Psychiatrist and director of the Nova Scotia Early Psychosis Program reflects on 25 years of progress

NSEPP Clinic Team, December 2019
NSEPP Clinic Team, December 2019

For 25 years, the Nova Scotia Early Psychosis Program (NSEPP) has been helping patients with psychotic disorders identify and treat their illness, and live their life to the fullest. 

NSEPP started as a research program by Dr. Lili Kopala, and was later identified and resourced as a specialty team. 

Since then, it has come to be known as a full-slate service for individuals living with psychosis and psychotic disorders. The team is researching new ways to drive the treatment and understanding of the illness forward, while providing expert care and support. 

Psychiatrist and director of NSEPP, Dr. Phil Tibbo, began psychosis research as a psychiatry resident during his medical training. He knew he wanted to include research in his career after completing an honors program in his undergraduate degree. 

“I enjoyed working with individuals with psychosis, and I saw great opportunities for research as there were gaps in our knowledge about psychosis from the biology to the treatment of it,” said Tibbo. 

Programs like the NSEPP recognize that like anything in health care, early identification and intervention improve outcomes for the patient. 

In the treatment of psychotic disorders, programs have developed around delivering intensive phase specific care within the first few years of illness. The research has aligned with these intensive programs, showing that the outcomes will be much better for the individual seeking treatment. 

“That’s what it’s all about, and our motto is the sooner, the better -- that’s truly what it is,” said Tibbo. 

A number of different health care disciplines are included in the delivery of these programs for patients and their family. The care can include the expertise of nursing, social work, psychiatry and psychology. 

The treatment is more than just medication, but often for psychosis, medication is the cornerstone of treatment. 

Tibbo and his team approach each individual’s case by first assessing if they need medication. 

While in most cases they do, some patients don’t require it. 

“Think of the medication as a stepping stone to get them to the place that they can get started on other supports they need,” said Tibbo.

Whether their recovery includes medication or not, the goal for the individual stays the same. 

“The goal is to make sure the person can live their life the way they would like to live it,” said Tibbo. “That can be different for each patient, sometimes that personal sense of recovery doesn’t mean you’re illness free.” 

The program focuses on optimizing long-term outcomes, which can be symptom management, along with being functional in education, work and relationships.

New medication treatments have also changed over the years.

Since the program started, the NSEPP team has seen medications created and approved for treatment with fewer side effects, “which is something we want,” explained Tibbo. 

Long-acting therapies are also a new choice for treatment. With the development of the newer second-generation antipsychotics into injectable formulations, a patient can receive their medication every month to three months. The responsibility of remembering to take a pill, along with the daily reminder that you have an illness, is lessened. Injectable medication can help prevent hospitalization or reduce relapse rates that are due to inconsistency in taking medication.

While the treatment of psychotic disorders such as psychosis and schizophrenia are improving, the stigma still exists today, which can be counterproductive in people seeking treatment. 

“I think there’s that general assumption that if you have been diagnosed with that illness [psychosis or schizophrenia] your future is pretty bleak,” said Tibbo. “What we have been able to show with early intervention is that it is definitely not the case.”

Dr. Tibbo explains schizophrenia and psychosis are different for each person diagnosed. 

While for some, it may be severe, for others, it may not be. 

He mentioned that in the program, a third of their patients only need to follow up with their family doctor post-treatment in NSEPP. Psychotic disorders have been portrayed negatively in the media, but definite progress continues, and recovery and remission is possible. 

When it comes to the myths and stigma of psychotic disorders, Tibbo said the best way to fight it is to continue talking about it. 

“There is a public perception with it that there’s increased risk of violence, which is not the case. People are afraid of the unknown,” said Tibbo.

It is necessary to keep up the conversation about what psychotic disorders like psychosis and schizophrenia are and what they are not.

“I think we have seen acceptance over the years around depression and anxiety in mental health but we need more active work around psychosis and schizophrenia as well. We need to be advocates and educate.”

About the Nova Scotia Early Psychosis Program

NSEPP is a five-year program with a combination of discussions with the patient, their family when involved, and the clinical team to decide best practice. 

The decisions made are based on the needs of the patient and is a gradual process to their recovery. At any given time, NSEPP has 250 active patients going through the program. 

Learn more about the Nova Scotia Early Psychosis Program online