Background
Methods
Setting
Study population
Exposure
Symptom group | Individual symptoms† included in each group |
---|---|
Psychological symptom | |
Mood-related symptom | Depression, anhedonia, guilt, mood swings, suicidal/self-harm ideation or behaviour |
‘Neurotic’ symptom | Neuroses, anxiety, irritability and anger, restlessness, worrying thoughts |
Behavioural change | Deterioration, social withdrawal, impulsivity, reduced self-esteem, aggressive and disruptive behaviour, odd behaviour |
Change in volition | Apathy (loss of drive), tiredness/fatigue (loss of energy), boredom (loss of interest) |
Perceptual problem | Hallucinations, delusions, illusions |
Cognitive change | Disturbance of attention, concentration/preoccupation difficulties, cognitive/memory impairment, thought disorder/blocking |
Substance misuse | Opioids, alcohol, cannabis, hypnotic, cocaine, amphetamine, glue, tobacco, hallucinogen, ecstasy, antidepressant, solvent, other/multiple stimulant, general (codes without specific substance) |
Physical symptom | Speech abnormality, sleep disturbance, loss of weight, poor appetite, dryness of the mouth, dysphagia, hyperventilation, muscle tension, epigastric discomfort, palpitations, shortness of breath, excessive wind, decreased libido, menstrual problem (in females), failure of erection (in males) |
Covariates
Codes and identification
Statistical analysis
Patient and public involvement
Results
Patient characteristics
FEP patients (n = 3045) | Matched participants (n = 12,180) | p value | |
---|---|---|---|
Type of psychosis, n (%) | |||
Non-affective | 2036 (66.9) | NA | |
Drug-induced | 678 (22.3) | NA | |
Affective | 309 (10.2) | NA | |
Pregnancy-related | 22 (0.7) | NA | |
Year of the index date, median (IQR) | 2010 (2007, 2013) | 2010 (2007, 2013) | Matched |
Age, median (IQR) | 30 (23, 39) | 30 (23, 39) | Matched |
Male, n (%) | 1914 (62.9) | 7656 (62.9) | Matched |
Geographical region, n (%) | Matched | ||
London | 271 (8.9) | 1084 (8.9) | |
South England | 798 (26.2) | 3192 (26.2) | |
Midlands and East England | 599 (19.7) | 2396 (19.7) | |
North England | 532 (17.5) | 2128 (17.5) | |
Northern Ireland | 168 (5.5) | 672 (5.5) | |
Scotland | 356 (11.7) | 1424 (11.7) | |
Wales | 321 (10.5) | 1284 (10.5) | |
Smoking, n (%) | < 0.0001 | ||
Non-smoker | 1011 (33.2) | 6041 (49.6) | |
Ever smoker | 1764 (57.9) | 4031 (33.1) | |
Unknown | 270 (8.9) | 2108 (17.3) | |
Alcohol consumption, n (%) | NS | ||
Non-drinker | 298 (9.8) | 1026 (8.4) | |
Ever drinker | 1742 (57.2) | 5907 (48.5) | |
Unknown | 1005 (33.0) | 5247 (43.1) | |
Body mass index, median (IQR) | 23.8 (21.0, 27.9) | 24.5 (21.6, 28.3) | < 0.0001 |
< 18.5 kg/m2 (underweight), n (%) | 150 (4.9) | 326 (2.7) | |
≥ 18.5 kg/m2 and < 25 kg/m2 (normal), n (%) | 1085 (35.6) | 3578 (29.4) | |
≥ 25 kg/m2 and < 30 kg/m2 (overweight), n (%) | 501 (16.5) | 2025 (16.6) | |
≥ 30 kg/m2 (obese), n (%) | 355 (11.7) | 1355 (11.1) | |
Unknown, n (%) | 954 (31.3) | 4896 (40.2) | |
Number of different prescriptions in 5 years before the index date, median (IQR) | 4 (3, 6) | 3 (1, 5) | < 0.0001 |
Number of GP consultations in 5 years before the index date, median (IQR) | 55 (29, 95) | 25 (10, 53) | < 0.0001 |
4–5 years prior to the index date | 6 (2, 15)† | 3 (1, 9) | < 0.0001 |
3–4 years prior to the index date | 7 (2, 16)† | 4 (1, 10) | < 0.0001 |
2–3 years prior to the index date | 8 (2, 18)† | 4 (1, 11) | < 0.0001 |
1–2 years prior to the index date | 9 (3, 20)† | 4 (1, 11) | < 0.0001 |
0–1 year prior to the index date | 17 (8, 30)† | 4 (1, 12) | < 0.0001 |
Number of symptom records in 5 years before the index date, median (IQR)‡ | 2 (1, 5) | 0 (0, 1) | < 0.0001 |
Prodrome symptoms
