Abstract
Objective
This study was conducted to explore how general practitioners (GPs) manage subjects with early psychosis and collaborate with psychiatrists in the care of such patients.
Methods
Survey questionnaires exploring practice in patients with early psychosis were mailed to all GPs in South-Western France (n=3,829).
Results
The response rate was 23.6%. Half of GPs responding to the survey had actually diagnosed a possible case of schizophrenia during the previous year. In such cases, the most frequent decision was to refer the patient to a psychiatrist, despite the difficulties of convincing the patient and obtaining a rapid referral. According to GPs' answers, the relationships between primary care and the mental health team were characterised by a lack of communication: less than one out of three GPs had regular contact with a mental health team, and a large majority reported that they never or rarely had information about the diagnosis and treatment of subjects referred for early schizophrenia. Having regular contacts with mental health services had a major impact on GPs' management of subjects with early schizophrenia, in particular on reducing delays to obtain a psychiatric consultation and on level of information on diagnosis and treatment after referral.
Conclusion
Promotion of networking between primary care and mental health services is required to reduce delayed access to care in subjects with early schizophrenia.
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References
Goldberg D, Mann A, Tylee A (2001) In: Thornicroft G, Szumkler G (eds) Primary care, in textbook of community psychiatry. Oxford University Press, Oxford, pp 411–416
Hodges B, Inch C, Silver I (2001) Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1950–2000: a review. Am J Psychiatry 158:1579–1586
Kendrick T, Burns T, Freeling P (1995) Randomised controlled trial of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. BMJ 311:93–97
Nazareth I, King M, Tai SS (1996) Monitoring psychosis in general practice: a controlled trial. Br J Psychiatry 169:475–482
Lang FH, Johnstone EC, Murray GD (1997) Service provision for people with schizophrenia. II. Role of the general practitioner. Br J Psychiatry 171:165–168
Bebbington P, Tylee A (1998) The management of schizophrenia in the community: primary and secondary care. Prim Care Psychiatry 4:51–62
Burns T, Cohen A (1998) Item-of-service payments for general practitioner care of severely mentally ill persons: does the money matter? Br J Gen Pract 48:1415–1416
Carr VJ, Lewin TJ, Barnard RE et al (2004) Attitudes and roles of general practitioners in the treatment of schizophrenia compared with community mental health staff and patients. Soc Psychiatry Psychiatr Epidemiol 39:78–84
Kendrick T, Burns T, Garland C, Greenwood N, Smith P (2000) Are specialist mental health services being targeted on the most needy patients? The effects of setting up special services in general practice. Br J Gen Pract 50:121–126
Carr VJ, Lewin TJ, Barnard RE et al (2002) Comparisons between schizophrenia patients recruited from Australian general practices and public mental health services. Acta Psychiatr Scand 105:346–355
Lincoln CV, McGorry P (1995) Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis. Psychiatr Serv 46:1166–1171
Yung AR, McGorry PD, McFarlane CA, Jackson HJ, Patton GC, Rakkar A (1996) Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull 22:283–303
Krstev H, Carbone S, Harrigan SM, Curry C, Elkins K, McGorry PD (2004) Early intervention in first-episode psychosis—the impact of a community development campaign. Soc Psychiatry Psychiatr Epidemiol 39:711–719
Goldberg D, Huxley P (1980) Mental illness in the community: the pathway to psychiatric care. Tavistock, London
Gater R, Goldberg D (1991) Pathways to psychiatric care in South Manchester. Br J Psychiatry 159:90–96
Lincoln C, Harrigan S, McGorry PD (1998) Understanding the topography of the early psychosis pathways. An opportunity to reduce delays in treatment. Br J Psychiatry 172:21–25
Addington J, van Mastrigt S, Hutchinson J, Addington D (2002) Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatr Scand 106:358–364
Cougnard A, Kalmi E, Desage A et al (2004) Pathways to care of first-admitted subjects with psychosis in South-Western France. Psychol Med 34:267–276
Fuchs J, Steinert T (2004) Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Soc Psychiatry Psychiatr Epidemiol 39:375–380
Verdoux H, Cougnard A, Grolleau S, Besson R, Delcroix F (in press) A survey of general practioners' knowledge of symptoms and epidemology of schizophrenia. Eur Psychiatr
StataCorp (2001) Stata Statistical Software: Release 7.0
Direction de la Recherche des Etudes et de l'Evaluation des Statistiques (2002) Projections Médecins 2002–2020. DREES, Série Statistiques 30
Edwards P, Roberts I, Clarke M et al (2002) Increasing response rates to postal questionnaires: systematic review. BMJ 324:1183
Thomson C, Paterson-Brown S, Russell D, McCaldin D, Russell I (2004) Short report: encouraging GPs to complete postal questionnaires—one big prize or many small prizes? A randomized controlled trial. Fam Pract 21:697–698
Shiers D, Lester H (2004) Early intervention for first episode psychosis. BMJ 328:1451–1452
Verhaak PF (1993) Analysis of referrals of mental health problems by general practitioners. Br J Gen Pract 43:203–208
Réseau de Promotion pour la Santé Mentale 78 (2003) Rapport de l'enquête 2000 du réseau de promotion pour la Santé Mentale dans les Yvelines Sud. La Lettre de promotion Santé Mentale Yvelines Sud 4
Carr VJ (1997) The role of the general practitioner in the treatment of schizophrenia: general principles. Med J Aust 166:91–94
King M, Nazareth I (1996) Community care of patients with schizophrenia: the role of the primary health care team. Br J Gen Pract 46:231–237
Hardy J (2004) Secondary care must become more responsive to primary care. BMJ 329:401
Bindman J, Johnson S, Wright S et al (1997) Integration between primary and secondary services in the care of the severely mentally ill: patients' and general practitioners' views. Br J Psychiatry 171:169–174
Edwards J, McGorry P (2002) Implementing early intervention in psychosis. Martin Dunitz, London
Verdoux H, Tignol J (2003) Focus on psychiatry in France. Br J Psychiatry 183:466–471
Lewin TJ, Carr VJ (1998) Rates of treatment of schizophrenia by general practitioners. A pilot study. Med J Aust 168:166–169
Lucena RJ, Lesage A, Elie R, Lamontagne Y, Corbiere M (2002) Strategies of collaboration between general practitioners and psychiatrists: a survey of practitioners' opinions and characteristics. Can J Psychiatry 47:750–758
Hardy-Baylé M, Bronnec C (2003) Jusqu'où la psychiatrie peut-elle soigner? Odile Jacob, Paris
Acknowledgements
The study was supported by a grant from the French Ministry of Health (Programme Sciences bio-médicales, Santé et Société 2002, CNRS (SHS-SDV)–INSERM–MiRe-DREES, convention MiRe no. 10/02). Medical books on early psychosis were provided by Sanofi-Synthelabo. We thank the general practitioners who participated in the survey, and kindly acknowledge Ray Cooke who supervised the English of this paper. We thank the referees of a previous version of this paper for their helpful and thoughtful comments.
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Verdoux, H., Cougnard, A., Grolleau, S. et al. How do general practitioners manage subjects with early schizophrenia and collaborate with mental health professionals?. Soc Psychiat Epidemiol 40, 892–898 (2005). https://doi.org/10.1007/s00127-005-0975-1
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DOI: https://doi.org/10.1007/s00127-005-0975-1