Stavanger University Hospital, Regional Centre for Clinical Research in Psychosis, Psychiatric Clinic, Stavanger and Institute of Psychiatry, University of Bergen, Bergen, Norway.
Early Interv Psychiatry. 2009 Sep;3 Suppl 1:S13-6. doi: 10.1111/j.1751-7893.2009.00125.x.
To discuss how health-care systems can achieve early detection of patients with first-episode psychosis.
A selective literature review was conducted.
The optimal design of health-care systems to promote early detection of psychosis had received considerable attention. Primary and specialist care both had important roles to play. Referral from primary care was a key pathway for patient identification. However, the recognition of emerging psychosis in the primary care setting can be challenging, and there was a need for educational initiatives to support primary care in performing this essential function. Rapid access to specialist care should be available when required. However, patients with early psychosis may not seek help from primary care for a variety of reasons, such as social withdrawal, lack of insight or fear of stigmatization. With this in mind, a number of assertive outreach programmes had been established that permit self-referral, rapid assessment and fast access to treatment. There was some evidence that these rapid detection units were successful in identifying 'harder-to-reach' patients. Finally, information campaigns aimed at the general public can raise awareness and promote help-seeking behaviours, and this appeared to be an important factor in reducing the duration of untreated psychosis.
To promote the rapid identification of patients with psychosis, health-care systems require a range of measures that recognize the different ways in which psychosis can be presented to the medical services. Education of general practitioners, assertive outreach, low-threshold detection teams and general information campaigns are all important elements of early detection.
探讨医疗保健系统如何实现对首发精神病患者的早期发现。
进行了选择性文献回顾。
医疗保健系统的最佳设计以促进精神病的早期发现已受到广泛关注。初级保健和专科护理都有重要作用。从初级保健转诊是识别患者的关键途径。然而，在初级保健环境中识别新发精神病可能具有挑战性，需要开展教育计划来支持初级保健履行这一基本职能。当需要时，应能迅速获得专科护理。然而，由于各种原因，如社会退缩、缺乏洞察力或害怕污名化，患有早期精神病的患者可能不会向初级保健寻求帮助。考虑到这一点，已经建立了一些果断的外展计划，允许自我转诊、快速评估和快速获得治疗。有一些证据表明，这些快速检测单位成功地发现了“更难接触”的患者。最后，针对公众的宣传活动可以提高认识，促进寻求帮助的行为，这似乎是减少未治疗精神病持续时间的一个重要因素。
为了促进精神病患者的快速识别，医疗保健系统需要采取一系列措施，认识到精神病可以通过不同的方式呈现给医疗服务。对全科医生的教育、果断的外展、低门槛检测小组和一般信息宣传都是早期发现的重要组成部分。
