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Swiss GPs and early psychoses: Results from a national survey
50 SWISS GPS AND EARLY PSYCHOSES: RESULTS FROM A NATIONAL SURVEY A. E. S i m o n , * D. U m b r i c h t
Department of Psychiatry, External Psychiatric Services, Bruderholz, Switzerland General practitioners frequently represent the first contact for patients suffering from early psychoses and their families. Thus, exact information about the knowledge, current practice and needs of GPs in dealing with that patient group is needed. In a large, nationwide, two-phased survey among GPs in Switzerland, we assessed their attitudes, knowledge and needs with respect to assessment and treatment of patients suffering from early schizophrenic psychosis, using a comprehensive questionnaire. Of the 3878 GPs contacted, 1089 (28.2%) responded once, and 185 GPs responded twice. We defined a number of core items that are crucial for the assessment and corroboration of the diagnosis of an early schizophrenic psychosis to constitute a composite score that discriminated different levels of knowledge. Across all the knowledge levels, two core items were regularly under-identified: social decline and observation over a period of several months. This finding was independent of geographic variables and former psychiatric training. Even GPs who had attended seminars about early psychoses, showed this pattern of knowledge deficit. In addition, a factor analysis of items assessing knowledge and diagnostic steps was performed. It yielded 7 factors capturing history taking, somatic work-up, behavioural symptoms, affective symptoms, psychotic symptoms, prolonged observation and neuropsychological work-up. GPs in rural settings, with psychiatric training and of male sex demonstrated high scores on history taking, while GPs in cities, with more recent specialty training and of female sex emphasized somatic work-up and focused more on behavioural symptoms, respectively. Our results suggest that GPs demonstrate specific knowledge gaps concerning crucial aspects for the successful detection of patients in early stages of psychosis. Moreover, GPs in urban settings and recent specialty training seem to overemphasize somatic work-ups and neglect careful history taking. Education of GPs in the field of early detection of schizophrenic psychosis will have to address these deficits.
CHANGES IN THE INCIDENCE OF SCHIZOPHRENIA IN BRITISH COLUMBIA: 1907 TO 1913 G. N. Smith,* L. Lupton, W. G. H o n e r
Psychiatry, University of British Columbia, Vancouvel; BC, Canada Variability in the incidence of diseases over time can provide valuable information about risk factors. Inspection of British Columbia historical reports suggests that the incidence of schizophrenia doubled between 1909 and 1911 (20 to 40 per 100,000) and did not return to 1909 levels until 1914. This increase in incidence could be an artifact of expanding psychiatric services, altered admission criteria, or changes in diagnostic criteria, or could be indicative of a true increase in incidence. Individuals who were born during the ilffluenza pandemics of 1890 to 1894 would be in the age at risk for schizophrenia during 1911 to 1913 (17 to 23 years of age). An excess of patients within this age range would suggest influenza as a risk factor. In order to test the competing hypotheses, the records of patients hospitalized between 1907 and 1909 were compared to those between 1911 and 1913. In 1911, the British Columbia population was 392,480 of which 77% were male and 43% were Canadian-born. The remaining population included immigrants from Britain (27%),
3. Epidemiology Europe (10%), the U.S.A. (9%) and Asia (7%). DSM-IV diagnoses were applied based on patient clinical records and those with schizophrenia, schizophreniform, schizoaffective or bipolar disorders were included. All patients were hospitalized for the first time and were less than 60 years of age. There were 251 first-episode patients admitted between 1907 and 1909, and 580 between 1911 and 1913. An analysis of archival records failed to reveal any expansion of psychiatric services or changes in government or hospital policies that could explain the 1911-1913 increase. The application of DSM-IV criteria using patient records indicated that the increase was not due to changes in diagnostic criteria. Age and gender distribution was similar in the two time periods and there was no excess of patients born during the 1890-1894 influenza pandemics. From 1907-1909 to 1911-1913, the incidence of schizophrenia remained similar in the Canadian-born population (18 to 23 per 100,000) and in Asian-born immigrants (23 to 25 per 100,000). The rate increased in British (43 to 57 per 100,000) and US-born immigrants (28 to 57 per 100,000), and showed a substantial change in European-born immigrants (36 to 110 per 100,000).
