Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention
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ORIGINAL PAPER
Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy Angelo Cocchi • Anna Meneghelli • Arcadio Erlicher Alessia Pisano • Maria Teresa Cascio • Antonio Preti
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Received: 7 July 2012 / Accepted: 27 June 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose This study set out to investigate the patterns of referral in a sample (n = 206) of patients having first-time access to an Italian comprehensive program that targets the early detection of and early intervention on subjects at the onset of psychosis. The primary goal of the study was to investigate the duration of untreated illness (DUI) and/or the duration of untreated psychosis (DUP) in the sample since the implementation of the program. Method Data on pathways of referrals prospectively collected over a 11-year period, from 1999 to 2010; data referred to patients from a defined catchment area, and who met ICD-10 criteria for a first episode of a psychotic disorder (FEP) or were classified to be at ultra-high risk of psychosis (UHR) according to the criteria developed by the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne. Changes over time in the DUI and DUP were investigated in the sample. Results Referrals increased over time, with 20 subjects enrolled per year in the latter years of the study. A large majority of patients contacted a public or private mental health care professional along their pathway to treatment, occurring more often in FEP than in UHR patients. FEP
A. Cocchi A. Meneghelli A. Erlicher A. Pisano M. T. Cascio Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Via Livigno, 3, 20128 Milan, Italy e-mail: [email protected]; [email protected] A. Preti (&) Centro Medico Genneruxi, via Costantinopoli 42, 09129 Cagliari, Italy e-mail: [email protected]
patients who had contact with a non-psychiatric health care professional had a longer DUP. Over time, DUP and DUI did not change in FEP patients, but DUI increased, on average, in UHR patients. Conclusions The establishment of an EIP in a large metropolitan area led to an increase of referrals from people and agencies that are not directly involved in the mental health care system; over time, there was an increase in the number of patients with longer DUI and DUP than those who normally apply for psychiatric services. Keywords Early intervention in psychosis Patterns of referral Duration of untreated psychosis Prevention Mental disorders/epidemiology
Introduction The range of contacts made by distressed people and their relatives with individuals and organizations to seek help is known globally as the ‘‘pathway to care’’ [1]. The routes taken to gain access to help by patients experiencing symptoms of psychosis for the first time are influential in determining whether treatment is prompt or delayed [2]. Indeed, the concept of duration of untreated psychosis (DUP) was developed t
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