Abstract
BackgroundThe pathways to care in a first onset psychosis are diverse and may influence the chances of early treatment and therefore the duration of untreated psychosis. We test which pathways to care are associated with a delay in receiving treament and a longer duration of untreated psychosis (DUP).MethodsIn a population based survey, we interviewed 480 people with first episode psychosis aged 18 to 64 years over a 2-year period. Information from structured interview and case files provided DSM-IV diagnostic, clinical, and demographic information. Consecutive contacts in the care pathway were mapped using the World Health Organisation’s Encounter Form. Using information from all sources, DUP was defined as time from symptom onset to first treatment with antipsychotic medication.ResultsThe most common first contacts were primary care physicians (35.2%), emergency rooms in general hospital settings (21.3%), and criminal justice agencies (25.4%). In multivariate regression models, compared to DUP for those first in contact with primary care, DUP was shortest for first encounters with psychiatric emergency clinics (RR = 0.4, 95% CI: 0.23-0.71) and longest for first encounters with criminal justice agencies (RR = 1.61, 95% CI: 1–2.58). Older age was associated with a longer DUP (RR = 1.01 per year, 95% CI: 1–1.04). A shorter DUP was associated with a diagnosis of mania and affective psychoses-NOS compared with schizophrenia (RR = 0.22, 95% CI: 0.14-0.35; RR = 0.18, 95% CI: 0.06-0.54, respectively), for Black compared with White ethnicity (RR = 0.52, 95% CI: 0.34-0.82), and for each close person in the social network (RR = 0.9, 95% CI: 0.84-0.96).ConclusionsTo further reduce DUP, better links are needed between primary care, emergency rooms, criminal justice and psychiatric services.
Highlights
The pathways to care in a first onset psychosis are diverse and may influence the chances of early treatment and the duration of untreated psychosis
Patients presenting with psychotic disorders are usually young at first episode, and some may avoid prompt treatment if they lack insight; they can experience poorer quality of life, impaired social functioning, more severe symptoms, a prolonged duration of untreated psychosis (DUP) and a poorer long term prognosis with more relapses [3,4]
This paper reports on naturalistic care pathways and DUP from the East London First Episode Psychosis Study (ELFEPS) and addresses the following research questions: (i) Which services/agencies are encountered by these patients in their pathways to specialist psychiatric care, (ii) which of these services/agencies and individual characteristics of these patients are independently associated with the shortest DUP
Summary
The pathways to care in a first onset psychosis are diverse and may influence the chances of early treatment and the duration of untreated psychosis. The provision of emergency and crisis care has changed from dedicated psychiatric “emergency clinics” [9] staffed by mental health professionals and “emergency rooms” in general hospital settings towards a network of other community based agencies [10]. These include home treatment, crisis and early intervention teams [11,12,13] for which there is evidence of improved patient care, the prevention of admissions to hospital with marginal improvement in satisfaction with services [14]
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