Do I need to be referred by a doctor to receive services at PEPP-Montreal ?
No. Anyone can contact PEPP-Montreal directly, including individuals experiencing psychotic symptoms themselves or their families.
If families initiate treatment, why is it so difficult to involve them in an intervention?
I believe that anyone who says you cannot be involved doesn't know what he's doing! When I give a talk, either here or in the United States, this is the most common question I hear. To answer this, we have to address the question of intent. The intent of the clinician is to help the patient get better. The intent of the family is to stay involved and get the best possible help for their family member. If these intentions are clear, why should there be any barriers? Of course, we don't want to discuss things with families that patients tell us are in confidence and are of no relevance. However, if the patient admits to wanting to kill himself, it's everybody's business.
Nothing prevents clinicians from listening to families. If families call, they don't have to discuss the “patient”. If a patient declares that he doesn't want treatment, a clinician can still invite the family to educational workshops. If a crisis happens, it's helpful to have already established a relationship with a clinician because it saves time during the admission process. In one case in Ontario, the reverse happened. A clinician was reprimanded for not keeping the family informed, even though it was against the patient's wishes, because the situation was very serious.
-Ashok Malla, MD, Mini-Psych School 2006
How can you tell if the medications aren’t working?
I think the first criterion is: Does the person seem a little bit happier? Do they seem to be suffering less? Signs and symptoms don’t give a diagnosis. What gives the diagnosis really is the degree of pain and suffering and impairment of functioning. So, my major criterion for remission is this: Are you happier? Are you going out more? Are you meeting your friends more? Are you back to school? Are you realizing your dreams?
Now, sometimes I see patients taking the medication, still having hallucinations and probably some delusions, but functioning much better, going back to school, doing work, etc. That’s a very important point. We know that better functioning is correlated with fewer symptoms, so we watch symptoms also. We are very satisfied when hallucinations and delusions are less present and people go back to what we call “the normal reality”.
-Ridha Joober, MD, PhD, Mini-Psych School 2009
