Abstract
Background
In contrast to findings from the developed world where general practitioners and mental health professionals are central in first episode psychosis pathways, studies from Africa have found GPs to play a less prominent role with other help providers such as traditional healers being more important.
Methods
We compared pathways to care, treatment delays and gender differences in patients with first versus multi episode psychosis.
Results
Private sector GPs were first contacts in first episode patients in as many as 38% of patients and were significantly more likely to be the first contact (odds ratio = 4.5, 95% CI = 1.38–14.67) and final referring agent (odds ratio = 6.8, 95% CI = 1.56–25.12) in first episode patients. Female multi episode patients were significantly more likely to make first contact with primary care practitioners whereas male multi episode patients were more likely to first come into contact with the police (P = 0.003) and be admitted compulsorily (P = 0.009). Only 5.6% (n = 4) of patients contacted traditional healers at some point in their pathway to care. Treatment delays and DUP in first episode patients were longer and reached a median of 4.5 versus 2.5 months in multi episode patients. Treatment discontinuation of antipsychotics occurred in 82% of multi episode patients. Despite significantly longer overall treatment delays in first episode patients the distribution of treatment delays in multi episode patients followed a similar pattern to DUP in first episode patients with a subgroup having very long delays.
Conclusions
Pathways to care in this treatment setting correspond more to findings from first world and newly industrialized countries. A subgroup of multi episode patients had very long periods of untreated illness. Limitations include small sample size and the retrospective nature of data collection.
Similar content being viewed by others
References
Abiodun OA (1995) Pathways to mental health care in Nigeria. Psychiatr Serv 46(8):823–826
Bebbington PE, Craig T, Garety P, Fowler D, Dunn G, Colbert S, Fornells-Ambrojo M, Kuipers E (2006) Remission and relapse in psychosis: operational definitions based on case-note data. Psychol Med 36(11):1551–1562
Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G (2003) Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. Br J Psychiatry 182:105–116
Birchwood M, Todd P, Jackson C (1998) Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 172(33):53–59
Bruffaerts R, Sabbe M, Demyttenaere K (2004) Attenders of a university hospital psychiatric emergency service in Belgium—general characteristics and gender differences. Soc Psychiatry Psychiatr Epidemiol 39(2):146–153
Bruffaerts R, Sabbe M, Demyttenaere K (2006) Who visits the psychiatric emergency room for the first time? Soc Psychiatry Psychiatr Epidemiol 41(7):580–586
Burnett R, Mallett R, Bhugra D, Hutchinson G, Der G, Leff J (1999) The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population. Psychol Med 29(2):475–483
Chen EY, Dunn EL, Miao MY, Yeung WS, Wong CK, Chan WF, Chen RY, Chung KF, Tang WN (2005) The impact of family experience on the duration of untreated psychosis (DUP) in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 40(5):350–356
Chong SA, Mythily, Lum A, Chan YH, McGorry P (2005) Determinants of duration of untreated psychosis and the pathway to care in Singapore. Int J Soc Psychiatry 51(1):55–62
Chong SA, Mythily S, Verma S (2005) Reducing the duration of untreated psychosis and changing help-seeking behaviour in Singapore. Soc Psychiatry Psychiatr Epidemiol 40(8):619–621
Commander MJ, Cochrane R, Sashidharan SP, Akilu F, Wildsmith E (1999) Mental health care for Asian, black and white patients with non-affective psychoses: pathways to the psychiatric hospital, in-patient and after-care. Soc Psychiatry Psychiatr Epidemiol 34(9):484–491
Compton MT, Esterberg ML, Druss BG, Walker EF, Kaslow NJ (2006) A descriptive study of pathways to care among hospitalized urban African American first-episode schizophrenia-spectrum patients. Soc Psychiatry Psychiatr Epidemiol 41(7):566–573
Cougnard A, Kalmi E, Desage A, Misdrahi D, Abalan F, Brun-Rousseau H, Salmi LR, Verdoux H (2004) Factors influencing compulsory admission in first-admitted subjects with psychosis. Soc Psychiatry Psychiatr Epidemiol 39(10):804–809
Diagnostic and statistical manual of mental disorders (2005) American Psychiatric Association, DSM-IV Task force and working group, 4th edition text revision and American Psychiatric Association, Washington DC. Ref type: serial (book, monograph)
Erinosho OA (1977) Pathways to mental health delivery-systems in Nigeria. Int J Soc Psychiatry 23(1):54–59
Etheridge K, Yarrow L, Peet M (2004) Pathways to care in first episode psychosis. J Psychiatr Ment Health Nurs 11(2):125–128
Fuchs J, Steinert T (2004) Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Soc Psychiatry Psychiatr Epidemiol 39(5):375–380
Gater R, de Almeida e Sousa, Barrientos G, Caraveo J, Chandrashekar CR, Dhadphale M, Goldberg D, al Kathiri AH, Mubbashar M, Silhan K (1991) The pathways to psychiatric care: a cross-cultural study. Psychol Med 21(3):761–774
Gater R, Goldberg D (1991) Pathways to psychiatric care in South Manchester. Br J Psychiatry 159:90–96
