“Lanthanic Presentation” in First-Episode Psychosis Predicts Long Service Delay: The Challenge of Detecting Masked Psychosis

Abstract

Background/Aims: Studies of pathways to care in first-episode psychosis have documented a substantial treatment delay occurring after patients enter mental health services. An initial presentation with neurotic rather than psychotic symptoms is common in first-episode psychosis. The term “lanthanic patient” has been used to refer to patients presenting with a reason for help-seeking that is unrelated to the underlying pathology. The aim of this study is to explore whether a lanthanic presentation is related to prolonged service delay. Methods: The sample comprises 62 patients with recent-onset psychosis. Data on sociodemographic, clinical, help-seeking, and pathway indicators were collected using a comprehensive, semistructured-interview schedule. Results: Service delay accounted for more than half of the overall treatment delay. An initially presenting complaint of neurotic symptoms was related to prolonged service delay. The effect remained after controlling for other potential risk factors of service delay. Conclusion: Anomalous experiences of pleasure, desire, or motivation are common in emerging psychosis. These difficulties are often misinterpreted as complaints of depression and anxiety by health professionals. The presence of such symptoms can introduce a focal vision on the part of health care professionals on the immediate presentation rather than the underlying psychopathology, leading to the underdetection of psychosis.

Societal Costs of Schizophrenia in Denmark: A Nationwide Matched Controlled Study of Patients and Spouses Before and After Initial Diagnosis

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Schizophrenia-spectrum psychopathology in obsessive–compulsive disorder: an empirical study

“…It has previously been found that psychotic symptoms are under-detected or diagnostically disregarded in clinical settings [10,86]. A recent study found that the presence of apparently 'neurotic' symptoms in first-episode psychosis resulted in a disregard of underlying psychotic psychopathology [39]. In this sample, a clinical focus on obsessive-compulsive symptomatology may have had similar consequences.…”

Exploring schizophrenia spectrum psychopathology in borderline personality disorder

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