Skip to main content

Advertisement

SpringerLink
Log in

Schizophrenia in a Primary Care Setting

  • Schizophrenia and Other Psychotic Disorders (SJ Siegel, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

In recent years, the focus of mental health care for people with schizophrenia has shifted from an expectation of lifelong disability to a ‘recovery’ approach in which patients and specialists anticipate discharge to management within primary care. Although the active symptoms of mental illness are generally well-managed with modern pharmacotherapy, primary care physicians often express concern about their lack of understanding and expertise in general management of schizophrenia. Moreover, the ability of patients to access care for their physical disorders in a timely fashion together with a higher prevalence of physical co-morbidities is likely to be responsible for the greater mortality and premature death of this already stigmatised and disadvantaged group. This paper focuses on new evidence over the past 5 years, considering the management of physical and mental health of schizophrenia patients in primary care, optimal processes and the reasons why these may not always be realised in practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. The Schizophrenia Commission. The abandoned illness: a report from the Schizophrenia Commission. London: Rethink Mental Illness; 2012.

    Google Scholar 

  2. Vieweg WVR, Hasnain M, Pandurangi A. Editorial: coordinated medical and psychiatric care in schizophrenia. 2012. Am J Med. doi:10.1016/j.amjmed.2011.10.1016

  3. http://www.nimh.nih.gov/health/statistics/prevalence/schizophrenia.shtml. NIMH quotes evidence of Regier DA, et al. (The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry. 1993;50(2):85–94) as still being current. Figures extrapolated for US adult population of 209 million.

  4. Barbato A. Schizophrenia & public health. Geneva: WHO; 1998.

    Google Scholar 

  5. Santos AB, Henggeler SW, Burns BJ. Research on field-based services: models for reform in the delivery of mental health care to populations with complex clinical problems. Am J Psychiatry. 1995;152:1111–23.

    Article  CAS  PubMed  Google Scholar 

  6. Lapporta M, Falloon I. Preventive interventions in the community. In: Kavanagh DJ, editor. Schizophrenia. An overview and practical handbook. London: Chapman and Hall; 1992.

    Google Scholar 

  7. Birchwood M, McCorry P, Jackson H. Early intervention in schizophrenia. Br J Psychiatry. 1997;170:2–5.

    Article  CAS  PubMed  Google Scholar 

  8. Hardoon S, Hayes J, Blackburn R, et al. Recording of severe mental illness in United Kingdom primary care, 2000–2010. PLoS One. 2013;8(12), e82365.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Prah P, Petersen I, Nazareth I, et al. National changes in oral antipsychotic treatment for people with schizophrenia in primary care between 1998 and 2007 in the United Kingdom. Pharmacoepidemiol Drug Saf. 2012;21(2):161–9.

    Article  PubMed  Google Scholar 

  10. McConnell KJ, Gast SH, Ridgely MS, et al. Behavioural health insurance parity: does Oregon’s experience presage the national experience with the Mental Health Parity and Addiction Equity Act? Am J Psychiatry. 2012;169(1):31–8.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Millard C, Wessley S. Parity of esteem between physical and mental health. BMJ. 2014;349:g6821.

    Article  PubMed  Google Scholar 

  12. Allebeck P. Schizophrenia: a life-shortening disease. Schizophr Bull. 1989;15:81–9.

    Article  CAS  PubMed  Google Scholar 

  13. Cahoon EK, McGinty E, Ford D, et al. Schizophrenia and potentially preventable hospitalizations in the United States: a retrospective cross-sectional study. BMC Psychiatry. 2013;13:37. This is the most recent and largest study of acute hospitalizations for physical illness among schizophrenia patients.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Viron M, Baggett T, Hill M, et al. Schizophrenia for primary care providers: how to contribute to the care of a vulnerable patient population. Am J Med. 2012;125:223–30. An excellent overview of schizophrenia and the physical health needs of sufferers.

