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Cited by 6Schizophrenia research and treatmentMental Health Treatment and AccessPsychiatric care and mental health services

The case for improved transdiagnostic detection of first-episode psychosis: electronic health record cohort study.

Fusar-Poli, Paolo, Oliver, Dominic, Spada, Giulia, Estrade, Andres, McGuire, Philip·2021·Schizophrenia Research
DOI 10.1016/j.schres.2020.11.031
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Abstract

Background 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.Methods 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.Results 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.Conclusions 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.

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  • Timely diagnosis of schizophrenia and bipolar disorder is challenging due to the prodromal phase, in which patients do not yet meet full diagnostic criteria, and due to symptom overlap with other disorders such as anxiety and depression.

    “However, timely diagnosis of schizophrenia and bipolar disorder is challenging due to the prodromal phase, in which patients do not yet meet full diagnostic criteria, and due to symptom overlap with other disorders such as anxiety and depression.”

    From Predicting Diagnostic Progression to Schizophrenia or Bipolar Disorder via Machine Learning (2025) · cites this paper as [7]

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Authors
Fusar-Poli, P., Oliver, D., Spada, G., Estrade, A., & McGuire, P.
Affiliations
King's College London (GB)
ORCID
Venue
Schizophrenia Research
Publisher
Elsevier BV
Published
2021-02
Volume
228
Pages
547-554
ISSN
0920-9964 (ISSN-L)
DOI
10.1016/j.schres.2020.11.031
OpenAlex
W3105095542
Cited by
6
References
62
Citations by year
2025: 2 · 2024: 1 · 2023: 1 · 2021: 2
FWCI
0.54
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Schizophrenia Research (publishedVersion)
  • PubMed (publishedVersion)
Funders
Medical Research Council (MC_PC_16048)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
first-episode psychosis, early intervention services
MeSH terms
Aged, Humans, London, Male, Psychotic Disorders, Retrospective Studies, Cohort Studies, Electronic Health Records

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