First Presentation With Psychotic Symptoms in a Population-Based Sample

Abstract

Objective Increasing evidence supports the effectiveness of comprehensive early intervention at first onset of psychotic symptoms. Implementation of early intervention programs will require population-based data regarding overall incidence of psychotic symptoms and care settings of first presentation. Methods In five large healthcare systems, electronic health records data were used to identify all first occurrences of psychosis diagnoses among people aged 15 through 59 between 1/1/2007 and 12/31/2013. For a random sample of these putative cases, review of full-text medical records confirmed clinician documentation of psychotic symptoms and excluded those with documented prior diagnosis of or treatment for psychosis. Initial incidence rates (based on putative cases) and confirmation rates (from record reviews) were used to estimate true incidence according to age and setting of initial presentation. Results Incidence estimates based on putative cases were 126 per 100,000 per year among those aged 15 to 29 and 107 per 100,000 among those aged 30–59. Rates of chart review confirmation ranged from 84% among those aged 15–29 diagnosed in emergency department or inpatient settings to 19% among those aged 30 to 59 diagnosed in general medical outpatient visits. Estimated true incidence rates were 86 per 100,000 per year among those aged 15 to 29 and 46 per 100,000 in those aged 30 to 59. Conclusions Including all care settings, total incidence of first-episode psychosis is higher than previous estimates based on surveys or inpatient data. Early intervention programs must accommodate frequent presentation after age 30 and presentation in outpatient, including primary care, settings.

Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review

“…The frequency at which the positive symptoms of psychosis are reported within the acute mood episodes of bipolar disorder (BD) (mania, depression and mixed states) has in some studies been found to be almost comparable to the rates observed in schizophrenia (SCZ) . Indeed, across jurisdictions, individuals with a diagnosis of BD make up a sizeable proportion of hospital admissions following a psychotic episode . Alongside this issue of prevalence, recent research trends have contributed to a rise in studies specifically investigating auditory verbal hallucinations (AVHs) and their relationship to other symptoms in BD.…”

“…1 Indeed, across jurisdictions, individuals with a diagnosis of BD make up a sizeable proportion of hospital admissions following a psychotic episode. 2,3 Alongside this issue of prevalence, recent research trends have contributed to a rise in studies specifically investigating auditory verbal hallucinations (AVHs) and their relationship to other symptoms in BD. First, mental health research has moved towards increased scrutiny of psychiatric symptoms as they occur across diagnoses.…”

How data science can advance mental health research

“…Information gathered from electronic health records and other digital sources (internet searches, social media, and mobile phone data) has a huge potential for surveillance of mental disorders and their treatment. 54 This could support the planning of services, implementation of interventions, evaluation of treatments, priority setting and the development of health policy and practice.…”

Pre-print full manuscript

“…We included 44 separate estimates of the incidence of all psychotic disorders derived from 27 citations, including estimates from multicentre studies ( Figure 2). Incidence varied around fifteenfold, from 6.3 (95%CI: 4.5-8.8) per 100,000 person-years in Santiago (Spain) 37 to 90.0 (95%CI: 88.3-91.8) in the USA 42 . The overall pooled incidence of all psychotic disorders was 26.6 (95%CI: 22.0-31.7), though heterogeneity was high (I 2 : 99.6%).…”