Gater R, Jordanova V, Maric N, Alikaj V, Bajs M, Cavic T, Dimitrov H, Iosub D, Mihai A, Szalontay AS, Helmchen H, Sartorius N (2005) Pathways to psychiatric care in Eastern Europe. Br J Psychiatry 186:529–535
Grant C, Addington J, Addington D, Konnert C (2001) Social functioning in first- and multiepisode schizophrenia. Can J Psychiatry 46(8):746–749
Gureje O, Acha RA, Odejide OA (1995) Pathways to psychiatric care in Ibadan, Nigeria. Trop Geogr Med 47(3):125–129
Gureje O, Lasebikan VO (2006) Use of mental health services in a developing country. Results from the Nigerian survey of mental health and well-being. Soc Psychiatry Psychiatr Epidemiol 41(1):44–49
Haas GL, Garratt LS, Sweeney JA (1998) Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. J Psychiatr Res 32(3–4):151–159
Harrigan SM, McGorry PD, Krstev H (2003) Does treatment delay in first-episode psychosis really matter? Psychol Med 33(1):97–110
Harrison J, Kisely SR, Jones JA, Blake I, Creed FH (1997) Access to psychiatric care; the results of the pathways to care study in Preston. J Public Health Med 19(1):69–75
Ho BC, Andreasen NC, Flaum M, Nopoulos P, Miller D (2000) Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. Am J Psychiatry 157(5):808–815
Krstev H, Carbone S, Harrigan SM, Curry C, Elkins K, McGorry PD (2004) Early intervention in first-episode psychosis—the impact of a community development campaign. Soc Psychiatry Psychiatr Epidemiol 39(9):711–719
Lieberman JA, Alvir JM, Koreen A, Geisler S, Chakos M, Sheitman B, Woerner M (1996) Psychobiologic correlates of treatment response in schizophrenia. Neuropsychopharmacology 14(3 suppl):13S–21S
Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353(12):1209–1223
Lincoln C, Harrigan S, McGorry PD (1998) Understanding the topography of the early psychosis pathways. An opportunity to reduce delays in treatment. Br J Psychiatry Suppl 172(33):21–25
Linszen D, Lenior M, De HL, Dingemans P, Gersons B (1998) Early intervention, untreated psychosis and the course of early schizophrenia. Br J Psychiatry Suppl 172(33):84–89
Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 62(9):975–983
Mkize LP, Uys LR (2004) Pathways to mental health care in KwaZulu-Natal. Curationis 27(3):62–71
Mohan R, McCrone P, Szmukler G, Micali N, Afuwape S, Thornicroft G (2006) Ethnic differences in mental health service use among patients with psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 41(10):771–776
Morey RA, Inan S, Mitchell TV, Perkins DO, Lieberman JA, Belger A (2005) Imaging frontostriatal function in ultra-high-risk, early, and chronic schizophrenia during executive processing. Arch Gen Psychiatry 62(3):254–262
Morgan C, Mallett R, Hutchinson G, Bagalkote H, Morgan K, Fearon P, Dazzan P, Boydell J, McKenzie K, Harrison G, Murray R, Jones P, Craig T, Leff J (2005) Pathways to care and ethnicity. 1: sample characteristics and compulsory admission. Report from the AESOP study. Br J Psychiatry 186:281–289
Oosthuizen P, Emsley RA, Keyter N, Niehaus DJ, Koen L (2005) Duration of untreated psychosis and outcome in first-episode psychosis. Perspective from a developing country. Acta Psychiatr Scand 111(3):214–219
Patel V, Simunyu E, Gwanzura F (1997) The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe. Soc Psychiatry Psychiatr Epidemiol 32(2):97–103
Peralta V, Cuesta MJ, Martinez-Larrea A, Serrano JF, Langarica M (2005) Duration of untreated psychotic illness: the role of premorbid social support networks. Soc Psychiatry Psychiatr Epidemiol 40(5):345–349
Perkins DO, Gu H, Boteva K, Lieberman JA (2005) Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 162(10):1785–1804
Platz C, Umbricht DS, Cattapan-Ludewig K, Dvorsky D, Arbach D, Brenner HD, Simon AE (2006) Help-seeking pathways in early psychosis. Soc Psychiatry Psychiatr Epidemiol 41(12):967–974
Pradhan SC, Singh MM, Singh RA, Das J, Ram D, Patil B, Jain AK, Thomas JK (2001) First care givers of mentally ill patients: a multicenter study. Indian J Med Sci 55(4):203–208
Razali SM, Najib MA (2000) Help-seeking pathways among Malay psychiatric patients. Int J Soc Psychiatry 46(4):281–289
Reeler AP (1992) Pathways to psychiatric care in Harare, Zimbabwe. Cent Afr J Med 38(1):1–7
Sartorius N, Jablensky A, Korten A, Ernberg G, Anker M, Cooper JE, Day R (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders. Psychol Med 16(4):909–928
Seok JB, Kwon JS, Yoon KS, Lee C, Youn T, Moon CH, Yoon KC (2005) Functional imaging evidence of the relationship between recurrent psychotic episodes and neurodegenerative course in schizophrenia. Psychiatry Res 139(3):219–228
Szymanski SR, Cannon TD, Gallacher F, Erwin RJ, Gur RE (1996) Course of treatment response in first-episode and chronic schizophrenia. Am J Psychiatry 153(4):519–525
Verdoux H, Cougnard A, Grolleau S, Besson R, Delcroix F (2005) How do general practitioners manage subjects with early schizophrenia and collaborate with mental health professionals? A postal survey in South-Western France. Soc Psychiatry Psychiatr Epidemiol 40(11):892–898
Wyatt RJ (1991) Neuroleptics and the natural course of schizophrenia. Schizophr Bull 17(2):325–351
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Temmingh, H.S., Oosthuizen, P.P. Pathways to care and treatment delays in first and multi episode psychosis. Soc Psychiat Epidemiol 43, 727–735 (2008). https://doi.org/10.1007/s00127-008-0358-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-008-0358-5