    Article  PubMed  Google Scholar 

  15. Marston L, Nazareth I, Petersen I, et al. Prescribing of antipsychotics in UK primary care: a cohort study. BMJ Open. 2014;4, e006135. doi:10.1136/bmjopen-2014-006135.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Nover C, Jackson S. Primary care-based educational interventions to decrease risk for metabolic syndrome for adults with major psychotic and/or affective disorders: a systematic review. Syst Rev. 2013;2:116.

    Article  PubMed Central  PubMed  Google Scholar 

  17. National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: treatment and management (NICE Clinical Guideline 178). NICE, 2014.

  18. Lehman AF, Lieberman JA, Dixon LB, et al. Practice guideline for the treatment of patients with schizophrenia, 2nd Edition. Washington, DC: American Psychiatric Association; 2004.

    Google Scholar 

  19. Addington, D, Roch-Hugo B, Goldberg J, et al. Clinical practice guideline: treatment of schizophrenia. Can J Psychiatry 2005; 50 (suppl 1).

  20. Crawford MJ, Jayakumar S, Lemmey S, et al. Assessment and treatment of physical health problems among people with schizophrenia: national cross-sectional study. Br J Psychiatry. 2014;205:473–7.

    Article  PubMed  Google Scholar 

  21. Pirraglia, Rowland E, Wen-Chih W, et al. Benefits of a primary care clinic co-located and integrated in a mental health setting for veterans with serious mental illness. Prev Chronic Dis. 2012;9, E51.

    PubMed Central  PubMed  Google Scholar 

  22. Reilly S, Planner C, Gask L, et al. Collaborative care approaches for people with severe mental illness. Cochrane Database of Systematic Reviews. 2013, Issue 11. Art. No.: CD009531. DOI:10.1002/14651858. CD009531.pub2.

  23. Reilly S, Planner C, Hann M, et al. The role of primary care in service provision for people with severe mental illness in the United Kingdom. PLoS One. 2012;7(5), e36468. doi:10.1371/journal.pone0036468. This is an important study that provides useful insights into the naturalistic arrangements for patients who are managed in secondary/shared care and primary care alone.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Murphy BP, Brewer WJ. Early intervention in psychosis: strengths and limitations of services. Adv Psychiatr Treat. 2011;17:401–7.

    Article  Google Scholar 

  25. De Maio M, Graham P, Vaughan D, et al. Review of international early psychosis programmes and a model to overcome unique challenges to the treatment of early psychosis in the United States. Early Interv Psychiatry. 2015;9:1–11.

    Article  PubMed  Google Scholar 

  26. Warner R. Problems with early and very early intervention in psychosis. Br J Psychiatry. 2005;187 Suppl 48:s104–7.

    Article  Google Scholar 

  27. Bird V, Premakumar P, Kendall T, et al. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry. 2010;197:350–6.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Marshall M, Rathbone J. Early intervention for psychosis (review). Cochrane Database Syst Rev. 2011;6, CD004718.

    PubMed  Google Scholar 

  29. Bosanac P, Patton GC, Castle DJ. Early intervention in psychotic disorders: faith before facts? Psychol Med. 2010;40:353–8.

    Article  CAS  PubMed  Google Scholar 

  30. McGorry P, Johanessen JO, Lewis S, et al. Early intervention in psychosis: keeping faith with evidence-based health care. Psychol Med. 2010;40:399–404.

    Article  CAS  PubMed  Google Scholar 

  31. Castle DJ. Should early psychosis intervention be the focus for mental health services? Adv Psychiatr Treat. 2011;17:398–400.

    Article  Google Scholar 

  32. Perkins D, Gu H, Boteva K, et al. Relationship between duration of untreated psychosis and outcome in first episode schizophrenia: a critical review and meta-analysis. Am J Psychiatr. 2005;162:1785–804.

    Article  PubMed  Google Scholar 

  33. Marshall M, Lewis S, Lockwood A. Association between duration of untreated psychosis and outcome in cohorts of first episode patients. A systematic review. Arch Gen Psychiatry. 2005;62:975–83.

