Skip to main content
×
×
Home

First-episode psychosis: primary care experience and implications for service development

  • Mamdouh El-Adl (a1), John Burke (a2) and Karen Little (a3)
Abstract
Aim and Methods

To 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.

Results

Out 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 Implications

Individuals 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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      First-episode psychosis: primary care experience and implications for service development
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      First-episode psychosis: primary care experience and implications for service development
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      First-episode psychosis: primary care experience and implications for service development
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Hide All
1 Garety, P, Jolley, S. Early intervention in psychosis. Psychiatr Bull 2000; 24: 321–3.
2 Yung, AR, McGorry, PD. Prediction of psychosis: setting the stage. Br J Psychiatry 2007; 191 (suppl 51): s18.
3 Compton, MT, Esterberg, ML. Treatment delay in first–episode nonaffective psychosis: a pilot study with African American family members and the theory of planned behaviour. Compr Psychiatry 2005; 46: 291–5.
4 McGlashan, TH. Recovery style from mental illness and long-term outcome. J Nerv Ment Dis 1987; 175: 681–5.
5 Larsen, TK, Johannsen, JO, Opjordsmoen S. First episode schizophrenia with long duration of untreated psychosis. Br J Psychiatry 1998; 172 (suppl 33): s4552.
6 Wyatt, RJ, Damiani, M, Henter, ID. First episode schizophrenia. Br J Psychiatry 1998; 172 (suppl 33): s7783.
7 Perkins, D, Lieberman, J, Hongbin, G, Tohen, M, McEvoy, J, Green, A, et al. Predictors of antipsychotic treatment response in patients with first episode schizophrenia, schizoaffective and schizophreni-form disorders. Br J Psychiatry 2004; 185: 1824.
8 Ho, BC, Alicata, D, Ward, J, Moser, DJ, O'Leary, DS, Arndt, S, et al. Untreated initial psychosis: relation to cognitive deficits and brain morphology in first episode schizophrenia. Am J Psychiatry 2003; 160: 142–8.
9 Mihalopoulos, C, McGorry, PD, Carter, RC. Is phase-specific, community oriented treatment of early psychosis an economically viable method of improving outcome? Acta Psychiatr Scand 1999; 100: 4755.
10 Department of Health. National Service Framework for Mental Health. TSO (The Stationery Office), 1999.
11 Shiers, D, Lester, H. Early intervention for first episode psychosis needs greater involvement of primary care professionals for its success. BMJ 2004; 328: 1451–2.
12 McAvoy, BR, Kaner, EFS. General practice postal survey: a questionnaire too far. BMJ 1996; 313: 732–4.
13 Birchwood, M, Fowler, D, Jackson, C. Early Intervention in Psychosis: A Guide to Concepts, Evidence and Interventions: xixii. John Wiley, 2000.
14 Edwards, J, McGorry, P. Implementing Early Intervention in Psychosis. A Guide to establishing Early Psychosis Services: 1529. Martin Dunitz, 2000.
15 Lincoln, C, McGorry, PD. Pathways to care in early psychosis: clinical and consumer perspectives. In The Recognition and Management of Early Psychosis: A Preventive Approach (eds McGorry, PD, Jackson, HJ): 5179. Cambridge University Press, 1999.
16 Johnstone, EC. Schizophrenia. In Companion to Psychiatric Studies, (6th edn) (eds Johnstone, EC, Freeman, CPL, Zealy, AK): 369–98. Churchill Livingstone, 1998.
17 Larsen, TK, McGlashan, TH, Johannessen, JO, Friis, S, Guldberg, C, Haahr, U, et al. Shortened duration of untreated first episode psychosis: changes in patient characteristics at treatment. Am J Psychiatry 2001; 158: 1917–9.
18 Singh, SP, Wright, C, Burns, T Joyce, E, Barnes, TRE. Developing early intervention services in the NHS: a survey to guide workforce and training needs. Psychiatr Bull 2003; 27: 254–8.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 14 *
Loading metrics...

Abstract views

Total abstract views: 50 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 23rd July 2018. This data will be updated every 24 hours.

