Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Schizophr Res. 2021 Feb;228:547-554. doi: 10.1016/j.schres.2020.11.031. Epub 2020 Nov 22.
Improving outcomes of a First Episode of Psychosis (FEP) relies on the ability to detect most individuals with emerging psychosis and treat them in specialised Early Intervention (EI) services. Efficacy of current detection strategies is undetermined.
RECORD-compliant clinical, 6-year, retrospective, transdiagnostic, lifespan-inclusive, Electronic Health Record (EHR) cohort study, representing real-world secondary mental healthcare in South London and Maudsley (SLaM) NHS. All individuals accessing SLaM in the period 2007-2017 and receiving any ICD-10 diagnosis other than persistent psychosis were included. Descriptive statistics, Kaplan-Meier curves, logistic regression, epidemiological incidence of psychosis in the general population were used to address pathways to care and detection power of EI services for FEP.
A total of 106,706 individuals underwent the 6-year follow-up: they were mostly single (72.57%) males (50.51%) of white ethnicity (60.01%), aged on average 32.96 years, with an average Health Of the Nation Outcome Scale score of 11.12 and mostly affected with F40-48 Neurotic/stress-related/somatoform disorders (27.46%). Their transdiagnostic risk of developing a FEP cumulated to 0.072 (95%CI 0.067-0.077) at 6 years. Those individuals who developed a FEP (n = 1841) entered healthcare mostly (79.02%) through inpatient mental health services (29.76%), community mental health services (29.54%) or accident and emergency departments (19.50%); at the time of FEP onset, most of them (46.43%) were under the acute care pathway. Individuals contacting accident and emergency departments had an increased risk of FEP (OR 2.301, 95%CI 2.095-2.534, P < 0.001). The proportion of SLaM FEP cases that were eligible and under the care of EI services was 0.456 at any time. The epidemiological proportion of FEP cases in the sociodemographically-matched general population that was detected by EI service was 0.373.
More than half of individuals who develop a FEP remain undetected by current pathways to care and EI services. Improving detection strategies should become a mainstream area in the future generation of early psychosis research.
改善首次精神病发作（FEP）的结果依赖于识别大多数出现精神病的个体并在专门的早期干预（EI）服务中对他们进行治疗的能力。目前检测策略的效果尚未确定。
RECORD 一致的临床，6 年，回顾性，跨诊断，终生包容性，电子健康记录（EHR）队列研究，代表了伦敦南部和莫兹利（SLaM）NHS 的现实世界中的二级精神保健。在 2007 年至 2017 年期间访问 SLaM 的所有人，除持续性精神病外，均接受任何 ICD-10 诊断。使用描述性统计，Kaplan-Meier 曲线，逻辑回归，普通人群中精神病的流行病学发病率来解决护理途径和 EI 服务对 FEP 的检测能力。
共有 106,706 人进行了 6 年的随访：他们主要是单身（72.57％）男性（50.51％），白人（60.01％），平均年龄为 32.96 岁，平均健康的国家产出量表评分为 11.12，主要患有 F40-48 神经症/应激相关/躯体形式障碍（27.46％）。他们在 6 年内累积发生 FEP 的风险为 0.072（95％CI 0.067-0.077）。那些发展为 FEP 的人（n=1841）主要通过住院精神卫生服务（29.76％），社区精神卫生服务（29.54％）或急症室（19.50％）进入医疗保健系统；在 FEP 发作时，他们中的大多数（46.43％）处于急性护理途径。接触急症室的人发生 FEP 的风险增加（OR 2.301，95％CI 2.095-2.534，P<0.001）。在任何时候，SLaM FEP 病例中有资格并接受 EI 服务的比例为 0.456。通过 EI 服务检测到的与人口统计学匹配的普通人群中 FEP 病例的流行病学比例为 0.373。
超过一半的 FEP 发展患者仍未被当前的护理途径和 EI 服务发现。改善检测策略应成为未来早期精神病学研究的主流领域。
