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Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting

  • F. Cheng (a1) (a2) (a3), J. B. Kirkbride (a1) (a2), B. R. Lennox (a1) (a2), J. Perez (a3), K. Masson (a3), K. Lawrence (a3), K. Hill (a4), L. Feeley (a3), M. Painter (a2), G. K. Murray (a1) (a2) (a3), O. Gallagher (a3) (a5), E. T. Bullmore (a1) (a2) and P. B. Jones (a1) (a2)...

Abstract

Background

Early Intervention in Psychosis Services (EIS) for young people in England experiencing first-episode psychosis (FEP) were commissioned in 2002, based on an expected incidence of 15 cases per 100 000 person-years, as reported by schizophrenia epidemiology in highly urban settings. Unconfirmed reports from EIS thereafter have suggested higher than anticipated rates. The aim of this study was to compare the observed with the expected incidence and delineate the clinical epidemiology of FEP using epidemiologically complete data from the CAMEO EIS, over a 6-year period in Cambridgeshire, for a mixed rural–urban population.

Method

A population-based study of FEP (ICD-10, F10–39) in people aged 17–35 years referred between 2002 and 2007; the denominator was estimated from mid-year census statistics. Sociodemographic variation was explored by Poisson regression. Crude and directly standardized rates (for age, sex and ethnicity) were compared with pre-EIS rates from two major epidemiological FEP studies conducted in urban English settings.

Results

A total of 285 cases met FEP diagnoses in CAMEO, yielding a crude incidence of 50 per 100 000 person-years [95% confidence interval (CI) 44.5–56.2]. Age- and sex-adjusted rates were raised for people from black ethnic groups compared with the white British [incidence rate ratio (IRR) 2.1, 95% CI 1.1–3.8]. Rates in our EIS were comparable with pre-EIS rates observed in more urban areas after age, sex and ethnicity standardization.

Conclusions

Our findings suggest that the incidence observed in EIS is far higher than originally anticipated and is comparable to rates observed in more urban settings prior to the advent of EIS. Sociodemographic variation due to ethnicity and other factors extend beyond urban populations. Our results have implications for psychosis aetiology and service planning.

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Copyright

The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence . The written permission of Cambridge University Press must be obtained for commercial re-use.

Corresponding author

*Address for correspondence: Professor P. B. Jones, University Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Cambridge Biomedical Campus, Cambridge CB2 0SX, UK. (Email: pbj21@cam.ac.uk)

References

Hide All
Allardyce, J, Boydell, J, Van Os, J, Morrison, G, Castle, D, Murray, RM, McCreadie, RG (2001). Comparison of the incidence of schizophrenia in rural Dumfries and Galloway and urban Camberwell. British Journal of Psychiatry 179, 335339.
Amin, S, Singh, SP, Brewin, J, Jones, PB, Medley, I, Harrison, G (1999). Diagnostic stability of first-episode psychosis. Comparison of ICD-10 and DSM-III-R systems. British Journal of Psychiatry 175, 537543.
Barnett, JH, Sahakian, BJ, Werners, U, Hill, KE, Brazil, R, Gallagher, O, Bullmore, ET, Jones, PB (2005). Visuospatial learning and executive function are independently impaired in first-episode psychosis. Psychological Medicine 35, 10311041.
Barnett, JH, Werners, U, Secher, SM, Hill, KE, Brazil, R, Masson, K, Pernet, DE, Kirkbride, JB, Murray, GK, Bullmore, ET, Jones, PB (2007). Substance use in a population-based clinic sample of people with first-episode psychosis. British Journal of Psychiatry 190, 515520.
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2008). Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65, 762771.
Bosanac, P, Patton, GC, Castle, DJ (2010). Early intervention in psychotic disorders: faith before facts? Psychological Medicine 40, 353358.
Coid, JW, Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB (2008). Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study. Archives of General Psychiatry 65, 12501258.
Craig, TKJ, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M, Dunn, G (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 1067–1060.
Croudace, TJ, Kayne, R, Jones, PB, Harrison, GL (2000). Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis. Psychological Medicine 30, 177185.
Department of Health (2001). Mental Health Policy Implementation Guide. National Health Service: London.
Fearon, P, Kirkbride, JB, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Lun Alan Fung, W, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine 36, 15411550.
Frisher, M, Crome, I, Martino, O, Croft, P (2009). Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005. Schizophrenia Research 113, 123128.
Grawe, RW, Falloon, IRH, Widen, JH, Skogvoll, E (2006). Two years of continued early treatment for recent-onset schizophrenia: a randomised controlled study. Acta Psychiatrica Scandinavica 114, 328336.
Jablensky, A, Sartorius, N (2008). What did the WHO studies really find? Schizophrenia Bulletin 34, 253255.
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Kirkbride, JB, Boydell, J, Ploubidis, GB, Morgan, C, Dazzan, P, McKenzie, K, Murray, RM, Jones, PB (2008 a). Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychological Medicine 38, 10831094.
Kirkbride, JB, Coid, JW, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB (2008 b). Psychoses, ethnicity and socio-economic status. British Journal of Psychiatry 193, 1824.
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP study. Archives of General Psychiatry 63, 250258.
Kirkbride, JB, Jones, PB (2010). The prevention of schizophrenia – what can we learn from eco-epidemiology? Schizophrenia Bulletin. Published online: 25 October 2010. doi:10.1093/schbul/sbq120.
Kuehn, BM (2010). Early interventions for schizophrenia aim to improve treatment outcomes. Journal of the American Medical Association 304, 139145.
Lester, H, Birchwood, M, Bryan, S, England, E, Rogers, H, Sirvastava, N (2009). Development and implementation of early intervention services for young people with psychosis: case study. British Journal of Psychiatry 194, 446450.
March, D, Hatch, SL, Morgan, C, Kirkbride, JB, Bresnahan, M, Fearon, P, Susser, E (2008). Psychosis and place. Epidemiologic Reviews 30, 84100.
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975983.
Marshall, M, Rathbone, J (2008). Early intervention for psychosis. Cochrane Database of Systematic Reviews, 18, CD004718.
McGorry, P, Johanessen, JO, Lewis, S, Birchwood, M, Malla, A, Nordentoft, M, Addington, J, Yung, A (2010). Early intervention in psychosis: keeping faith with evidence-based health care. Psychological Medicine 40, 399404.
McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305326.
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.
Mihalopoulos, C, Harris, M, Henry, L, Harrigan, S, McGorry, P (2009). Is early intervention in psychosis cost-effective over the long term? Schizophrenia Bulletin 35, 909918.
Moore, THM, Zammit, S, Lingford-Hughes, A, Barnes, TRE, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.
Noble, M, McLennan, D, Wilkinson, K, Whitworth, A, Barnes, H, Dibben, C (2008). The English Indices of Deprivation 2007. Communities and Local Government: London.
ONS (2001). Census 2001. Office for National Statistics (http://www.ons.gov.uk/census/get-data/index.html). Accessed 29 December 2009.
ONS (2004). Census 2001 Definitions. The Stationery Office: London.
ONS (2009 a). Population Estimates by Ethnic Group Methodology Paper. Office for National Statistics: Newport.
ONS (2009 b). Table 8 – Mid-2007 UK, England and Wales, Scotland and Northern Ireland population estimates. In Population Estimates for UK, England and Wales, Scotland and Northern Ireland – Current Datasets. Office for National Statistics: Fareham.
Pelosi, AJ, Birchwood, M (2003). Is early intervention for psychosis a waste of valuable resources? British Journal of Psychiatry 182, 196198.
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