Knowledge, attitudes, and self-perceived skills regarding ultrahigh risk (UHR) for psychosis and schizophrenia in primary care physicians: new insights from Tunisia

Abstract

BackgroundThere is evidence indicating that an important proportion of young people at ultrahigh risk (UHR) for psychosis do consult in primary care, but their identification may be hindered by multiple factors, such as primary care physicians (PCPs)’ limited skills and perceived stigma toward the condition. This study aimed to investigate attitudes/beliefs toward both UHR and schizophrenia and perceived self-efficacy in screening for, diagnosing, and managing these conditions among PCPs. The secondary objective was to determine the potential effects of psychosis level (UHR vs. schizophrenia) on PCP’s views.MethodsA cross-sectional survey was carried out among Tunisian PCPs working in primary care setting in Tunisia (N = 232, 66.4% females, mean age of 47.5 ± 9.9 years). An anonymous paper-and-pencil self-administered questionnaire was adopted to collect data. PCPs were asked to read vignettes describing individuals with UHR and schizophrenia and answer a series of questions that followed.ResultsThe schizophrenia vignette aroused significantly more feelings of “need to help the person” than the UHR vignette (87.8% vs. 88%, p = .022). The perceptions that the person depicted in the vignette is “strange” and “not intelligent” were more frequently endorsed for UHR than schizophrenia (18.7% vs. 16%, p = 0.028, and 8.4% vs. 5.6%, p = 0.043, respectively), whereas the person with schizophrenia was perceived are more dangerous than the UHR person (38.4% vs. 25.2%, p = 0.033). Only 28.9% and 14% of participants agreed that they have the necessary skills to make the diagnosis and manage the condition depicted in the UHR vignette, respectively.ConclusionFindings indicated that a high proportion of our Tunisian PCPs show a deficit in identifying both UHR and schizophrenia diagnoses. Given that PCPs can be key sources of referral of at-risk young help-seekers to specialized early intervention services, urgent interventions are needed to help PCPs enhance their knowledge and reduce stigma associated with psychosis.