Only a small proportion of patients with first episode psychosis come via prodromal services: a retrospective survey of a large UK mental health programme

Abstract

BackgroundLittle is known about patients with a first episode of psychosis (FEP) who had first presented to prodromal services with an “at risk mental state” (ARMS) before making the transition to psychosis. We set out to identify the proportion of patients with a FEP who had first presented to prodromal services in the ARMS state, and to compare these FEP patients with FEP patients who did not have prior contact with prodromal services.MethodsIn this study information on 338 patients aged ≤37 years who presented to mental health services between 2010 and 2012 with a FEP was examined. The data on pathways to care, clinical and socio-demographic characteristics were extracted from the Biomedical Research Council Case Register for the South London and Maudsley NHS Trust.ResultsOver 2 years, 14 (4.1% of n = 338) young adults presented with FEP and had been seen previously by the prodromal services. These ARMS patients were more likely to enter their pathway to psychiatric care via referral from General Practice, be born in the UK and to have had an insidious mode of illness onset than FEP patients without prior contact with the prodromal services.ConclusionsIn the current pathways to care configuration, prodromal services are likely to prevent only a few at-risk individuals from transitioning to psychosis even if effective preventative treatments become available.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1468-y) contains supplementary material, which is available to authorized users.

30 Years on: How the Neurodevelopmental Hypothesis of Schizophrenia Morphed Into the Developmental Risk Factor Model of Psychosis

“…However, even in those areas with well organized outreach services, only a small proportion of those who develop a first episode of psychosis comes via such clinics; only 4% in South London. 78 Consequently, if we wish to prevent a significant proportion of cases of psychosis, we must intervene at an earlier point. 79 Initially, it seemed possible that the occurrence of minor psychotic symptoms in early adolescence might specifically predict later psychosis.…”

The reality of at risk mental state services: a response to recent criticisms

“…Individuals accessing these services are not representative of all the people at risk of psychotic disorder This issue raised by Ajnakina et al is fundamentally a problem of the relatively poor reach of ARMS services. Ajnakina et al draw this conclusion from studies from a single ARMS clinic in South London (Ajnakina et al, 2017). They state that individuals who attended their ARMS service and later developed psychosis were more likely to be born in the UK than those who developed psychosis without accessing their ARMS service.…”

Need for evidence-based early intervention programmes: a public health perspective

“…A recent retrospective investigation of electronic health records data from South East London showed that 16.3% of the patients presented to mental health services with a first-episode psychotic disorder (FEP) had a prior contact with local prodromal services,9 similar to recently disclosed data from Melbourne 10. However, only 4.1% met criteria for UHR/CHR and consequently ‘transitioned’, while the remaining 12.3% had already been diagnosed with FEP at initial contact with prodromal services 9. A similar trend, lending support to the prevention paradox, has also been shown in other cohorts across the world—only a negligible portion of those who develop FEP benefits from UHR/CHR services 2.…”