Social Psychiatry and Psychiatric Epidemiology

, Volume 55, Issue 2, pp 175–186 | Cite as

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

  • Elisabetta Miglietta
  • Antonio LasalviaEmail author
  • Chiara Bonetto
  • Carla Comacchio
  • Doriana Cristofalo
  • Sarah Tosato
  • Katia De Santi
  • Sara Petterlini
  • Gioia Zanatta
  • Carla Cremonese
  • Luana Ramon
  • Mirella Ruggeri
  • The PICOS Veneto Group
Original Paper



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.


First-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.

Ethical approval

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.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Elisabetta Miglietta
    • 1
  • Antonio Lasalvia
    • 1
    • 2
    Email author
  • Chiara Bonetto
    • 1
  • Carla Comacchio
    • 1
  • Doriana Cristofalo
    • 1
  • Sarah Tosato
    • 1
    • 2
  • Katia De Santi
    • 1
    • 2
  • Sara Petterlini
    • 1
  • Gioia Zanatta
    • 1
  • Carla Cremonese
    • 3
  • Luana Ramon
    • 4
  • Mirella Ruggeri
    • 1
    • 2
  • The PICOS Veneto Group
  1. 1.Department of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryUniversity of VeronaVeronaItaly
  2. 2.Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di VeronaVeronaItaly
  3. 3.Psychiatric Clinic, Department of NeuroscienceUniversity of PaduaPaduaItaly
  4. 4.Department of Mental HealthNHS, Local Health Authority Portogruaro (VE)PortogruaroItaly

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