Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.
Psychol Med. 2010 Oct;40(10):1585-97. doi: 10.1017/S0033291710000371. Epub 2010 Mar 18.
Although there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).
Included studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.
Additional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.
尽管人们对精神分裂症治疗延迟与结局之间的关联达成了共识，但对于首次出现精神病发作的患者的就医途径知之甚少。就医途径复杂，涉及多种接触途径，并且可能会影响治疗的延迟。我们对首次出现精神病发作的患者的就医途径的性质和决定因素进行了系统评价。
我们检索了四个数据库（Medline、HealthStar、EMBASE、PsycINFO），以确定 1985 年至 2009 年期间发表的文章。我们手动检索了参考文献列表和相关期刊，并使用正向引文检索来识别其他文章。如果研究采用观察性设计来评估首次出现精神病发作（FEP）患者的就医途径，则将其纳入研究。
纳入的研究（n=30）探讨了就医途径中的首次接触以及导致治疗的转诊来源。在 21 项研究中的 13 项中，最大比例的患者的首次接触是医生。然而，在 22 项研究中的 9 项中，最大比例的患者的转诊来源是急诊服务。我们没有发现探索就医途径的性别、社会经济和/或种族决定因素，或就医途径对治疗延迟的影响的研究结果具有一致性。
需要进一步研究，以了解首次出现精神病发作的患者的求治行为、服务对这些接触的反应以及心理健康服务的就医途径的决定因素，为提供精神卫生服务提供信息。
