MedWire News: There is wide range of ages and diagnostic groups among patients with first-episode psychosis (FEP), warn UK investigators who highlight the lack of research and treatment guidelines for such patients.
There has been a great deal of research into FEP in recent years. However, the majority of studies have focused on younger schizophrenia patients, and there has been a wide range of inclusion/exclusion criteria, as well as diagnostic criteria.
To investigate further, Robert Reay, from Tyne and Wear NHS Trust in Morpeth, Northumberland, and colleagues adapted the Population Adjusted Clinical Epidemiology (PACE) process to gather data on the incidence and diagnostic diversity of FEP in patients aged ≥16 years presenting between 1998 and 2005 in a county in Northern England.
In all, 500 patients presented with FEP during the study period, of whom 57% were male, 99% were Caucasian, 46% were aged <36 years, 30% were aged 36–64 years, and 24% were aged ≥65 years.
The most common diagnosis was schizophrenia, at 55%, while 29% of patients had affective psychoses, 9% had drug and alcohol induced psychoses, and 8% had organic psychoses. The most common individual diagnoses at presentation were psychotic depression and acute and transient psychotic disorder, at 19% each.
The frequency of diagnoses varied with age, with acute and transient psychotic disorder the most common disorder in patients aged less than 36 years, at 25%. For patients aged 36–64 years the most common disorder was psychotic depression, at 27%, while for patients aged 65 years and older, organic psychosis was the most common, at 26%, the team notes in the journal Acta Psychiatrica Scandinavica.
The annual incidence of all psychoses was 30.95 per 100,000 population, while that of schizophrenia spectrum disorder and affective psychoses was 17.02 and 8.94 per 100,000 population, respectively.
The team concludes: “First-episode psychosis is a varied condition in terms of age and diagnostic groups, but many patients are routinely excluded from research, leading to an incomplete picture.
“The value of the PACE methodology is that it has given a clearer picture of the full spectrum of FEP within an English county, so that unmet needs can be identified and services targeted and evaluated more accurately.”
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