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Understanding the role of the family physician in early psychosis intervention
- Kelly K. Anderson, Suzanne Archie, Richard G. Booth, Chiachen Cheng, Daniel Lizotte, Arlene G. MacDougall, Ross M. G. Norman, Bridget L. Ryan, Amanda L. Terry, Rebecca Rodrigues,
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- Journal:
- BJPsych Open / Volume 4 / Issue 6 / November 2018
- Published online by Cambridge University Press:
- 30 October 2018, pp. 447-453
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Background
The family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.
AimsOur objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.
MethodWe will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.
DiscussionThese findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.
Declaration of interestNone.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Mental hospital and general hospital psychiatric units: a comparison of services within the same geographic area
- Ashok K. Malla, Ross M. G. Norman
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- Journal:
- Psychological Medicine / Volume 13 / Issue 2 / May 1983
- Published online by Cambridge University Press:
- 09 July 2009, pp. 431-439
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A comparison was made between the characteristics of patients admitted to the only psychiatric hospital in Newfoundland, Canada, and those admitted to general hospital psychiatric units within the same area. Patients were compared on demographic characteristics, diagnosis, incidence of violence and suicidal attempts, treatment, length of stay and previous admissions. The results suggest that patients admitted to the mental hospital are more likely to be single, male, of lower socio-economic status and to suffer from more chronic conditions. There is also a higher incidence of violence among patients admitted to the mental hospital. These findings have implications for the types of changes that will be required in general hospital units if the role of mental hospitals continues to decline.
The effect of a mental hospital strike on general hospital psychiatric services
- Ross M. G. Norman, Ashok K. Malla
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- Psychological Medicine / Volume 14 / Issue 4 / November 1984
- Published online by Cambridge University Press:
- 09 July 2009, pp. 913-921
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Data collected from 6043 psychiatric in-patient records were analysed to assess the impact of a strike at a mental hospital on in-patient services in general hospital psychiatric units in St John's, Newfoundland, Canada. As a whole, during the strike general hospital units showed an increase in the number of involuntary admissions, the number of prior mental hospital admissions of patients, and indications of violent or suicidal behaviour; and a decrease in the occupational status of patients admitted and the prescription of minor tranquillizers. There was also evidence of considerable variation between general hospitals in the extent to which their admission pattern changed during the strike and the permanence of some of the strike effects. The data indicate that all patients showing violent or suicidal behaviour who would normally have been admitted to the mental hospital were treated in the general hospital units during the strike. On the other hand, a large number of patients diagnosed with schizophrenia, personality disorder or mental retardation, who normally would have been admitted to the mental hospital, apparently went without hospitalization during the strike. A substantial proportion of this latter group would usually have been admitted involuntarily.
Dysphoric mood and symptomatology in schizophrenia
- Ross M. G. Norman, Ashok K. Malla
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- Psychological Medicine / Volume 21 / Issue 4 / November 1991
- Published online by Cambridge University Press:
- 09 July 2009, pp. 897-903
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The relationships between depression, anxiety and positive and negative symptoms of schizophrenia were examined in a study of 95 schizophrenic patients who were receiving out-patient care. Various measures of depression and anxiety showed a pattern of interrelationships which suggested that they were measuring a general state of dysphoria rather than separate dimensions of anxiety and depression. Dysphoria was found to be more reliably related to level of positive symptomatology than to negative symptoms.
Contributors
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- By Donald Addington, Jean Addington, Kelly Allott, Amanda Baker, Gregor Berger, Michael Berk, Max Birchwood, Warrick J. Brewer, Peter Burnett, Tyrone Cannon, Andrew Chanen, Philippe Conus, Barbara Cornblatt, Thomas Craig, Alex Fornito, David Fowler, Shona M. Francey, John Gleeson, Susy Harrigan, Meredith Harris, Leanne Hides, Christian G. Huber, Henry J. Jackson, Anthony F. Jorm, Eóin Killackey, Joachim Klosterkötter, Martin Lambert, Tim Lambert, Shon Lewis, Don Linszen, Dan Lubman, Nellie Lucas, Craig Macneil, Ashok K. Malla, Max Marshall, Louise K. McCutcheon, Patrick D. McGorry, Catharine McNab, Maria Michail, Anthony P. Morrison, Merete Nordentoft, Ross M. G. Norman, Keith H. Nuechterlein, Christos Pantelis, Lisa J. Phillips, Richie Poulton, Paddy Power, Jo Robinson, Frauke Schultze-Lutter, Jim van Os, José Luis Vázquez-Barquero, Dennis Velakoulis, Darryl Wade, Daniel Weinberger, Durk Wiersma, Stephen J. Wood, Annemarie Wright, Murat Yücel, Alison R. Yung, Robert B. Zipursky
- Edited by Henry J. Jackson, University of Melbourne, Patrick D. McGorry
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- The Recognition and Management of Early Psychosis
- Published online:
- 10 August 2009
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- 19 February 2009, pp xi-xvi
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10 - Pathways to care andreducing treatment delay in early psychosis
- from Section 4 - Access and reducing delay to treatment: reducing the duration of untreated psychosis
- Edited by Henry J. Jackson, University of Melbourne, Patrick D. McGorry
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- The Recognition and Management of Early Psychosis
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- 10 August 2009
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- 19 February 2009, pp 161-174
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Duration of untreated psychosis and its relationship to clinical outcome
- Ross M. G. Norman, Shôn W Lewis, Max Marshall
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- The British Journal of Psychiatry / Volume 187 / Issue S48 / August 2005
- Published online by Cambridge University Press:
- 02 January 2018, pp. s19-s23
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- August 2005
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Background
A major reason for interest in early intervention for psychotic disorders is the hypothesised relationship between longer duration of untreated psychosis (DUP) and poorer outcome of treatment.