    Article  PubMed  Google Scholar 

  34. International Early Psychosis Association. International clinical practice guidelines for early psychosis. Br J Psychiatry. 2005;187 Suppl 48:s120–4.

    Article  Google Scholar 

  35. Warner R. Invited commentary on … Ethnic variations in pathways into early intervention services for psychosis. Br J Psychiatry. 2013;202:284–5.

    Article  PubMed  Google Scholar 

  36. Bhui K, Ullrich S, Coid JW, et al. Which pathways to psychiatric care lead to earlier treatment and a shorter duration of untreated psychosis? BMC Psychiatry. 2014;14:72.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Anderson KK, Flora N, Archie S, et al. A meta-analysis of ethnic differences in pathways to care at the first episode of psychosis. Acta Psychiatr Scand. 2014;130:257–68.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Lloyd-Evans B, Crosby M, Stockton S, et al. Initiatives to shorten duration of untreated psychosis: systematic review. Br J Psychiatry. 2011;198:256–63.

    Article  PubMed  Google Scholar 

  39. Lloyd-Evans B, Sweeney S, Hinton M, et al. Evaluation of a community awareness programme to reduce delays in referrals to early intervention services and enhance early detection of psychosis. BMC Psychiatry. 2015;15:98.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Singh SP. Outcome measures in early psychosis: relevance of duration of untreated psychosis. Br J Psychiatry. 2007;191 Suppl 50:s58–63.

    Article  Google Scholar 

  41. Birchwood M, Connor C, Lester H, et al. Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. Br J Psychiatry. 2013;203:58–64.

    Article  PubMed  Google Scholar 

  42. Shiers D, Lester H. Early intervention for first episode psychosis needs greater involvement of primary care professionals for its success. Br Med J. 2004;328:1451–2.

    Article  Google Scholar 

  43. El-Adl M, Burke J, Little K. First-episode psychosis: primary care experience and implications for service development. Psychiatr Bull. 2009;33:165–8.

    Article  Google Scholar 

  44. Simon A, Lester H, Tait L, et al. The international study on general practitioners and early psychosis (IGPS). Schizophr Res. 2009;108:182–90.

    Article  PubMed  Google Scholar 

  45. Morrison AP, French K, Stewart SLK, et al. Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. Br Med J. 2012;344, e2233.

    Article  Google Scholar 

  46. Stafford MR, Jackson H, Mayo-Wilson F, et al. Early interventions to prevent psychosis: systematic review and meta-analysis. Br Med J. 2013;346:f184. A robust review & meta-analysis. It is notable that most of the CBT trials included were small; only 2 were large multisite studies and neither showed a statistically robust effect in favour of CBT.

    Article  Google Scholar 

  47. Fusar-Poli P, Bonoldi I, Yung AR, et al. Meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry. 2012;69:220–9. Contains a useful discussion of the whole area of very early detection and transition to psychosis rates.

    Article  PubMed  Google Scholar 

  48. Yung AR, Yuen HP, Berger G, et al. Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophr Bull. 2007;33:673–81.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Wiltink S, Velhorst E, Nelson B, et al. Declining transition rates to psychosis: the contribution to potential changes in referral pathways to an ultra-high-risk service. Early Interv Psychiatry. 2015;9:200–6.

    Article  PubMed  Google Scholar 

  50. Yung AR, Woods SW, Ruhrman S, et al. Whither the attenuated psychosis syndrome? Schizophr Bull. 2012;38:1130–4.

    Article  PubMed Central  PubMed  Google Scholar 

  51. IRIS (2012). IRIS guidelines update. IRIS Initiative Ltd.

  52. Patel MX. Attitudes to psychosis: health professionals. Epidemiol Psychiatry Soc. 2004;13:213–128.

    Article  Google Scholar 

  53. Carr VJ, Lewin TJ, Barnard RE, et al. Attitudes and roles of general practitioners in the treatment of schizophrenia compared with community mental health staff and patients. Soc Psychiatry Psychiatr Epidemiol. 2004;39:78–84.

