Psychiatric antecedents in young patients with first episode psychosis: what relevance for clinical outcomes?

Abstract

Examining psychiatric antecedents and help-seeking behavior for people with First Episode Psychosis (FEP) could help understand determinants for timely care pathways, decrease the "Duration of Untreated Psychosis" (DUP), and consequently improve their prognosis. The aims of this study were: (1) to calculate the proportion of FEP participants with previous contact with mental healthcare services recruited within a specialized "Early Intervention in Psychosis" service, and (2) to longitudinally compare sociodemographic, clinical, and treatment parameters between FEP patients with and without psychiatric antecedents across a 2-year follow-up period. All participants (aged 12-35 years) were enrolled within the "Parma Early Psychosis" (Pr-EP) program. At baseline, they completed the Health of the Nation Outcome Scale (HoNOS). A mixed-design ANOVA and a Kaplan-Meier survival analysis were used. Of the 489 FEP participants, 204 (41.7%) patients had prior contact with mental health services. In 83% of cases, a care discontinuity was observed. Main psychiatric antecedents at entry were personality disorders (32.8%), anxious-depressive disorder (28.9%), conduct disorder (16.2%), and learning disorder (9.8%). FEP subjects with antecedents were more likely to receive a diagnosis of schizophrenia at baseline. Having previous contact with psychiatric services resulted to be a predictor of poorer clinical and functional outcome. It is very important to carefully monitor mental health suffering and related help-seeking-behavior in young patients typically manifested in their early 20s, especially in terms of psychosis prevention. Particular attention should also be given to service engagement as care continuity within adolescent-adult transition.