First Episode Psychosis: Primary care experience and implications to service development

Abstract

Background

First episode psychosis (FEP) studies show that average time between onset of symptoms and first effective treatment is often one year or more¹. This long duration of untreated psychosis (DUP) is undesirable for various reasons:

1. • Early treatment helps minimise the risk of serious consequences ^2,3

2. • Shorter DUP is associated with better clinical response.⁴

3. • Early results suggest that early intervention in psychosis (EIP) service is more cost effective than generic services.⁵

The attitude to treatment of ‘Psychosis’ has recently changed from focusing on severe and enduring mental illness to include early intervention.¹⁰ New terms appeared including duration of untreated psychosis (DUP) from onset of positive psychotic symptoms until starting treatment and duration of untreated illness (DUI) from onset of prodrome until starting treatment.¹¹

Aim

To access the local Primary Care experience of FEP before developing the local EIP service.

Method

A confidential questionnaire consisted of 8 questions sent by the Clinical Governance Support Team (CGST) to all Northamptonshire GPs requesting response within 3 weeks.

Main results

Response rate is 43% (123 GPs responded out of 284). GPs are less likely to start treatment of FEP. FEP are less likely to ask for a psychiatric referral but more likely to accept if offered by GP. 53% of GPs tend to refer all FEP cases to psychiatric service & 43% only refer those who request/accept referral. 74% of GPs agreed that EIP service was needed, 21% were unsure The likely causes of delayed referral of FEP by GPs: Patients disengaging, stigma, difficulty accessing psychiatric service, carers’ lack of knowledge and diagnostic uncertainty.

Conclusion

FEP patients are less likely to ask for referral to psychiatric service but likely to accept if offered. The likely causes for FEP delayed referral to psychiatric service: patients disengaging, stigma, carers’ lack of knowledge, service is difficult to access or inappropriate and diagnostic uncertainty. GPs need to be adequately informed about EIP & their important role to achieve this.