Abstract
BackgroundDetection of psychotic disorders is an important issue, since early treatment might improve prognosis. Timely diagnosis of psychotic disorders depends on recognition of psychotic symptoms and their interpretation. The aim of this study is to examine to what extent reported psychotic symptoms are accounted for in clinical diagnosis.MethodsThe medical files of all patients who had a first contact with one of two mental health care services (N = 6477) were screened for reported psychotic symptoms and subsequent clinical diagnosis. Patients who reported psychotic symptoms and who were diagnosed with a psychotic disorder were followed-up for two years to register prescription of antipsychotic treatment and continuity of care.ResultsIn the files of 242 (3.7%) patients specific psychotic symptoms were recorded. 37% of these patients were diagnosed with a non-affective psychotic disorder, 7% with other psychotic disorders and 56% with non-psychotic disorders or no diagnosis at all. About 90% of the patients diagnosed with a psychotic disorder did receive any prescription of antipsychotics, and about 50% were in continuous care during the first 2 years.ConclusionRelatively large proportions of patients presenting with psychotic symptoms were diagnosed with a non-psychotic diagnosis or not diagnosed at all. This applies also to patients reporting at least two or more psychotic symptoms. Although we did not verify the appropriateness of clinical diagnosis, these findings are an indication that psychotic disorders may be underdetected. Improving the diagnostic process in mental health care services may be the most obvious way to promote early intervention in psychosis.
Highlights
Detection of psychotic disorders is an important issue, since early treatment might improve prognosis
Different strategies have been developed to improve the detection of first episode psychosis both in the prodromal phase and during the first psychotic episode to minimize the delay of treatment after the onset of psychosis [3,4]
The role of treatment delay has been shown to be an important factor associated with response to antipsychotic treatment, in terms of severity of global psychopathology, positive and negative symptoms, functional outcomes and time to response [5,6,7]
Summary
Detection of psychotic disorders is an important issue, since early treatment might improve prognosis. Detection and intervention of psychotic disorders are important issues in mental health practice and research [1,2]. The role of treatment delay has been shown to be an important factor associated with response to antipsychotic treatment, in terms of severity of global psychopathology, positive and negative symptoms, functional outcomes and time to response [5,6,7]. As a consequence, it (page number not for citation purposes). The recommended duration of antipsychotic prophylaxis in the Dutch guidelines is one year longer, because relapse rates do not seem to level off during the first years after remission from a first episode [17]
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