Clinician Recognition of First Episode Psychosis

Abstract

Purpose: Psychotic disorders develop during mid-adolescence through early adulthood, with the initial few months a "critical period" offering the greatest promise for recovery. However, the duration of untreated psychosis is typically over a year. This study aimed to identify aspects of care episodes contributing to delays in diagnosis of a first psychotic episode.

Methods: Study subjects included 161 adolescents and young adults referred to a first episode psychosis treatment program. We captured the various ways that people who experience a severe mental illness engage in treatment using standardized interviews with patients and informants (e.g., family member) and medical record review.

Results: A psychotic disorder diagnosis was not given for 38% of subjects at their initial episode of care. Time to first care episode was virtually the same for subjects that did and did not receive a psychosis diagnosis; 50% within 1 month and 84% within 6 months. Compared to initial care episodes with a psychosis diagnosis, those without a psychosis diagnosis less often involved emergency services (80% vs. 38%, respectively; p value = 1 × 10^-7) and more often outpatient primary care (6% vs. 18%; p value = .032) and mental health (32% vs. 49%; p value = .045) services. However, dangerousness indicators were similar (29% vs. 28%; p value = 1). Dangerousness indicators increased to 54% (p value = .002) by the time of eventual diagnosis for those requiring multiple care episodes.

Conclusions: Clinicians were important contributors to delays in diagnosis and treatment of psychosis. Interventions targeting outpatient health care providers may be fruitful in reducing the duration of untreated psychosis.

Keywords: Adolescent mental health; Duration of untreated psychosis; First episode psychosis; Treatment delays.

Figure 1

a Duration of Untreated Psychosis. First Care Episode Psychosis Diagnosis versus First Care Episode No Psychosis Diagnosis b Duration of Untreated Psychosis. First Care Episode Psychosis Diagnosis versus Psychosis Diagnosis Care Episode, Multiple Care Episodes