Pathways to care in a New Zealand first-episode of psychosis cohort

Mark Turner, Cecilia Smith-Hamel, Roger Mulder
Australian and New Zealand Journal of Psychiatry 2006, 40 (5): 421-8

OBJECTIVES: To present the clinical and sociodemographic characteristics of patients referred to a New Zealand early intervention for psychosis service and to describe the pathways to care for these patients.

METHOD: Clinical and sociodemographic characteristics were examined in 200 patients consecutively admitted to an early psychosis service over a 5-year period. Assessment measures included DSM-IV diagnosis, the Quality of Life Scale, Positive and Negative Syndrome Scale and information on pathways to care.

RESULTS: The majority of patients were young (mean age = 22.35), single (90.1%), male (72.5%), of New Zealand European descent (63.7%), living in the parental home (60.2%) and on a government benefit (60.2%). Overall, 40.8% of patients were initially diagnosed with a schizophrenia spectrum disorder, 36.4% with a mood disorder and 22.8% were classified as 'other psychoses' (substance-induced psychosis, brief psychotic disorder, etc.). Those with a schizophrenia spectrum disorder had a median duration of untreated psychosis of 120 days compared with 29 days for other diagnoses. Overall, 64.1% of referrals came from the Inpatient Service, 36.3% of patients had a compulsory admission under the Mental Health Act, and 41.8% had contact with police in 6 months prior to referral to the service. No differences in inpatient admission rates, police involvement or compulsory admission were evident for ethnicity or diagnosis.

CONCLUSIONS: The pathways to care, clinical and sociodemographic descriptors of the present sample are somewhat different to those previously reported in international cohorts. This reflects the inclusion of patients with affective psychoses, the age range of 18-30 years and New Zealand's distinctive healthcare system. Examination of the sociodemographic characteristics and pathways to care in the present cohort suggests that service reconfigurations are required to optimize the experience of inpatient admission, given the substantial proportion of clients with non-schizophrenia spectrum disorders that present acutely for treatment.

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