First-episode psychosis: primary care experience and implications for service development

  • Mamdouh El-Adl (a1), John Burke (a2) and Karen Little (a3)
Submit a response

eLetters

Re: GP's and early intervention in psychosis

Mamdouh EL-Adl, Consultant Psychiatrist
25 May 2009

Dear editor

We wish to express our thanks to Dr Bowers for the interest in our article FEP: Primary Care Experience and implications for service development (Psychiatric Bull 2009; 33: 165-168). Dr Bowers Feels that the GPs figures of seeing only one or two patients with FEP (First Episode Psychosis) every year stated by majority of GPs (68%) is rather low! This interestingly agreed with what is published by David Shiers & Helen Lister in their BMJ editorial in 2004 “Most general practitioners (GPs) see one to two new people with first-episode psychosis a year” (1).

Dr Bowers view that GPs’ ability to answer questions about their prescribing trends to patients with FEP is likely to be difficult. I may disagree with Dr Bowers’ view as the low numbers does not exclude or make it difficult for GP to comment on engagement or otherwise as mentioned above.Dr Bowers’ statement about getting the patients views on barriers to mental health services would certainly have helped triangulate the data puts the idea for another study. The scope of this study was about GPs’ experience and not patients or carer’s experience. As we stated in the aim of our study: “To capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service” (2)

Finally Dr Bowers expressed his concern about the length of time elapsed since conducting our study until it has been published. We appreciate the importance of avoiding such delay but would point out the following: (A) Clinicians with busy clinical duties need to plan the study, make the time for data analysis, writing & submitting papers, responding to reviewers and waiting after putting the publication in the queue of the papers accepted for publication until it is published. (B) The real question should be whether this delay has any impact on applicability of the study results or not. We feel if in some areas that share similarities with Northamptonshire demography, service and resourceswho have already adopted a service model for their EIS (Early InterventionService), it is not too late to review their model and pick what could be considered as useful for their service as the EIS model needs to be flexible & develop over the years. If on the other hand, some areas have not yet developed their EIS model, it is not at all late.

References:1.Shiers D, Lester H. Early intervention for first episode psychosis needs greater involvement of primary care professionals for its success. BMJ 2004; 328: 1451 2.EL-Adl M, Burke J & Little K (2009) Frist Episode Pstychosis: Primary care experience and implications for service development. Psychiatric Bulletin (2009) 33: 165-168.
... More

Conflict of interest: None Declared

Write a reply

GP's and early intervention in psychosis

Dr Alexis Bowers, Specialist Registrar
12 May 2009

Dear Editor,

I read with interest Dr El-Adl et al's article (Psychiatr Bull 2009; 33: 165-168) on GP experiences of patients with a first psychotic episode.Delay in the initiation of treatment in these patients has been associatedwith poorer long term outcomes.[1] I do, however, have a number of concerns about the reported results.

The low reported incidence of new cases per year within the authors locality (100) was demonstrated by the majority (68%) of GP's seeing only one or two cases per year. I do find it difficult, given these low cell counts, to see how GP's could answer questions about initiating treatment (10%, 25%, 50% and 75% of the time)and thus conclude that GP's are unlikely to start treatment before referring to secondary care services.

The information requested from the GP's regarding engagement of patients with first episode psychosis and causes of delayed referral are based on these low patient numbers and would be subject to recall bias on behalf of the GP. Getting the patient's views on barriers to mental health services would certainly have helped triangulate the data.

I was also concerned that the data published was five years old and as such the current generalisability of these results could be questioned. With the NICE schizophrenia guidelines recently updated [2] and earlyintervention/crisis resolution teams the norm rather than the exception ElAdl et al echo the view that active engagement with our primary care colleagues is paramount in ensuring these patients receive both a responsive and effective service.

1 Barnes T, Leeson V, Mutsatsa S, Watt H, Hutton S and Joyce E. Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia. BJP 2008 193: 203-209.

2 DEPARTMENT OF HEALTH (2009) Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. The Stationary Office.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *