Center Of Prevention and Evaluation
Worried about recent changes in thoughts and feelings?
The COPE Clinic evaluates and treats adolescents and young adults (ages 12-30) who may be at risk for psychosis.
We are located at the Columbia University Medical Center / NYSPI in New York City.
The Center of Prevention and Evaluation (COPE) is a clinical research program located at the New York State Psychiatric Institute and Columbia University Medical Center. COPE’s focus is teenagers and young adults who are experiencing a certain set of problems – specifically anxiety, social withdrawal, unusual thoughts, and sensory misperceptions. This constellation of symptoms is called the “at-risk mental state” and is associated with both current difficulties in function and an increased risk for developing psychosis, as compared with peers.
COPE’s mission is to increase understanding about the risk for and early stages of evolving psychotic disorder. With a greater understanding about the at-risk mental state, we can improve detection and intervention aimed at preventing psychosis and improving function. At COPE, studies are underway that aim to help us better identify who is likely to develop psychosis by studying the senses, brain imaging, cognitive functioning, and the effect of stress on the mind.
Only about 30% of people identified as being at risk go on to develop psychosis. Nevertheless, COPE recommends clinical treatment for its participants and offers them cost-free medication consultation and psychotherapy for two years.
What does it mean to be at risk?
Certain changes in thoughts and feelings have been identified as indications of an at-risk mental state that may be experienced before the onset of a psychiatric illness. For some, the symptoms of the at-risk mental state may indicate the early stages of a psychotic disorder that will develop over time. For others, the symptoms seem to fade with time or remain mild, and no psychiatric illness develops. Only about 30% of people who experience at-risk mental state go on to develop a psychotic disorder.
Signs of psychosis risk
Signs are indicators of risk that are noticed by others. Young people at risk might begin to appear withdrawn and to lack interest in social contact. They often lose interest in activities that were formerly a source of pleasure. They may require prodding to engage in daily activities such as showering and changing clothes. They may also begin to appear less emotional or to be confused by their emotions. Sometimes a relative, friend, or teacher will notice that their appearance is odd, that they have become focused on unusual ideas, or that they have developed a sense of self-importance. These changes often accompany a decline in school or work performance.
Symptoms of psychosis risk
Young people who are at risk can experience a variety of symptoms. It is common for people at risk to have some difficulty staying focused and getting their point across in conversation. They might find themselves feeling as if they are often the center of attention, or they may even worry that other people are out to harm them. They might start to feel confused about what is real, imaginary, or dreamed. Some participants report that they have less control over their thoughts. Others say that their eyes and ears are playing tricks on them, and that they sometimes hear, see, or smell things that others do not. People who are at risk might have only one or two of these symptoms, but it is also possible to have several of them at once.
Signs of psychosis risk
- Becoming more socially isolated
- Difficulty in functioning in school, work or home
- Worsening personal hygiene and grooming
- Requiring prodding to complete basic activities
- Loss of usual interest in activities
- Reduction in emotional expression
- Loss of motivation and energy
- Increased difficulty with conversation
- Odd appearance
Symptoms of psychosis risk
- Difficulty organizing thoughts or speech
- Difficulty following conversation
- Lack of pleasure in formerly enjoyed activities
- Increasing desire to be alone
- Heightened sensitivity to light and sound
- Hearing things such as voices others do not hear
- Seeing, smelling, or tasting things others don’t
- Suspicion of others
- Feeling a loss of control over thoughts
- Preoccupation with the supernatural
- Confusion about what is real and imaginary
- Unrealistically inflated sense of self-importance
COPE offers a number of treatment options on an outpatient basis. Treatments offered include individual and/or group psychotherapy, family support and education, and medication consultations. All services provided are free of charge, with the exception of any medications that may be prescribed.
Treatment at COPE is optional. Some people who come to COPE already have a doctor elsewhere, wait to begin treatment, or choose not to pursue treatment at all. This choice has no effect on their status as research participants—they receive the same evaluations and opportunities as the patients in treatment.
We recognize that changes in thoughts and feelings can be very confusing and even frightening. Our research clinic provides an opportunity for young people and their families to get help from mental health professionals and learn how to handle these upsetting changes. The staff at COPE is comprised of M.D.s, Ph.D.s, and MSWs, who work as a team in order to incorporate a variety of perspectives on the unique issues facing each patient.
COPE is proud to be located at a university hospital and to include medical residents, psychology interns, and social work interns as supervised clinical staff.
