Early psychosis - how can we help?

Dr David Shiers OBE, Honorary Research Consultant, Psychosis Research Unit 

The BMJ recently published two articles to support GPs and other non-specialist doctors in helping their patients who experience psychosis for the first time.

In many countries, the provision of early intervention in psychosis (EIP) by community-based mental health services is transforming the experiences and outlook of people with emerging psychosis and their families. However timely access to these services hinges on identification and referral by doctors working in non-specialist service settings such as primary care and hospital accident units.   

The BMJ practice pointer highlights how GPs can meet the practical challenge of distinguishing a relatively uncommon presentation like psychosis, perhaps one new case per year, from more common and less severe psychiatric disorders. The article draws parallels with GP recognition of serious but uncommon physical disorders; the particular ability of GPs to work with diagnostic uncertainty; the strengths of primary care as a familiar healthcare setting for an individual and their family built on continuity of care developed over time from repeated encounters for a variety of problems. 

The BMJ clinical update aims to help generalists such as GPs understand the benefits of EIP that justify a far more optimistic outlook than often appreciated. Nor does the GP contribution stop with identification and referral to specialist care of a first episode of psychosis. The BMJ clinical update not only summarises the current evidence for EIP but also emphasises the contribution that primary care can make to keeping the body in mind to reduce the downstream risk of poor physical health that their patients with early psychosis face. 

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