First contact with psychiatric specialists hastens schizophrenia treatment

Patients with first-onset psychosis wait less time for treatment if they visit emergency clinics staffed by specialist psychiatric teams than their counterparts who access healthcare in community settings, report researchers.

The findings emerge from a study of 480 inner-city dwelling individuals with any psychotic syndrome and indicate that after emergency clinics with specialist psychiatric staff, patients whose first encounters were at general practices, psychiatric services or accident and emergency rooms in general hospitals had the shortest duration of untreated psychosis (DUP).

Conversely, the DUP was longest for patients whose first encounters were with health visitors and social workers, and the criminal justice system (CJS).

“Those working in these settings should be encouraged to initiate prompt referral to emergency rooms in general hospitals or general practice and then to psychiatric services”, write Kamaldeep Bhui (Queen Mary University of London, UK) and co-authors in BMC Psychiatry.

The three most common first contacts for the study population, aged 18–64 years, were general practitioners, at 35.2%, followed by the CJS (police, solicitors), at 25.4%, then accident and emergency rooms, at 21.3%.

Those who attended general practices first were more likely to be women, to not have a diagnosis of schizophrenia, to not be detained within a week of contact with psychiatric services, and were less likely to be single or Black.

Those in first contact with the CJS were more likely to be male, Black, to have a diagnosis of schizophrenia and to be detained within a week of contact – commonly reflecting violent or threatening behaviour at presentation, note Bhui et al.

In a multivariate Poisson regression analysis in comparison with first contact at a general practice, DUP was shortest for patients whose first encounters were with psychiatric emergency clinics, at a rate ratio of 0.40, and longest for those whose encounters were with the CJS or with hospital medical and surgical services, with rate ratios of 1.61 and 2.32, respectively.

“[P]sychiatric emergency clinics have been progressively phased out in the UK with funding shifted to community-based services, a policy trend that may need review in inner-city urban areas”, suggests the research team.

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