What to expect at COPE
Participation in COPE begins with a specialized and thorough evaluation, including detailed interviews and neuropsychological testing. This includes tests of sensory perception and brain imaging. Participants also have the opportunity to be involved in other studies that include brain imaging and genetics, and open-ended interviews. Participants are compensated in cash for all research participation.
COPE offers a variety of clinical services for participants in the study.
COPE re-evaluates participants every three months for four years. Our goal is to understand people as they grow and change over time. For this reason, we touch base with our participants regularly, whether or not they choose to come in for treatment. Follow-up appointments are relatively brief but are important for monitoring each person’s well-being.
COPE understands that making the decision to go for a psychological evaluation can be difficult. Many who come to our clinic are seeking help for the first time and worry that they will be labeled with a psychiatric diagnosis rather than treated as a unique person. The treatment team at COPE is well aware of this concern and is dedicated to the consideration of each person as a whole, with his or her distinctive hopes, worries, strengths and needs.
What if I am at risk?
Experiencing these signs and symptoms does not mean that a psychotic disorder is certain to develop. Only about 30% of people who are identified as being at risk for psychosis go on to develop a psychotic disorder. In other words, about 70% of participants identified as being at risk either do not progress to full psychosis or experience an improvement in symptoms. It is very important to get help as early as possible so that the symptoms can be evaluated and addressed before they intensify.
If such experiences do intensify, the COPE clinic supports every person it treats and will offer state-of-the art treatment as the clinical situation requires. Importantly, even if a person has more intense symptoms and progresses to what would be considered full psychosis, recovery is most easily accomplished at the earliest stage of developing problems. We are proud of the clinical outcomes of many individuals who have been a part of our clinic who have, despite developing full psychosis for a time, been able to recover with a combination of counseling and medication treatment and resume many of their previous activities at work or school, and with friends and family.
What is psychosis?
Psychosis affects about 3% of the population at some point in their lives. While its causes are not yet fully understood, studies suggest that psychosis usually results from a combination of genetic (inherited) risk and environmental exposures such as head injury, stress and drug use. Psychosis is known to result from a chemical imbalance in the brain, and the new medications that have been developed to address this imbalance are often very effective.
“Psychotic” is a word that has a precise meaning in psychiatry but carries many inaccurate connotations in popular culture. It does not mean “homicidal” or “mad,” and it does not describe the entirety of a person’s character or experience. While television and movies often portray psychotic people as dangerous, the vast majority of people suffering from psychosis are in fact withdrawn and socially isolated. People who suffer from psychosis can be successfully treated and live fulfilling lives.
The term “psychosis” refers to delusions, hallucinations, and thought disorder that occur in schizophrenia and mood disorders. These all take many forms. For example, delusions , or erroneous beliefs, may involve the idea that one is being controlled from the outside, that one is being persecuted, or that one has been given magical powers. Hallucinations are usually auditory and often involve hearing voices, though they can sometimes affect vision, taste, and smell as well. It is common in psychosis to hear one or more voices speaking or to hear one’s thoughts spoken aloud. Thought disorder refers to the disorganized thinking that makes it hard for someone to formulate basic thoughts and communicate them in a way that is easily understood. Difficulty thinking clearly is usually detected when someone is consistently difficult to follow in conversation.
People who are at risk for psychosis may experience these types of thoughts and perceptions for a very short time, or else they may experience them in a limited way, retaining the ability to see that the delusions and hallucinations are unlikely. In contrast, people are considered to have developed a psychotic disorder when they lose perspective on their symptoms and can no longer dismiss delusions or recognize hallucinations as unreal.
Am I eligible?
COPE accepts English-speaking people between the ages of 12 and 30 who are at risk and do not already carry a diagnosis of psychotic disorder. Evaluations by staff will help you determine your eligibility.
Make a Donation
The COPE Clinic is a not for profit research program at the Columbia University Department of Psychiatry, and is funded by grants from the National Institute of Mental Health and support from private individuals and foundations. This generous support is vital to COPE’s existence and mission; it enables mental health research to continue toward the goal of eradicating disease and improving the lives of those who suffer from mental illness. All contributions, large and small, allow us to offer cost-free treatment to young people in need as the centerpiece of our research. Please consider making a gift to COPE today.
On behalf of the entire COPE team, and all of the individuals we serve, thank you for your consideration, generosity and support.
Contributions can be sent to the address below, with checks made payable to ‘Columbia University’ and ‘COPE’ in the memo line. Receipts will be mailed to the donor’s return address and labeled as charitable contributions.
The COPE Clinic at NYSPI
1051 Riverside Drive, Box 55
New York, NY 10032