. In addition, we look for those negative symptoms.

Now, not everybody with schizophrenia is going to have negative symptoms, necessarily. Some people will have very pronounced negative symptoms, some people won't. But almost everybody will have at least something in what we call the criterion A, which are those positive, or again, excess symptoms. When I say excess, that's in comparison to the typical human experience. Again, we often see those negative symptoms as well. And so if we're seeing those for a period of six months or longer, then schizophrenia would be the appropriate diagnosis. If it's been shorter than six months, then we'd be looking at what we call a schizophreniform disorder, which is where we have the symptoms of schizophrenia from one month to five month or one month to six months. And then, if it's less than that, if it's within the first 30 days, we may be looking at what we call a brief psychotic episode or a brief psychotic disorder. Sometimes those do not end up manifesting further into  schizophreniform or schizophrenia.

Now, who's at risk? What we know is that there's no one course to develop schizophrenia. It does appear that that there are biological vulnerabilities that individuals may have. In some cases, these may be hereditary in nature. We know that, for example, that individuals who have first-degree relatives who have experienced psychosis are more likely themselves to experience psychosis. So, there could be these genetic factors that could be involved. And then, there's also environmental exposure factors. This could involve trauma. It can involve other social determinants of health, including poverty, experiences of racism and discrimination, and very significantly, drug use.

Marijuana, unfortunately, for example, is involved in over half of the first episode of psychosis cases that are seen across the United States. We think that this may be due to the increased potency of THC in cannabis that's commonly available today. But again, substance use can sometimes be one of those things that becomes activating as well to those underlying vulnerabilities. Likewise, significant stresses can also potentially contribute as well to the development of psychosis and potentially schizophrenia.

Host: How many people would you say in the U.S. are affected by schizophrenia?

Craig Jones, LCSW: Our current population estimates indicate that about 1% of the United States population or so is affected by schizophrenia. So, about 3 million people. And we know that every year about 100,000 young adults and adolescents in the United States will experience first-episode psychosis.

Host: And you believe that, again, marijuana use has something to do with that, especially for young adults?

Craig Jones, LCSW: There is pretty significant evidence that, again, marijuana use is involved in 50% of first-episode psychosis cases. What we look for there, in particular, when we're at the effect of substance use with psychosis is we want to look at what we call the temporality of it, that is what happens when a person becomes intoxicated and what's going on some period of time later, beyond what we would expect the period of intoxication to look like.

Marijuana is a hallucinogen in nature, and so a person can experience psychosis with marijuana, but if they're still experiencing psychosis several weeks later, and they've not used in that period of time, that would be a sign to us that there's something else going on, that possibly the marijuana may have, in essence, unlocked psychosis as being an experience for that person.

Host: What kinds of therapy are used in these instances, especially at the Odyssey Clinic?

Craig Jones, LCSW: So, in the Odyssey Clinic, through the NAVIGATE Program that we've implemented, utilizing what's called Individual Resiliency Training as a therapeutic modality. This is kind of a marriage of illness management techniques that had been developed to help treat psychosis, as well as cognitive behavioral therapy for psychosis.

So, an individual in our program, for example, and through their IRT or their Individual Resiliency Training modules, would learn things such as about the nature of psychosis, so we can help them develop more insight into what they're experiencing, to learn more about medications and how we treat psychosis. We also help people learn how to live healthy lifestyles, how to avoid substance use, how to manage stress adequately, how to process the trauma of the experience of psychosis. This can be something that can be extremely disruptive to people's lives. And so, many times they're rebuilding themselves very much so, so we help them to learn how to do that through these modules. While we're doing that with the client who's experiencing psychosis, we're also working with the families as well.

And the families, we're offering them psychoeducation, so they're getting much of that similar information that our clients get through the IRT modules, as well as we're also providing additional supports. For both our individuals and our families, we're also running support groups as well, which have been tremendously successful so far. And we've gotten great client feedback and family feedback for those.

Host: I was going to ask you about the outcomes from this treatment. So, you're saying you're getting good results.

Craig Jones, LCSW: We are. One of the things that we know about first-episode psychosis is that many individuals, who go through these programs see significant improvements in their quality of life. In fact, most people see significant improvements in their quality of life as a result of this. This includes things such as being able to return back to school or work or maybe start those in the first case, depending where a person is at in their life's journey. We also see that folks experience less relapse overall. So, that is that their symptoms, whenever they return, may be less intense and may not necessarily require hospitalization or, if hospitalization is required, usually people are in the hospital for fewer days at that point.