    Article  PubMed  Google Scholar 

  54. Arkar H, Eker D. Influence of having a hospitalized mentally ill member of the family on attitudes towards mental patients in Turkey. Soc Psychiatry Psychiatr Epidemiol. 1992;27:151–5.

    CAS  PubMed  Google Scholar 

  55. Ucok A, Soygur H, Atakli C, et al. The impact of antistigma education on the attitudes of general practitioners regarding schizophrenia. Psychiatry Clin Neurosci. 2006;60:439–43.

    Article  PubMed  Google Scholar 

  56. Album D, Westin S. Do diseases have a prestige hierarchy? A survey among physicians and medical students. Soc Sci Med. 2008;66:182–8.

    Article  PubMed  Google Scholar 

  57. Moore A. Shared care. Fair share. Health Service Journal supplement (22/11/2012), 10–11.

  58. Corrigan PW, Mittal D, Reaves C, et al. Mental health stigma and primary care health decisions. Psychiatry Res. 2014;218(1–2):35–8.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Lam TP, Lam K, Lam E, et al. Attitudes of primary care physicians towards patients with mental illness in Hong Kong. Asia Pac Psychiatry. 2013;5:E19–28.

    Article  PubMed  Google Scholar 

  60. Lam TP, Lam K, Lam E, et al. Does postgraduate training in community mental health make a difference to primary care physicians’ attitudes to depression and schizophrenia? Community Ment Health J. 2014. doi:10.1007/s10597-015-9829-9.

    Google Scholar 

  61. Mittal D, Corrigan P, Sherman MD, et al. Healthcare providers’ attitudes toward persons with schizophrenia. Psychiatry Rehabil J. 2014;37(4):297–303.

    Article  Google Scholar 

  62. Galon P, Graor CH. Engagement in primary care treatment by persons with severe and persistent mental illness. Arch Psychiatr Nurs. 2012;26(4):272–84.

    Article  PubMed  Google Scholar 

  63. National Association of Community Health Centers. Health wanted. The State of Unmet Need for Primary Health Care in America. 2012, Bethesda MD

  64. Druss BG, von Esenwein SA, Compton MT, et al. A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study. Am J Psychiatry. 2010;167:151–9.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Collins C, Hewson DL, Munger R, et al. Evolving models of behavioural health integration in primary care. New York: Milbank Memorial Fund; 2010.

    Book  Google Scholar 

  66. World Health Organisation. mhGAP: Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders. Geneva: WHO Press; 2008.

    Google Scholar 

  67. Yeomans D, Taylor M, Currie A, et al. Resolution and remission in schizophrenia—getting well and staying well. Adv Psychiatry Treat. 2010;16:86–95.

    Article  Google Scholar 

  68. Andraeason NC, Carpenter Jr WT, Kane JM, et al. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 2005;162:441–9.

    Article  Google Scholar 

  69. Fear CF, Yeomans D, Moore B, et al. Managing schizophrenia in primary care: the utility of remission criteria as outcome indicators. J Ment Health in Family Med. 2009;6:107–12.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Rose Jones, Barnaby Major and Christopher Fear declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. 2Gether Foundation NHS Trust, Stonebow Unit, Stonebow Road, Hereford, HR1 2ER, UK

    Rose Jones

  2. 2Gether Foundation NHS Trust, 62, Etnam Street, Leominster, HR6 8AQ, UK

    Barnaby Major

  3. 2Gether Foundation NHS Trust, Monkmoor Court, 31-34 Commercial Road, Hereford, HR1 2BG, UK

    Christopher Fear

Authors
  1. Rose Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barnaby Major
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher Fear
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher Fear.

Additional information

This article is part of the Topical Collection on Schizophrenia and Other Psychotic Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jones, R., Major, B. & Fear, C. Schizophrenia in a Primary Care Setting. Curr Psychiatry Rep 17, 84 (2015). https://doi.org/10.1007/s11920-015-0620-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-015-0620-y

Keywords

Search

Navigation