A nationwide study was carried out comprising 50,877 persons aged 18-66, who were registered in 2003 in the Danish Psychiatric Register or in the National Patient Register with a psychiatric ICD-10 diagnosis. Of the population 87.1% were ethnic Danes, 7.8% migrants, 4.0% off-springs with one Danish born parent, 0.7% off-springs with both parents born outside Denmark and 0.3% adoptees. Males comprised 49% women 51% of the population. The 5 ethnic groups had significant differences in utilization of care, diagnostic distribution and use of coercion. Women had a higher contact rates in all groups apart from migrants. The contact rate among persons of Middle Eastern background was relatively low. Patients with a non-Danish background were more frequently nonvoluntarily admitted and had significantly more frequently contact with services due to a forensic measures. Substance abuse was higher among men in all ethnic groups. Contacts due to schizophrenia were higher among non-Danish patients and highest among young offspring males. Self-mutilating behaviour was seen more frequently among female off-springs from non-Western countries than among migrant women from non-Western countries. The paper will analyse selected significant differences among the ethnic groups. appropriate and diagnostic uncertainty. GPs need to be adequately informed about EIP & their important role to achieve this. References McGlashan TH: Recovery style from mental illness and long-term outcome.
Aim and MethodsTo capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service. A survey of Northamptonshire general practitioners (GPs) using a confidential questionnaire was carried out.ResultsOut of 284 GPs, 123 (43%) responded. General practitioners are unlikely to start treatment before referring to a specialist service: 63 GPs (51% of responders) start treatment in 10% or less of individuals with first-episode psychosis and 19 (15.5%) GPs start treatment in 75% or more before referring them to psychiatric service; 42 GPs (34%) refer those who request/accept a referral and 66 GPs (53%) refer all even if they refuse. Overall, 92 GPs (74%) agreed that an early intervention in psychosis service is needed and 77 (63%) GPs welcome having a mental health clinic in their surgery.Clinical ImplicationsIndividuals are more likely to accept referral to a psychiatric service if offered than to ask for it. People disengaging, stigma, the service being difficult to access/inappropriate and carers' lack of knowledge about mental illness are the likely causes for delayed referral.
Over the past few decades there has been a growing interest in first-episode psychosis (FEP), help-seeking behaviour and pathways to care. Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care (Yung & McGorry, 2007). FEP studies show that the average time between onset of symptoms and first effective treatment is often 1 year or more (McGlashan, 1987). This long duration of untreated psychosis (DUP) is undesirable. Early treatment helps minimise the risk of the serious consequences of untreated psychosis, in terms of changes in mental state and behaviour (Larsen et al, 1998; Wyatt et al, 1998) and can reduce suffering (Ho et al, 2003). Some early results suggested that an ‘early intervention in psychosis’ (EIP) service is more cost-effective than generic services (Mihalopoulos et al, 1999).
Is phasespecific , community oriented treatment of early psychosis an economically viable method of improving outcome? Acta Psychiatrica Scandinavia, 100, 47-55.
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