We know that the family participation itself also tremendously improves the outcomes for our clients because then the families understand what's going on and they learn how to be supportive in the right kind of ways to their loved ones. This itself tremendously helps to decrease the alienation that oftentimes people experiencing psychosis feel because they often feel as though people don't understand them, don't understand what they've gone through. And so, when we can bring people together to understand those things, whether it's the family or through our groups or through general education to the public. This seems to really improve things for folks.

Host: That's great. Craig, tell us about the origin of the name of the clinic, the Odyssey Clinic, and how is it related to the mental disorder?

Craig Jones, LCSW: When we were thinking about how we were going to name the clinic, we actually hosted a bit of a contest at the Psychiatric Resource Institute to determine what we thought would be a good name. And we had several great suggestions, but the Odyssey Clinic really kind of came through. And I'll admit it was one of my suggestions, and the reason why I really liked this idea is I think back to the Odyssey, to Homer's epic of Odysseus's journey back home from the Trojan War. It took him 10 years to get back home. And throughout that period of time, he dealt with all sorts of different trials and proverbial monsters, and so forth, as he was moving his way through the ancient world.

But importantly, Odysseus did not get home by himself. He had help along the way. And I thought about our clients, and the experiencing psychosis is also feeling lost. The world looked one way prior to the onset of psychosis, and it began to look very different afterwards. They needed help, just like Odysseus, to be able to find their way back home.

And it's really been an honor for our clinic to be able to be a part of that process for our clients and their families as they find ways of kind of getting back to where they want to be in their lives, back to the proverbial home.

Host: Now, do you need a referral for services?

Craig Jones, LCSW: For our clinic, actually, individuals do not necessarily need a referral for services. We do take referrals, and so forth, but we also take referrals from clients themselves. We also take referrals from families. So, families call us and get more information about our program. And then, we can talk with the client, and, see if they meet criteria for our program. We do a pretty brief assessment for that. And then, we try to get people in very quickly. It's our goal whenever possible to try to get services started ideally within a week of that initial contact. And that's with seeing a therapist for an intake and also having a psychiatric evaluation. So, we can really get a good sense of what's going on so we can start services as quickly as possible. And so, we wanted to make sure that in our program we were as mobile and as agile as possible when it came to working with anybody who needed our help.

Host: Now, does insurance cover services?

Craig Jones, LCSW: Many of our services are covered by insurance. Some of our services are not, at this point. Those services are not covered by insurance. We are hoping that new codes that were approved by the Substance Abuse and Mental Health Services Administration last year, we're hoping that those codes, when they become active, will cover those services at that point. People are not receiving charges, however, I will note, for those services.

So, we do work with individuals who have insurance. For individuals who don't have insurance, we do everything we can to help them to get insurance. And for individuals who may not qualify there, then we try to work within the university, within our financial counseling department to see what kind of things we could do to help the person be able to access the care that they need.

Host: Anything else in closing that you want to mention just about the Odyssey Clinic?

Craig Jones, LCSW: The Odyssey Clinic is a fairly new clinic at UAMS. We opened on July 1st, 2024, and we just opened our second branch up in our Fayetteville location on December 1st of 2024. We're really excited to bring coordinated specialty care services to the state of Arkansas, and both in providing direct services to our clients and their families, as well as in providing general services to the state of Arkansas. We're really also trying to focus quite a bit on educating the public as well as professionals about psychosis.

And so, for example, we held our first annual Arkansas Schizophrenia Conference in late September of 2024. And on January 30th, 2025, we'll be hosting our first annual Northwest Arkansas Schizophrenia Conference in Fayetteville on January 30th. We're really excited about this program that we're putting together. Interested persons can reach out to me, or they can sign up at uams.health/odyssey. That's where people can sign up for our program. They would also receive additional information as well about future educational events that we'll be doing as well.

Host: Craig Jones, thank you so much for highlighting the important work that's taking place at the Odyssey Clinic. It's obvious that you are passionate about your work. Thank you so much.

Craig Jones, LCSW: Thank you very much.

Host: You can call the Odyssey Clinic today at 501-526-7464 to see how we can help you or your loved one. Again, that number is 501-526-7464. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for other topics of interest to you. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. Thanks for listening.