Last episode psychosis

Abstract

Last Episode Psychosis 1 1 First time the first author was introduced to the concept Last Episode Psychosis was in the autumn of 2008 at a telephone conversation with Michael Schmidt, MD, Copenhagen, Denmark which in practice is schizophrenia could be defined as every psychotic episode which is not first episode. This definition is not very operational, but could be refined later for, e.g. research purposes. In Fig. 1, we present the number of first ever schizophrenia admissions to Danish psychiatric departments in the years 1996 to 2007, a few hundred per year. The figure also shows the number of last episode psychosis, around 6000 to 7000 per year (P. Munk-Jørgensen, personal communication). Last Episode Psychosis is not last ever episode psychosis, but it is last episode psychosis –for the time being. If the person is discharged, he or she may have last episode psychosis also next year and the following year, called revolving door patients 20 years ago. First ever contact and readmitted (in- and out-patient) with schizophrenia in Denmark, ICD-10 F20. Figure 2 shows the average life expectancy for male and female schizophrenia patients from 1997 to 2006 compared to the average life expectancy for the general Danish population (J. Nielsen, personal communication). Average life expectancy. The data in Fig. 1 is absolute numbers and Fig. 2 presents crude rates not standardized. The figures are calculated from The Danish Nationwide Psychiatric Research Register (Fig. 1) and the Danish Causes of Death Register (Fig. 2). Several more arguments but the numerical for focusing Last Episode Psychosis is urgent: Eleven percentage of homeless people are suffering from schizophrenia which is much higher than the background population (1), the effects of antipsychotic drugs in chronic patients are more limited compared to the first episode patients (2), the risk of myocardial infarction in patients with chronic schizophrenia is twice the background population (3), and they have an up to eight times increased risk for cardiovascular mortality (4). Patients with schizophrenia have a double risk for diabetes (4), half of them have increased body weight (4) and they are three times as often smokers as the background population (4). Patients with schizophrenia have a decreased compliance (5, 6) which increases the risk for readmission (7), extended hospitalization period (7) and increased suicide risk (8). Populations of patients with schizophrenia have high prevalence of substance use disorder comorbidity (9). Patients with schizophrenia have an increased physical morbidity in general (10), they have more frequently complications in connections with operations (11). Furthermore, patients with schizophrenia are less likely to receive proper preventive medical care (10). The antipsychotic treatment of the chronic patients with schizophrenia is more often poly-pharmaceutical though a change to monotherapy might be possible (12) and antipsychotic treatment further increases the weight gain (13, 14). Patients with schizophrenia have an increased SMR compared to the background population (15-17). Furthermore, patients with chronic schizophrenia have lowered cognitive performance compared to other psychiatric disorders which interferes with social interaction (18) and compromised quality of life (19). It is the authors’ hope that an increased focus on the Last Episode Psychosis could improve the general care for patients with schizophrenia through increased focus in the clinical practice, increased research and increased political attention.