Symptom group | FEP patients (n = 3045) | Matched participants (n = 12,180) | Crude odds ratio (95% CI)‡ | Adjusted odds ratio‡* (95% CI) | ||
---|---|---|---|---|---|---|
n† | 5-year prevalence (%) | n† | 5-year prevalence (%) | |||
Psychological symptom | ||||||
Mood-related symptom | 1473 | 48.4 | 1275 | 10.5 | 10.1 (9.12, 11.3) | 7.60 (6.75, 8.56) |
‘Neurotic’ symptom | 1133 | 37.2 | 1106 | 9.1 | 6.54 (5.89, 7.27) | 4.87 (4.35, 5.47) |
Behavioural change | 490 | 16.1 | 657 | 5.4 | 3.53 (3.08, 4.05) | 2.67 (2.30, 3.09) |
Change in volition | 394 | 12.9 | 923 | 7.6 | 1.88 (1.64, 2.16) | 1.33 (1.14, 1.55) |
Perceptual problem | 162 | 5.3 | 5 | 0.04 | 130 (53.7, 313) | 112 (44.4, 283) |
Cognitive change | 38 | 1.3 | 30 | 0.3 | 5.41 (3.35, 8.75) | 3.80 (2.04, 7.09) |
Substance misuse | 338 | 11.1 | 134 | 1.1 | 13.0 (10.4, 16.4) | 8.09 (6.36, 10.3) |
Physical symptom | 939 | 30.8 | 1926 | 15.8 | 2.70 (2.43, 2.99) | 1.80 (1.61, 2.02) |
Time from the first symptom to diagnosis
Common symptom clusters in FEP patients
Assigned cluster, n (%) | Mean posterior probability for each cluster | ||
---|---|---|---|
NMSC | ASC | MSC | |
NMSC, n = 1487 (48.8) | 0.809 | 0.174 | 0.018 |
ASC, n = 1220 (40.1) | 0.128 | 0.713 | 0.159 |
MSC, n = 338 (11.1) | 0.022 | 0.236 | 0.743 |
Symptom clusters | p value† | |||
---|---|---|---|---|
NMSC patients (n = 1487) | ASC patients (n = 1220) | MSC patients (n = 338) | ||
Type of psychosis, n (%)‡ | < 0.0001 | |||
Non-affective | 1023 (68.8) | 819 (67.1) | 194 (57.4) | |
Drug-induced | 305 (20.5) | 277 (22.7) | 96 (28.4) | |
Affective | 146 (9.8) | 117 (9.6) | 46 (13.6) | |
Male, n (%) | 1064 (71.6) | 727 (59.6) | 123 (36.4) | < 0.0001 |
Age, median (IQR) | 29 (21, 38) | 31 (24, 38) | 33 (25, 41) | < 0.0001 |
Year of the index date, median (IQR) | 2010 (2007, 2013) | 2010 (2007, 2013) | 2010 (2007, 2012) | NS |
Geographical region, n (%) | < 0.0001 | |||
London | 158 (10.6) | 92 (7.5) | 21 (6.2) | |
South England | 406 (27.3) | 300 (24.6) | 92 (27.2) | |
Midlands and East England | 274 (18.4) | 249 (20.4) | 76 (22.5) | |
North England | 243 (16.3) | 236 (19.3) | 53 (15.7) | |
Northern Ireland | 53 (3.6) | 92 (7.5) | 23 (6.8) | |
Scotland | 189 (12.7) | 125 (10.3) | 42 (12.4) | |
Wales | 164 (11.0) | 126 (10.3) | 31 (9.2) | |
Smoking, n (%) | 0.022 | |||
Non-smoker | 495 (33.3) | 387 (31.7) | 129 (38.2) | |
Ever smoker | 802 (53.9) | 768 (63.0) | 194 (57.4) | |
Unknown | 190 (12.8) | 65 (5.3) | 15 (4.4) | |
Alcohol consumption, n (%) | 0.005 | |||
Non-drinker | 155 (10.4) | 112 (9.2) | 31 (9.2) | |
Ever drinker | 730 (49.1) | 777 (63.7) | 235 (69.5) | |
Unknown | 602 (40.5) | 331 (27.1) | 72 (21.3) | |
Body mass index, median (IQR) | 23.4 (20.9, 27.1) | 23.8 (21.0, 28.1) | 25.0 (21.3, 30.2) | < 0.0001 |
< 18.5 kg/m2 (underweight), n (%) | 65 (4.4) | 61 (5.0) | 24 (7.1) | |
≥ 18.5 kg/m2 and < 25 kg/m2 (normal), n (%) | 502 (33.8) | 460 (37.7) | 123 (36.4) | |
≥ 25 kg/m2 and < 30 kg/m2 (overweight), n (%) | 215 (14.5) | 215 (17.6) | 71 (21.0) | |
≥ 30 kg/m2 (obese), n (%) | 125 (8.4) | 154 (12.6) | 76 (22.5) | |
Unknown, n (%) | 580 (39.0) | 330 (27.1) | 44 (13.0) | |
Number of different prescriptions in 5 years before diagnosis, median (IQR) | 3 (2, 5) | 5 (3, 7) | 7 (5, 8) | < 0.0001 |
Number of GP consultations in 5 years before diagnosis, median (IQR) | 36 (19, 65) | 66 (42, 103) | 119 (79, 171) | < 0.0001 |
4–5 years prior to diagnosis | 4 (1, 10) | 8 (3, 17) | 15 (8, 27) | < 0.0001 |
3–4 years prior to diagnosis | 4 (1, 11) | 9 (3, 18) | 18 (9, 33) | < 0.0001 |
2–3 years prior to diagnosis | 5 (1, 11) | 10 (4, 20) | 21 (11, 33) | < 0.0001 |
1–2 years prior to diagnosis | 6 (2, 13) | 13 (5, 22) | 21 (12, 40) | < 0.0001 |
0–1 year prior to diagnosis | 11 (5, 21) | 21 (11, 33) | 32 (19, 52) | < 0.0001 |