By David Shiers, Musa Sami Saqib Latif, Sagnik Bhattacharyya.
The provision of early intervention in psychosis by community-based mental health services has transformed the experiences and outlook of people with emerging psychosis and their families. However, timely access to these services hinges on identification and referral by practitioners working in non-specialist service settings such as primary care and hospital accident units.
Early identification of psychosis and referral behaviour is influenced by health professionals’ attitudes towards psychosis. The British Medical Journal (BMJ) recently published a set of articles and a podcast to support the contribution made by non-specialist doctors, particularly general practitioners (GPs). Together, the publications aim to help non-specialist doctors understand the benefits of early intervention in psychosis that justify a far more optimistic outlook than typically recognised.
The BMJ practice pointer talks to the challenge for generalists such as GPs to recognise a relatively uncommon presentation like psychosis, perhaps one new case per year, from the highly prevalent distress and less severe psychiatric disorders that they encounter every day. The article acknowledges some of the strengths of primary care, particularly its familiarity as a healthcare setting for an individual and the continuity of care developed over time from repeated encounters for a variety of concerns.
Furthermore, the GP contribution doesn’t stop at the identification of a first episode of psychosis and referral to specialist care. The BMJ clinical update, therefore, summarises the current evidence for early intervention in psychosis and also emphasises the important and continued contribution that primary care can make to keeping the body in mind, in order to help avoid the downstream risk of poor physical health outcomes facing patients with early psychosis.
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References for further reading:
Clinical update: Early psychosis for the non-specialist doctor. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j4578 (8 Nov 2017)
Practice Pointer: How to approach psychotic symptoms in a non-specialist setting. BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4752 (8 Nov 2017)