AimsTo critically examine the evidence concerning DUP being related to treatment outcome and possible mediators of any such relationship.
MethodA systematic review of studies in which DUP is assessed and its relationship to treatment outcome is examined. In addition, studies relevant to possible neurotoxic effects of DUP were reviewed.
ResultsThe research is entirely of a correlational nature and, therefore, firm conclusions regarding causation are not possible. There is, however, substantial evidence of DUP being an independent predictor of treatment outcome, particularly remission of positive symptoms, over the first year or so of treatment. Findings regarding the possible neurotoxic effects of DUP are inconsistent.
ConclusionsThere continues to be evidence consistent with DUP influencing aspects of treatment outcome. Non-correlational studies, such as quasi-experimental designs, could provide stronger evidence regarding causality.
Duration of untreated psychosis and cognitive functioning in first-episode patients
- Ross M. G. Norman, Laurel Townsend, Ashok K. Malla
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- Journal:
- The British Journal of Psychiatry / Volume 179 / Issue 4 / October 2001
- Published online by Cambridge University Press:
- 02 January 2018, pp. 340-345
- Print publication:
- October 2001
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Background
The ‘toxicity’ model of duration of untreated psychosis (DUP) suggests that longer DUP will be associated with poorer performance on cognitive tests in first-episode patients.
AimsTo test this hypothesis on a sample of 113 patients in a community-based early intervention programme for psychosis.
MethodInformation was collected concerning a number of possible predictors of cognitive functioning including DUP. These were examined for their relation to performance on an extensive battery of cognitive tests administered shortly after the patients' admission to the programme.
ResultsAlthough several variables such as gender, premorbid adjustment, education and handedness predicted cognitive functioning, no relation was found between DUP and performance on any component of the test battery.
ConclusionsFindings do not provide support for a toxic effect of DUP on cognitive functioning. Other mechanisms through which DUP might affect outcome such as psychological engulfment, social support and adherence to medication are discussed.
Duration of untreated psychosis: a critical examination of the concept and its importance
- ROSS M. G. NORMAN, ASHOK K. MALLA
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- Journal:
- Psychological Medicine / Volume 31 / Issue 3 / April 2001
- Published online by Cambridge University Press:
- 12 April 2001, pp. 381-400
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Background. The concept of duration of untreated psychosis (DUP) has recently attracted much interest because of its possible relationship to treatment outcome and implications for preventive efforts with reference to psychotic disorders, especially schizophrenia. In this paper we review critically the literature concerning the concept and its importance.
Methods. Articles concerned with measuring DUP and those that have been suggested to provide indirect or direct evidence of the effect of DUP on treatment outcome are reviewed.
Results. Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse. There has been little investigation of the relationship of DUP to other long-term outcomes such as negative symptoms and cognitive functioning neither have the possible confounds of DUP been widely investigated or controlled.
Conclusions. It is important that there should be more thorough investigations of DUP, its correlates, and the extent to which it does mediate any advantages of earlier intervention.
Neuropsychological correlates of syndromes in schizophrenia
- Ross M. G. Norman, A. K. Malla, S. L. Morrison-Stewart, E. Helmes, P. C. Williamson, J. Thomas, L. Cortese
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- Journal:
- The British Journal of Psychiatry / Volume 170 / Issue 2 / February 1997
- Published online by Cambridge University Press:
- 03 January 2018, pp. 134-139
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- February 1997
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Background
On the basis of Liddle's three-syndrome model of schizophrenia, it was predicted that: (1) symptoms of psychomotor poverty would be particularly correlated with impaired performance on neuropsychological tests likely to reflect functioning of the dorsolateral prefrontal cortex; (2) disorganisation would be particularly correlated with impaired performance on tests sensitive to medio-basal prefrontal functioning; and (3) reality distortion would be particularly correlated with measures sensitive to temporal lobe functioning.
MethodThe above hypotheses were tested on 87 subjects with a confirmed diagnosis of schizophrenia. Patients' symptoms were scored for each of the three syndromes. Patients completed six neuropsychological tests designed to measure impairment in specific areas of the brain.