SEX DIFFERENCES IN PSYCHOSIS: NORMAL OR PATHOLOGICAL? J. Spauwen,* L. Krabbendam, R. Lieb, H. U. Wittchen, J. van Os Department of Psychiatry and Neuropsychology, a~/Mondriaan/Riagg/RIBW/!Lijverdal Academic Centre, Maastricht University, European Graduate School of Neuroscience, Maastricht, Limburg, Netherlands Schizophrenia first appears in adolescence, in boys at an earlier age than girls. One way to elucidate the meaning of this key epidemiological finding, is to examine whether a similar age-related sex difference exists in the expression of subtler, non-clinical but much more frequent psychotic experiences such as low grade delusional ideas or auditory hallucinations that are continuous with the disorder but do not require treatment. (1) The Early Developmental Stages of Psychopathology (EDSP) study (2) was designed to collect data on prevalence, risk factors, comorbidity and course of mental disorders in a random population sample of adolescents and young adults in the Munich area (Germany). The data reported here are from the second follow-up wave (n=2548) and include demographic findings and the M-CIDI G-section for schizophrenia and schizophreniform disorders. This section assesses lifetime prevalence of positive psychotic symptoms. Logistic regression indicated that there was no main effect of age (in years) or sex on the presence of at least one positive symptom (OR t.00, 95% CI 0.97-1.03 and OR 0.92, 95% CI 0.75-1.13, respectively). However, a significant interaction between age and sex was present (likelihood ratio test: Z2=6.7, p=0.0097). Stratified analysis revealed that in the younger haft of the cohort (split around the median age of 21 years) the risk of having a positive psychotic symptom was higher for males than for females (OR=0.70, 95% CI 0.52-0.95), while no sex difference was found in the older cohort (OR=l.18, 95% CI 0.89-1.58). Non-clinical experiences of psychosis showed similar associations with sex as has been reported in the clinical disorder of schizophrenia, suggesting that sex differences in psychosis may reflect differential variation of a continuous phenotype, rather than differential expression of a rare causal pathological risk factor. This contrasts with some previous hypotheses, in particular that a rare early brain anomaly interacts with normal maturation to produce schizophrenia. 1. van Os J, Hanssen M, Bijl RV, Vollebergh W. Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison.
International Congress on Schizophrenia Research 2003
Department of Psychiatry, External Psychiatric Services, Bruderholz, Switzerland General practitioners frequently represent the first contact for patients suffering from early psychoses and their families. Thus, exact information about the knowledge, current practice and needs of GPs in dealing with that patient group is needed. In a large, nationwide, two-phased survey among GPs in Switzerland, we assessed their attitudes, knowledge and needs with respect to assessment and treatment of patients suffering from early schizophrenic psychosis, using a comprehensive questionnaire. Of the 3878 GPs contacted, 1089 (28.2%) responded once, and 185 GPs responded twice. We defined a number of core items that are crucial for the assessment and corroboration of the diagnosis of an early schizophrenic psychosis to constitute a composite score that discriminated different levels of knowledge. Across all the knowledge levels, two core items were regularly under-identified: social decline and observation over a period of several months. This finding was independent of geographic variables and former psychiatric training. Even GPs who had attended seminars about early psychoses, showed this pattern of knowledge deficit. In addition, a factor analysis of items assessing knowledge and diagnostic steps was performed. It yielded 7 factors capturing history taking, somatic work-up, behavioural symptoms, affective symptoms, psychotic symptoms, prolonged observation and neuropsychological work-up. GPs in rural settings, with psychiatric training and of male sex demonstrated high scores on history taking, while GPs in cities, with more recent specialty training and of female sex emphasized somatic work-up and focused more on behavioural symptoms, respectively. Our results suggest that GPs demonstrate specific knowledge gaps concerning crucial aspects for the successful detection of patients in early stages of psychosis. Moreover, GPs in urban settings and recent specialty training seem to overemphasize somatic work-ups and neglect careful history taking. Education of GPs in the field of early detection of schizophrenic psychosis will have to address these deficits.
