Duration of untreated psychosis and pathways to care in first-episode psychosis

Abstract

BackgroundStudies have consistently found that many individuals with first-episode psychosis experience significant delays before receiving treatment. Current research investigating treatment delays has focused on the relationship between demographic factors and duration of untreated psychosis (DUP). However, treatment-seeking behaviours in this group have not been investigated.AimsTo examine psychological processes that influence the decision-making process to contact primary care, in individuals with emerging psychosis.MethodThe influence of coping style, health locus of control and past health help-seeking behaviour on DUP was investigated in clients with a first episode of psychosis. This involved scrutiny of general practitioner (GP) records in an average of 6 years before the first treatment.ResultsShorter DUP was associated with more frequent GP attendance in the 6 years before the onset of psychosis and lower health threat avoidant coping scores.ConclusionsPatients with short DUP have a history of higher contact with their GP and, as a group, tend not to avoid health threats. The study underlines the importance of engaging young people and their families with primary care as one of a series of strategies to reduce DUP.

Measuring pathways to care in first-episode psychosis: A systematic review

“…The related and crucial question: what prevents families from seeking help when problems become apparent also remains relatively unexplored and may be associated with other variables such as explanatory models of illness, stigma and socio-economic or educational background. Some studies have assessed the influence of presenting symptoms, coping styles, health locus of control and help-seeking behaviour on DUP but not used measures of pathways into care and were therefore not included in this review (Skeate et al, 2002, Drake et al, 2000. The very interesting finding that individuals who develop psychosis while under the care of mental health teams have a long delay before treatment is initiated ((Norman et al, 2004) suggests that even mental health services might contribute to the other two reasons for delayed intervention: sufferer are not offered treatment or are deemed not to need it.…”

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

“…4 There is a limited evidence base in this area of primary care, but GPs may be key to the identification and management of first-episode psychosis, as they are usually the first point of patient contact, 5 their involvement in the management of psychosis is associated with a reduction of the use of the Mental Health Act, 6 and they are the most common final referral agent to early-intervention services. 7 However, early detection presents challenges as psychosis can take several months to emerge, 8 and may be difficult to distinguish from normal adolescent behaviour and substance misuse. 9,10 There can be changes in presentation during the early phase, 11 which may lead to diagnostic caution among GPs.…”

Prodromal schizophrenia in primary care: a randomised sensitisation study

“…[6][7][8][9] This finding points towards the need to deliver information to GPs about early warning signs of schizophrenia. However, as is commonly the case for mental health problems, patients may not instantly reveal their psychological difficulties.…”