ResultsThere was no support for the first two hypotheses. There was, however, evidence of a specific relationship between reality distortion and neuropsychological performance usually considered to be related to left temporal lobe functioning.
ConclusionsAlthough not directly supporting the first two hypotheses; the results are, in general, consistent with there being different cortical-subcortical circuits associated with each of psychomotor poverty and disorganisation. Temporal lobe functioning appears to have particular significance for the reality distortion syndrome.
Relationship between Movement Planning and Psychopathology Profiles in Schizophrenia
- Ashok K. Malla, Ross M. G. Norman, Omar Aguilar, Heather Carnahan, Leonard Cortese
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- Journal:
- The British Journal of Psychiatry / Volume 167 / Issue 2 / August 1995
- Published online by Cambridge University Press:
- 02 January 2018, pp. 211-215
- Print publication:
- August 1995
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Background
There has been evidence that psychopathology in schizophrenia consists of three separable syndromes: reality distortion, disorganisation, and psychomotor poverty. The objective of this study was to explore the relationship between planning and execution of movement and each of the syndromes in schizophrenia.
MethodTwenty-one right handed DSM–III–R schizophrenic patients performed a total of 80 trials of a motor movement task, varying distance of movement × size of the target × hand. Times taken to plan the movement (RT) and to carry it out (MT) were examined for their relationship with contemporaneous as well as lifetime profiles of the three syndromes in schizophrenia.
ResultsSignificant correlations are reported between RT and current as well as lifetime measures of disorganisation syndrome. Somewhat weaker correlations are reported between RT and psychomotor poverty, but only for the right-handed tasks. Partial correlations suggest that the influence of neuroleptic medication explains all but one of the correlations between psychomotor poverty and RT, but does not account for the relationship between disorganisation and RT. No other relationship emerged between any of the movement and symptom measures.
ConclusionsThese findings indicate that dysfunction in movement planning is related primarily to concurrent disorganisation, as well as to the prominence of disorganisation over the patient's history.
Prodromal Symptoms in Schizophrenia
- Ashok K. Malla, Ross M. G. Norman
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- Journal:
- The British Journal of Psychiatry / Volume 164 / Issue 4 / April 1994
- Published online by Cambridge University Press:
- 02 January 2018, pp. 487-493
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- April 1994
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This paper describes a prospective study of the relationship between non-psychotic prodromal symptoms and psychotic symptoms in 55 schizophrenic (DSM–III–R) out-patients. Once a month, a number of non-psychotic symptoms generally regarded as prodromal symptoms in schizophrenia were assessed, as well as psychotic symptoms, with standardised self-administered instruments and rating scales for a minimum of 12 months (range 12–29). The data were analysed for each patient using a longitudinal correlational design with a 1-month lag between the prodromal and psychotic symptoms over the total period. Results showed that in less than one-fifth of subjects did any of the prodromal symptoms, individually or in combination, show a significantly positive correlation with the subsequent level of psychotic symptoms. Such relationships were significant in an even smaller proportion of subjects when the confounding effect of concurrent psychotic symptoms on prodromal symptoms was partialled out. High levels of prodromal symptoms appeared to have adequate specificity but low sensitivity in their power to predict high levels of subsequent psychotic symptoms. There were no differences in age, gender, medication levels, and the number of previous admissions between the subjects who did or did not show a relationship between putative prodromal symptoms and psychotic symptoms.
Stressful Life Events and Schizophrenia II: Conceptual and Methodological Issues
- Ross M. G. Norman, Ashok K. Malla
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- Journal:
- The British Journal of Psychiatry / Volume 162 / Issue 2 / February 1993
- Published online by Cambridge University Press:
- 02 January 2018, pp. 166-174
- Print publication:
- February 1993
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Research on the relationship between stress and schizophrenia is fraught with conceptual and methodological problems. These problems include issues related to the nature and measurement of stress, the likelihood of reciprocal influences between stress and symptoms, and the adequate assessment of symptoms. Several recommendations are made regarding future research in this area. These include using multiple and broadly based measures of different types of stressors and symptoms, greater use of truly prospective research designs, and the evaluation of the effects of interventions specifically designed to reduce stress in patients who suffer from schizophrenia.
Stressful Life Events and Schizophrenia: I: A Review of the Research
- Ross M. G. Norman, Ashok K. Malla
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- Journal:
- The British Journal of Psychiatry / Volume 162 / Issue 2 / February 1993
- Published online by Cambridge University Press:
- 02 January 2018, pp. 161-166
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- February 1993
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Empirical research concerning the relationship between life event stressors and schizophrenia is critically reviewed. In accordance with the view that patients suffering from schizophrenia are vulnerable to stress, there is evidence of a relationship between stressors and variation in severity of symptoms over time. There is less indication that schizophrenic patients have had higher levels of stressors than the general population or than patients suffering from other psychiatric disorders. These findings are consistent with vulnerability-stress models of the development of schizophrenia.