Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Social Psychiatry and Psychiatric Epidemiology
Erschienen in: Social Psychiatry and Psychiatric Epidemiology 9/2008

01.09.2008 | ORIGINAL PAPER

Pathways to care and treatment delays in first and multi episode psychosis

Findings from a developing country

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 9/2008

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Abiodun OA (1995) Pathways to mental health care in Nigeria. Psychiatr Serv 46(8):823–826PubMed
2.
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):1551–1562PubMedCrossRef
3.
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 182:105–116PubMedCrossRef
4.
Birchwood M, Todd P, Jackson C (1998) Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 172(33):53–59PubMed
5.
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):146–153PubMedCrossRef
6.
Bruffaerts R, Sabbe M, Demyttenaere K (2006) Who visits the psychiatric emergency room for the first time? Soc Psychiatry Psychiatr Epidemiol 41(7):580–586PubMedCrossRef
7.
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):475–483PubMedCrossRef
8.
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):350–356PubMedCrossRef
9.
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
10.
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):619–621PubMedCrossRef
11.
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):484–491PubMedCrossRef
12.
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):566–573PubMedCrossRef
13.
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):804–809PubMed
14.
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)
15.
Erinosho OA (1977) Pathways to mental health delivery-systems in Nigeria. Int J Soc Psychiatry 23(1):54–59PubMedCrossRef
16.
Etheridge K, Yarrow L, Peet M (2004) Pathways to care in first episode psychosis. J Psychiatr Ment Health Nurs 11(2):125–128PubMedCrossRef
17.
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):375–380PubMedCrossRef
18.
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
19.
Gater R, Goldberg D (1991) Pathways to psychiatric care in South Manchester. Br J Psychiatry 159:90–96PubMed
20.
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 186:529–535PubMedCrossRef
21.
Grant C, Addington J, Addington D, Konnert C (2001) Social functioning in first- and multiepisode schizophrenia. Can J Psychiatry 46(8):746–749PubMed
22.
Gureje O, Acha RA, Odejide OA (1995) Pathways to psychiatric care in Ibadan, Nigeria. Trop Geogr Med 47(3):125–129PubMed
23.
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):44–49PubMedCrossRef
24.
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):151–159PubMedCrossRef
25.
Harrigan SM, McGorry PD, Krstev H (2003) Does treatment delay in first-episode psychosis really matter? Psychol Med 33(1):97–110PubMedCrossRef
26.
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):69–75PubMed
27.
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):808–815PubMedCrossRef
28.
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):711–719PubMedCrossRef
29.
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–21SPubMedCrossRef
30.
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):1209–1223PubMedCrossRef
31.
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):21–25PubMed
32.
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):84–89PubMed
33.
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):975–983PubMedCrossRef
34.
Mkize LP, Uys LR (2004) Pathways to mental health care in KwaZulu-Natal. Curationis 27(3):62–71PubMed
35.
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):771–776PubMedCrossRef
36.
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):254–262PubMedCrossRef
37.
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 186:281–289PubMedCrossRef
38.
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):214–219PubMedCrossRef
39.
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):97–103PubMedCrossRef
40.
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):345–349PubMedCrossRef
41.
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):1785–1804PubMedCrossRef
42.
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):967–974PubMedCrossRef
43.
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):203–208PubMed
44.
Razali SM, Najib MA (2000) Help-seeking pathways among Malay psychiatric patients. Int J Soc Psychiatry 46(4):281–289PubMedCrossRef
45.
Reeler AP (1992) Pathways to psychiatric care in Harare, Zimbabwe. Cent Afr J Med 38(1):1–7PubMed
46.
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):909–928PubMedCrossRef
47.
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):219–228CrossRef
48.
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):519–525PubMed
49.
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):892–898PubMedCrossRef
50.
Wyatt RJ (1991) Neuroleptics and the natural course of schizophrenia. Schizophr Bull 17(2):325–351PubMed
Metadaten
Titel
Pathways to care and treatment delays in first and multi episode psychosis
Findings from a developing country
Publikationsdatum
01.09.2008
Erschienen in
Social Psychiatry and Psychiatric Epidemiology / Ausgabe 9/2008
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-008-0358-5

Weitere Artikel der Ausgabe 9/2008

Social Psychiatry and Psychiatric Epidemiology 9/2008 Zur Ausgabe

ORIGINAL PAPER

The development of needs in a group of severely mentally ill

ORIGINAL PAPER

Attempted suicide and associated risk factors among youth in urban Japan

ORIGINAL PAPER

Deconstructing the ‘black box’ of the Camberwell assessment of need score in mental health services evaluation

ORIGINAL PAPER

Clinical correlates of the caregiving experience for Chinese caregivers of patients with schizophrenia

ORIGINAL PAPER

Unemployment, social isolation, achievement–expectation mismatch and psychosis: findings from the ÆSOP Study

ORIGINAL PAPER

What predicts illicit drug use versus police-registered drug offending?

Neu im Fachgebiet Psychiatrie

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

23.04.2024 Depression antepartal oder postpartal Nachrichten

Bislang gibt es kein Medikament zur Prävention von Wochenbettdepressionen. Das Injektionsanästhetikum Esketamin könnte womöglich diese Lücke füllen.

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

22.04.2024 DGIM 2024 Kongressbericht

Die Kombination aus Medikamenten und Psychotherapie gilt als effektivster Ansatz bei Depressionen. Das ist bei betagten Menschen nicht anders, trotz Besonderheiten.

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

22.04.2024 DGIM 2024 Nachrichten

Um Menschen nach der Flucht aus einem Krisengebiet bestmöglich medizinisch betreuen zu können, ist es gut zu wissen, welche Erkrankungen im jeweiligen Herkunftsland häufig sind. Dabei hilft eine Internetseite der CDC (Centers for Disease Control and Prevention).

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise