First episode schizophrenia in general practice: a national survey

AbstractObjective: We sought to establish the views of general practitioners about detecting and managing patients with a first episode of schizophrenia in Ireland.Method: Twenty per cent of GPs were invited to participate in a cross-sectional postal survey.Results: Sixty-two per cent (n = 261) participated. Almost all (99.2%) see at least one case of suspected first episode schizophrenia annually. The most commonly (80.7%) encountered symptom is ‘bizarre behaviour’. Many (47.7%) rarely or never prescribe antipsychotics to patients whom they suspect have a first episode of schizophrenia. However, 80.6% of GPs reported that they ‘always’ refer this group of patients to psychiatric services. Over half (57.8%) advised patients with schizophrenia to continue medication for less than a year. A large number of respondents reported that it is difficult to obtain a rapid psychiatric assessment.Conclusions: GPs want more information about identifying early psychosis, a closer liaison with psychiatric services and a rapid intervention service.

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Too many surveys! Eliciting the views of general practitioners for not participating in postal surveys

Australian Journal of Primary Health ◽

10.1071/py04029 ◽

2004 ◽

Vol 10 (2) ◽

pp. 76 ◽

Cited By ~ 11

Author(s):

Asaduzzaman Khan ◽

Rafat Hussain ◽

David Plummer ◽

Victor Minichiello

Keyword(s):

General Practice ◽

General Practitioners ◽

Overall Response Rate ◽

New South ◽

Postal Survey ◽

Cross Sectional ◽

Sexually Transmitted ◽

Research Activities ◽

South Wales ◽

Survey Results

This study explored the reasons general practitioners (GPs) are reluctant to participate in a postal survey. A cross-sectional postal survey was conducted among currently practising GPs in New South Wales, Australia, in 2002, who were asked to complete a questionnaire on the management of sexually transmitted infections (STIs). The overall response rate for the main STI survey was 45.4%. The GPs who did not respond to the STI questionnaire were sent a one-page non-response questionnaire asking them to report their reasons for not participating in the STI survey. Of the 491 non-responding GPs, 116 (23.6%) completed the non-response questionnaire and form the basis of the present paper. The key reasons reported by GPs for not participating in postal surveys were acute time constraints imposed by increasing workload including substantially increased paperwork, receiving too many survey requests, low STI caseload, and few incentives or returns on their time spent on completing surveys. While researchers need to be cognisant of constraints in general practice, it is also important to develop strategies for increasing GP involvement in research activities. To help improve participation of GPs in postal surveys, we recommend involvement of GPs in the design and conduct of research on issues relevant to general practice along with provision of feedback of survey results.

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General practitioners and schizophrenia: Results from a Swiss survey

The British Journal of Psychiatry ◽

10.1192/bjp.187.3.274 ◽

2005 ◽

Vol 187 (3) ◽

pp. 274-281 ◽

Cited By ~ 31

Author(s):

Andor E. Simon ◽

Christoph Lauber ◽

Katja Ludewig ◽

Hellmuth Braun-Scharm ◽

Daniel S. Umbricht

Keyword(s):

General Practice ◽

General Practitioners ◽

Chronic Schizophrenia ◽

First Episode ◽

Number Of Patients ◽

Treatment Knowledge ◽

Low Threshold ◽

Low Prevalence ◽

First Episode Schizophrenia ◽

Early Phases

BackgroundGeneral practitioners (GPs) have an important role in the care of patients with chronic schizophrenia and of those in the early phases of this disorder.AimsTo obtain information about the number of patients in the early and chronic stages of schizophrenia seen in general practice; the needs and attitudes of GPs, their diagnostic knowledge concerning early phases of schizophrenia and their knowledge and practice concerning treatment of patients with first-episode and multi-episode schizophrenia.MethodApostal survey was conducted among randomly selected GPs in Switzerland.ResultsAtotal of 1089 GPs responded to the survey. Early psychosis had a low prevalence in general practice, and GPs expressed a wish for specialised, low-threshold referral services. Diagnostic and treatment knowledge showed inconsistencies. Most GPs said they would treat first-episode schizophrenia with antipsychotics, but only a third recommended maintenance treatment after a first episode of schizophrenia that would conform with international recommendations.ConclusionsEasily accessible, low-threshold referral services are pivotal in supporting GPs in the management and treatment of emerging schizophrenia in primary healthcare patients.

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Cross-sectional analysis of coding, patient characteristics, consultation frequency and pharmacological treatment of adults with severe mental disorders in Irish general practice

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02747-4 ◽

2021 ◽

Author(s):

James Larkin ◽

Ivana Pericin ◽

Brian Osborne ◽

Philip Dodd ◽

Claire Collins

Keyword(s):

General Practice ◽

Mental Disorders ◽

Depressive Disorder ◽

General Practitioners ◽

Pharmacological Treatment ◽

Mental Health Problems ◽

Patient Characteristics ◽

Severe Mental Disorders ◽

Consultation Rate ◽

Cross Sectional

Abstract Background General practitioners are the gatekeepers of Irish healthcare and they offer continuity of care to patients. Irish general practice is therefore considered appropriate for preventing, diagnosing and managing most mental health problems. Aims This study sought to establish the coding frequency, consultation frequency, patient characteristics and pharmacological treatment of patients with severe mental disorders (SMDs) in Irish general practice. Methods A cross-sectional design was used. A finder tool embedded in the practice software assisted general practitioners (GPs) coding adult patients with SMDs. Eleven practices uploaded anonymous data on 2,203 patients. Variables analysed included disease code, consultations, prescriptions, sex, patient status and age. Results Overall, 2.9% (n = 2,337) of patients had ever been coded with a SMD, 2.4% (n = 1,964) coded with depressive disorder ever and 0.26% (n = 209) and 0.3% (n = 233) with bipolar disorder and schizophrenia, respectively. Overall, 68.0% (n = 1,336) of patients with depressive disorder were female, and 74.0% (n = 171) of patients with schizophrenia were public patients. The median consultation rate in the previous 3 years was highest for schizophrenia patients at 24.5 visits. Conclusions Coding of SMDs in Irish general practice appears incomplete. Patients with SMDs have high consultation rates. Patients with depressive disorder are more likely to be female and public patients. This research suggests that the improvement of coding in Irish general practice is the first practical step required to detecting prevalence rates.

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Monocytic Subsets and Their Signature Genes Differentially Impact Cortex and Cognition in First-Episode Schizophrenia

10.1101/2021.09.13.21262813 ◽

2021 ◽

Author(s):

Song Chen ◽

Keerthana Chithanathan ◽

Fengmei Fan ◽

Meihong Xiu ◽

Hongzhen Fan ◽

...

Keyword(s):

Calcium Binding ◽

Transmembrane Protein ◽

Visual Learning ◽

Protein A ◽

Occipital Cortex ◽

First Episode ◽

Future Research ◽

Cross Sectional ◽

Signature Genes ◽

First Episode Schizophrenia

Accumulating evidence supports involvement of innate immunity in the pathophysiology of schizophrenia. Monocytes are a highly heterogeneous population, subcategorized into classical (CD14++CD16-), intermediate (CD14++CD16+) and nonclassical subsets (CD14+CD16++). How monocytic subsets may shape brain structures and functions remains unclear. The primary goal of this cross-sectional study was to investigate the inter-relationships among monocytic subsets and their specific transcriptomic profiles, cerebral cortical thickness, and cognitive functions in first-episode schizophrenia (FES) patients. We performed whole-blood RNA sequencing (RNAseq) in 128 FES patients and 111 healthy controls (HCs) along with MATRICS Consensus Cognitive Battery (MCCB) measurement, as well as neuroimaging and flow cytometry among partial participants. RNAseq revealed significantly changed expressions of 54 monocytic signature genes in FES patients compared to HCs, especially for intermediate and nonclassical monocytic subsets, with the most outstanding alterations being downregulated S100 Calcium Binding Protein A (S100A) and upregulated Interferon Induced Transmembrane Protein (IFITM) family members, respectively. The percentage of nonclassical monocytes was decreased in FES patients. Cortical thicknesses and MCCB performance were expectantly reduced in FES patients too. Interestingly, negative inter-relationships of monocytic signature genes with both cortical thicknesses and cognition were found in HCs, which were weakened or even reversed in FES patients. Furthermore, the lateral occipital cortex fully mediated the negative effect of a classical monocytic gene Ribonuclease A Family Member 2 (RNASE2) on visual learning in patient group. This study suggests that monocytic dysfunctions play an essential role in cognitive deficit of schizophrenia, and their subtypes should be considered in future research.

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Collaboration amongst general practitioners and gynaecologists working in primary health care in Germany: a cross-sectional study

Primary Health Care Research & Development ◽

10.1017/s1463423621000165 ◽

2021 ◽

Vol 22 ◽

Author(s):

Barbara Trusch ◽

Christoph Heintze ◽

Elena Petelos ◽

Lorena Dini

Keyword(s):

Primary Care ◽

General Practitioners ◽

Interprofessional Collaboration ◽

Cross Sectional Study ◽

Postal Survey ◽

Sectional Study ◽

Healthcare Provision ◽

Cross Sectional ◽

Federal States ◽

Key Competencies

Abstract Aim: This cross-sectional study is the first one to explore the collaboration of the influencing factors thereof amongst general practitioners (GPs) and gynaecologists (Gyns) working in primary care in urban and rural settings in Germany. Background: The number of women aged ≥ 50 years is predicted to increase in the next years in Germany. This coincides with the ageing of primary care specialists providing outpatient care. Whereas delegation of tasks to nurses as a form of interprofessional collaboration has been the target of recent studies, there is no data regarding collaboration amongst physicians in different specialisations working in primary care. We explored collaboration amongst GPs and Gyn regarding the healthcare provision to women aged ≥ 50 years. Methods: A quantitative postal survey was administered to GPs and Gyns in three federal states in Germany, focusing on care provision to women aged ≥ 50 years. A total of 4545 physicians, comprising 3514 GPs (67% of the total GP population) randomly selected, and all 1031 Gyns practicing in these states received the postal survey in March 2018. A single reminder was sent in April 2018 with data collection ending in June 2018. Multiple logistic regressions were performed for collaboration, adjusted by age and sex, alongside descriptive methods. Findings: The overall response rate was 31% (1389 respondents): 861 GPs (25%) and 528 Gyns (51%), with the mean respondent age being 54.4 years. Seventy-two per cent were female. Key competencies of collaboration are associated with working in rural federal states and with network participation. Physicians from rural states [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.2, 1.9] and physicians in networks (OR = 3.0, CI = 2.3, 3.9) were more satisfied with collaboration. Collaboration to deliver services for women aged ≥ 50 years is more systematic amongst GPs and Gyns who are members of a network; increased networking could improve collaboration, and ultimately, outcomes too.

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Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders

JAMA Psychiatry ◽

10.1001/jamapsychiatry.2018.0185 ◽

2018 ◽

Vol 75 (5) ◽

pp. 458 ◽

Cited By ~ 23

Author(s):

Sherry Kit Wa Chan ◽

Stephanie Wing Yan Chan ◽

Herbert H. Pang ◽

Kang K. Yan ◽

Christy Lai Ming Hui ◽

...

Keyword(s):

Early Intervention ◽

Suicide Rate ◽

First Episode ◽

Early Intervention Service ◽

Schizophrenia Spectrum Disorders ◽

Schizophrenia Spectrum ◽

Intervention Service ◽

Spectrum Disorders ◽

First Episode Schizophrenia

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Connectome-Based Patterns of First-Episode Medication-Naïve Patients With Schizophrenia

Schizophrenia Bulletin ◽

10.1093/schbul/sbz014 ◽

2019 ◽

Vol 45 (6) ◽

pp. 1291-1299 ◽

Cited By ~ 13

Author(s):

Long-Biao Cui ◽

Yongbin Wei ◽

Yi-Bin Xi ◽

Alessandra Griffa ◽

Siemon C De Lange ◽

...

Keyword(s):

Network Architecture ◽

Functional Neuroimaging ◽

Brain Network ◽

First Episode ◽

Healthy Controls ◽

Cross Sectional ◽

Rich Club ◽

Functional Dynamics ◽

Neuroimaging Study ◽

First Episode Schizophrenia

Abstract Emerging evidence indicates that a disruption in brain network organization may play an important role in the pathophysiology of schizophrenia. The neuroimaging fingerprint reflecting the pathophysiology of first-episode schizophrenia remains to be identified. Here, we aimed at characterizing the connectome organization of first-episode medication-naïve patients with schizophrenia. A cross-sectional structural and functional neuroimaging study using two independent samples (principal dataset including 42 medication-naïve, previously untreated patients and 48 healthy controls; replication dataset including 39 first-episode patients [10 untreated patients] and 66 healthy controls) was performed. Brain network architecture was assessed by means of white matter fiber integrity measures derived from diffusion-weighted imaging (DWI) and by means of structural-functional (SC-FC) coupling measured by combining DWI and resting-state functional magnetic resonance imaging. Connectome rich club organization was found to be significantly disrupted in medication-naïve patients as compared with healthy controls (P = .012, uncorrected), with rich club connection strength (P = .032, uncorrected) and SC-FC coupling (P < .001, corrected for false discovery rate) decreased in patients. Similar results were found in the replication dataset. Our findings suggest that a disruption of rich club organization and functional dynamics may reflect an early feature of schizophrenia pathophysiology. These findings add to our understanding of the neuropathological mechanisms of schizophrenia and provide new insights into the early stages of the disorder.

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Morphology of the corpus callosum at different stages of schizophrenia: Cross-sectional study in first-episode and chronic illness

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.041251 ◽

2008 ◽

Vol 192 (6) ◽

pp. 429-434 ◽

Cited By ~ 56

Author(s):

Mark Walterfang ◽

Amanda G. Wood ◽

David C. Reutens ◽

Stephen J. Wood ◽

Jian Chen ◽

...

Keyword(s):

Corpus Callosum ◽

Chronic Schizophrenia ◽

Cross Sectional Study ◽

First Episode ◽

Schizophrenia Spectrum Disorders ◽

Cross Sectional ◽

Size And Shape ◽

Schizophrenia Spectrum ◽

First Episode Schizophrenia ◽

Parietal Cortices

BackgroundThe shape of the corpus callosum may differ in schizophrenia, although no study has compared first-episode with established illness.AimsTo investigate the size and shape of the corpus callosum in a large sample of people with first-episode and established schizophrenia.MethodCallosal size and shape were determined using highresolution magnetic resonance imaging on 76 patients with first-episode schizophrenia-spectrum disorders, 86 patients with established schizophrenia and 55 healthy participants.ResultsThere were no significant differences in total area across groups. Reductions in callosal width were seen in the region of the anterior genu in first-episode disorder (P<0.005). Similar reductions were seen in the chronic schizophrenia group in the anterior genu, but also in the posterior genu and isthmus (P = 0.0005).ConclusionsReductions in anterior callosal regions connecting frontal cortex are present at the onset of schizophrenia, and in established illness are accompanied by changes in other regions of the callosum connecting cingulate, temporal and parietal cortices.

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