Pathways to care, DUP, and types of interventions over 5 years following psychosis onset: findings from a naturalistic study conducted in routine generalist mental health services
To describe pathways to care, duration of untreated psychosis (DUP), and types of interventions provided to first-episode psychosis (FEP) patients by routine Italian mental health services over 5 years since the first service contact.
Naturalistic study conducted in Veneto, within the context of the Psychosis Incident Cohort Outcome Study (PICOS). A comprehensive set of measures was used, including schedules designed to collect information on referrals to psychiatric services and on psychological and pharmacological treatments at 1, 2, and 5 years since first service contact.
Overall, 397 patients were assessed. Most engaged with services with the help of family members (47.4%) and through emergency routes (60.3%). Those referred by clinicians were more likely to access care in a non-emergency way. Mean DUP was 5.62 months (SD 11.8) and longer DUP was associated with poorer functioning at 2 and 5 years. Interventions provided over 5 years were mainly constituted by antipsychotic medications (95.4% at 1 year; 85.8% at 2 years; 80.6% at 5 years), whereas a lower percentage (69.1% at 1 year; 61.5% at 2 years; 44.9% at 5 years) also received some forms of psychological interventions, mainly consisting of unspecific support sessions. Other structured interventions, such as CBT or family interventions, were seldom provided at each time-point.
Mental health services in Veneto seem effective in engaging FEP patients within a short time since illness onset. However, type of care provided does not meet quality standards recommended by treatment guidelines, especially regarding psychological interventions.
KeywordsFirst-episode psychosis (FEP) Pathways to care Patterns of care Psychological interventions Duration of untreated psychosis (DUP)
This study was partially supported by Fondazione Cariverona with the grant “Disabilità cognitiva e comportamentale nelle demenze e nelle psicosi. Sotto-obiettivo A.9. Basi morfofunzionali cognitive e genetiche delle psicosi maggiori: uno studio integrato longitudinale” to M. Ruggeri and S. Tosato.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interest.
The PICOS was approved by the ethics committee of the coordinating center—Azienda Ospedaliera di Verona (N. prog. 1103, 27.10.2004) and of the local collaborating sites.
- 1.National Institute for Clinical Excellence (NICE) (2014) Psychosis and schizophrenia in adults: prevention and management, http://www.nice.org.uk/CG178. Accessed 1 Aug 2019
- 2.American Psychiatric Association (APA) (2004) Practice guideline for the treatment of patients with schizophrenia, Second Edition. Am J Psychiatry 161(supplement):1–56Google Scholar
- 18.Lasalvia A, Tosato S, Brambilla P et al (2012) Psychosis Incident cohort outcome study (PICOS). A multisite study of clinical, social and biological characteristics, patterns of care and predictors of outcome in first-episode psychosis. Background, methodology and overview of the patient sample. Epidemiol Psychiatr Sci 21(3):281–303. https://doi.org/10.1017/s2045796012000315 CrossRefPubMedGoogle Scholar
- 20.World Health Organization (1992) Schedules for Clinical Assessment in Neuropsychiatry (SCAN), version 1.0. World Health Organization: GenevaGoogle Scholar
- 22.American Psychiatric Association (APA) (1994) Diagnostic and statistical manual of mental disorder, 4th edition (DSM-IV). American Psychiatric Association, WashingtonGoogle Scholar
- 24.Cocchi A, Meneghelli A, Erlicher A et al (2013) Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy. Soc Psychiatry Psychiatr Epidemiol 48(12):1905–1916. https://doi.org/10.1007/s00127-013-0736-5 CrossRefPubMedGoogle Scholar
- 36.Bertelsen M, Jeppesen P, Petersen L et al (2008) Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 65(7):762–771. https://doi.org/10.1001/archpsyc.65.7.762 CrossRefPubMedGoogle Scholar
- 39.Malla A, Joober R, Iyer S, Norman R, Schmitz N, Brown T (2017) Comparing three-year extension of early intervention service to regular care following 2 years of early intervention service in first-episode psychosis: a randomized single blind clinical trial. World Psychiatry 16(3):278–286. https://doi.org/10.1002/wps.20456 CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Cocchi A, Cavicchini A, Collavo M et al (2015) Implementation and development of early intervention in psychosis services in Italy: a national survey promoted by the associazione Italiana interventi precoci nelle psicosi. Early Interv Psychiatry 12(1):37–44. https://doi.org/10.1111/eip.12277 CrossRefPubMedGoogle Scholar