First Episode Psychosis: Primary Care Experience

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First Episode Psychosis Primary Care Experience
Implications to Service DevelopmentA survey of
GPs

• Mamdouh EL-Adl, John Burke Karen Little, UK.

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Introduction (1)

• FEP First Episode Psychosis
• DUP Duration of Untreated Psychosis.
• From onset of positive psychotic symptoms
  until initiation of treatment.
• DUI Duration of Untreated Illness.
• From onset of prodrome to initiation of
  treatment.
• 
  (Compton Esterberg, 2005)

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Introduction (2)

• FEP (First Episode Psychosis) studies
• Average duration between onset first
  effective treatment is one year or more.
• (McGlashan, 1998 Compton Esterberg, 2005)

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Introduction (3)

• Long DUP/DUI is undesirable, Why?
• Early treatment helps
• - ? suffering.
  (Ho et al, 2003)
• - ? risks. (Wyatt et al, 1998 Larsen et
  al 1998)
• 2. Shorter DUP is associated with better
  clinical response.
  (Perkins et al, 2004)
• 3. Early results suggested that EIP service is
  more cost effective. (Mihalopoulos et
  al, 1999)

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Introduction (4)

• Department of Health (2001) aims to establish a
  network of Early Intervention Services across UK.
• In UK, most GPs see 12 new people with FEP/year.
  (Shires Lester, 2004)

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Aims of the study

• To study the local primary care experience with
  FEP prior to developing the local EIP service.
• To strengthen the interface with primary care.

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Method

• A confidential questionnaire developed by M
  EL-Adl approved by 10 clinicians.
• Questionnaires sent by CGST (Clinical Governance
  Support Team) to all GPs in Northamptonshire
  (284).
• Responses collected analysed by CGST.

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Northamptonshire

• Population 650,000 700,000
• Main towns Northampton, Kettering, Corby,
  Wellingborough, Daventry.
• Adult psychiatric service
• - Medical staff 16 consultants 10 middle
  
• grade 15 SHO.
• - Beds 2 Acute inpatient units (80 beds)

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Service Model

• Primary Care well developed
• Secondary Care
• - Acute NGH (Northampton General Hospital)
• KGH (Kettering General
  Hospital)
• - Mental Health Adult, Elderly, L D, Child,
  Rehabilitation, Drug Alcohol.

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Results
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Response rate
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GPs starting treatment before referring to
psychiatric service
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GPs referral trends
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Number of FEP cases seen by GPs over last 12
months
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Table 11 Type of service preferred by GPs
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Table 12 GPs experience of main causes for
delayed referral to psychiatric care
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Conclusion

• EIP service developers could benefit considerably
  from studying primary care experience.
• GPs need to be adequately informed about EIP.
• Improving public awareness attitude towards
  mental illness is essential.

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Acknowledgement

• Thanks to Primary Care colleagues who
  participated in this study.
• Thanks to my colleagues who offered their support
  while planning for this project.
• Thanks to WPA-Cairo 2005 organising committee for
  giving me the opportunity to speak to you.

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Thank you

• Together for a better future