CHANGES IN THE INCIDENCE OF SCHIZOPHRENIA IN BRITISH COLUMBIA: 1907 TO 1913 G. N. Smith,* L. Lupton, W. G. H o n e r
Psychiatry, University of British Columbia, Vancouvel; BC, Canada Variability in the incidence of diseases over time can provide valuable information about risk factors. Inspection of British Columbia historical reports suggests that the incidence of schizophrenia doubled between 1909 and 1911 (20 to 40 per 100,000) and did not return to 1909 levels until 1914. This increase in incidence could be an artifact of expanding psychiatric services, altered admission criteria, or changes in diagnostic criteria, or could be indicative of a true increase in incidence. Individuals who were born during the ilffluenza pandemics of 1890 to 1894 would be in the age at risk for schizophrenia during 1911 to 1913 (17 to 23 years of age). An excess of patients within this age range would suggest influenza as a risk factor. In order to test the competing hypotheses, the records of patients hospitalized between 1907 and 1909 were compared to those between 1911 and 1913. In 1911, the British Columbia population was 392,480 of which 77% were male and 43% were Canadian-born. The remaining population included immigrants from Britain (27%),
3. Epidemiology Europe (10%), the U.S.A. (9%) and Asia (7%). DSM-IV diagnoses were applied based on patient clinical records and those with schizophrenia, schizophreniform, schizoaffective or bipolar disorders were included. All patients were hospitalized for the first time and were less than 60 years of age. There were 251 first-episode patients admitted between 1907 and 1909, and 580 between 1911 and 1913. An analysis of archival records failed to reveal any expansion of psychiatric services or changes in government or hospital policies that could explain the 1911-1913 increase. The application of DSM-IV criteria using patient records indicated that the increase was not due to changes in diagnostic criteria. Age and gender distribution was similar in the two time periods and there was no excess of patients born during the 1890-1894 influenza pandemics. From 1907-1909 to 1911-1913, the incidence of schizophrenia remained similar in the Canadian-born population (18 to 23 per 100,000) and in Asian-born immigrants (23 to 25 per 100,000). The rate increased in British (43 to 57 per 100,000) and US-born immigrants (28 to 57 per 100,000), and showed a substantial change in European-born immigrants (36 to 110 per 100,000).
SEX DIFFERENCES IN PSYCHOSIS: NORMAL OR PATHOLOGICAL? J. Spauwen,* L. Krabbendam, R. Lieb, H. U. Wittchen, J. van Os Department of Psychiatry and Neuropsychology, a~/Mondriaan/Riagg/RIBW/!Lijverdal Academic Centre, Maastricht University, European Graduate School of Neuroscience, Maastricht, Limburg, Netherlands Schizophrenia first appears in adolescence, in boys at an earlier age than girls. One way to elucidate the meaning of this key epidemiological finding, is to examine whether a similar age-related sex difference exists in the expression of subtler, non-clinical but much more frequent psychotic experiences such as low grade delusional ideas or auditory hallucinations that are continuous with the disorder but do not require treatment. (1) The Early Developmental Stages of Psychopathology (EDSP) study (2) was designed to collect data on prevalence, risk factors, comorbidity and course of mental disorders in a random population sample of adolescents and young adults in the Munich area (Germany). The data reported here are from the second follow-up wave (n=2548) and include demographic findings and the M-CIDI G-section for schizophrenia and schizophreniform disorders. This section assesses lifetime prevalence of positive psychotic symptoms. Logistic regression indicated that there was no main effect of age (in years) or sex on the presence of at least one positive symptom (OR t.00, 95% CI 0.97-1.03 and OR 0.92, 95% CI 0.75-1.13, respectively). However, a significant interaction between age and sex was present (likelihood ratio test: Z2=6.7, p=0.0097). Stratified analysis revealed that in the younger haft of the cohort (split around the median age of 21 years) the risk of having a positive psychotic symptom was higher for males than for females (OR=0.70, 95% CI 0.52-0.95), while no sex difference was found in the older cohort (OR=l.18, 95% CI 0.89-1.58). Non-clinical experiences of psychosis showed similar associations with sex as has been reported in the clinical disorder of schizophrenia, suggesting that sex differences in psychosis may reflect differential variation of a continuous phenotype, rather than differential expression of a rare causal pathological risk factor. This contrasts with some previous hypotheses, in particular that a rare early brain anomaly interacts with normal maturation to produce schizophrenia. 1. van Os J, Hanssen M, Bijl RV, Vollebergh W. Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison.
International Congress on Schizophrenia Research 2003