Research into practice

Psychosis is a major health problem. It takes up 13 per cent of all health resources and can cause prolonged illness, suffering, disability and early death. The most effective treatment is possible when psychosis is detected early and if the critical three-year period following first episode psychosis (FEP) is well managed.

Research shows that the longer the duration of untreated psychosis (DUP) the worse the outcome.¹ Suicides tend to happen in the first years of mental illness.

Recent research in Gloucestershire² aimed to discover the treatment and care experiences of people, particularly younger people aged 14 to 35 experiencing first episodes of psychosis. Using a mix of postal questionnaires and face-to-face interviews, 23 service users, 10 carers and 15 GPs took part in the study.

For some it was typically a life-changing event, such as starting university or changing jobs, that prompted younger adults to seek care. For others it was the stress associated with work or education, such as taking exams, that triggered difficulties.

Although two-thirds of service users said that if things became serious they would go to their GP, it was the parents of younger adults who first suggested that they sought care.

The study highlighted the side-effects of medication, which were often weight gain (specifically with olanzapine), drowsiness, dizziness and lethargy – all of which contributed further to feelings of depression. One user said that the things she most disliked about her experience were the “side-effects of medication – weight gain has a big effect on your self-esteem, especially when only 18 or 19. It should be more realistically explained.”

Another complained: “GPs’ first answer to any problem is more medication.” And yet 60 per cent of GPs stated that they did not have access to medication guidance for the treatment of suspected FEP. However, one did counter: “Remember this is only a very small area of a GP’s work.”

It was important for service users to be kept informed and have things explained to them. One was pleased to note that: “The lack of understanding about what it all was, was the most unbearable thing, so advice and support was essential.”

Other knowledge gaps and unmet needs were also highlighted. For example, although the care programme approach is the foundation of good mental health services, 83 per cent of people with FEP did not know what this was. Also, 90 per cent of carers had not received a formal carers’ assessment.

While most involved were generally satisfied with their care and treatment the study did throw up a number of recommendations for improvement. These included:

• Raising awareness of all staff providing services to young people of the early warning signs of psychosis.
• Raising awareness of the needs of young people with psychosis by reducing stigma and providing accurate information.
• Recognising symptoms emerge in adolescence and that young people’s needs are different from adults.
• Recognising that family members are usually first to realise that something is wrong and as such should be targeted for improved information.

Although the findings of the study must be judged within the limited extent of the research, it highlights the importance of combining early diagnosis with sensitive information, explanation and services. CC

¹ A L Johnstone et al, “The Northwick Park study of first episodes of schizophrenia”, British Journal of Psychiatry, 148, 1986.

² Eric Davis, Mental Health Service Response to First-episode Psychosis in Gloucestershire, Gloucestershire Partnership NHS Trust, 2003. Contact eric.davis@glospart.nhs.uk