The identification and management of people with an at-risk mental state (ARMS) for psychosis in primary and secondary care services: A qualitative interview study

被引:4
作者
Strelchuk, Daniela [1 ,2 ,3 ,6 ]
Wiles, Nicola [1 ,2 ,3 ]
Derrick, Catherine [1 ]
Zammit, Stan [1 ,2 ,3 ,4 ]
Turner, Katrina [2 ,3 ,5 ]
机构
[1] Univ Bristol, Ctr Acad Mental Hlth, Bristol Med Sch, Populat Hlth Sci, Bristol, England
[2] Univ Hosp Bristol NHS Fdn Trust, Biomed Res Ctr, Natl Inst Hlth Res Bristol, Bristol, England
[3] Univ Bristol, Bristol, England
[4] Cardiff Univ, MRC Ctr Neuropsychiat Genet & Genom, Div Psychol Med & Clin Neurosci, Cardiff, Wales
[5] Univ Bristol, Ctr Acad Primary Care, Bristol Med Sch, Populat Hlth Sci, Bristol, England
[6] Univ Bristol, Ctr Acad Mental Hlth, Bristol Med Sch, Populat Hlth Sci, Oakfield House, Bristol BS8 2BN, England
关键词
at-risk mental state; pathways into care; psychosis; qualitative interviews; CLINICAL HIGH-RISK; GENERAL-PRACTITIONERS; EPA GUIDANCE; INDIVIDUALS; PREVENTION; PATHWAYS; ACCESS;
D O I
10.1111/eip.13412
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Aims Early intervention in people with an at-risk mental state (ARMS) for psychosis can prevent the onset of psychosis. Clinical guidelines recommend that ARMS are referred to triage services, and then to Early Intervention (EI) teams in secondary care for assessment and treatment. However, little is known about how ARMS patients are identified and managed in UK primary and secondary care. This study explored patients' and clinicians' views of ARMS patients' care pathways.Methods Eleven patients, 20 GPs, 11 clinicians from the triaging Primary Care Liaison Services (PCLS) and 10 EI clinicians were interviewed. Data were analysed thematically.Results Most patients said their symptoms started in adolescence with depression and anxiety. Before being referred to EI teams, most patients were referred by their GP to well-being services for talking therapies, which they had not found helpful. Some GPs said secondary care's high acceptance thresholds and scarce treatment availability made them reluctant to refer to EI teams. Triage in PCLS was influenced by patients' risk of self-harm, and formulation of psychotic symptoms; only those without clear evidence of other pathology and not at high risk of self-harm were referred to EI teams, the others being referred to Recovery/Crisis services. Although patients referred to EI teams were offered an assessment, only some EI teams were commissioned to treat ARMS.Conclusions Individuals meeting ARMS criteria might not receive early intervention due to high treatment thresholds and limited treatment availability in secondary care, suggesting clinical guidelines are not being met for this patient group.
引用
收藏
页码:1116 / 1124
页数:9
相关论文
共 31 条
  • [1] Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis
    Addington, Jean
    Addington, Donald
    Abidi, Sabina
    Raedler, Thomas
    Remington, Gary
    [J]. CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE, 2017, 62 (09): : 656 - 661
  • [2] Only a small proportion of patients with first episode psychosis come via prodromal services: a retrospective survey of a large UK mental health programme
    Ajnakina, Olesya
    Morgan, Craig
    Gayer-Anderson, Charlotte
    Oduola, Sherifat
    Bourque, Francois
    Bramley, Sally
    Williamson, Jessica
    MacCabe, James H.
    Dazzan, Paola
    Murray, Robin M.
    David, Anthony S.
    [J]. BMC PSYCHIATRY, 2017, 17
  • [3] Pathways to care inat-riskmental states: A systematic review
    Allan, Sophie M.
    Hodgekins, Jo
    Beazley, Peter
    Oduola, Sheri
    [J]. EARLY INTERVENTION IN PSYCHIATRY, 2021, 15 (05) : 1092 - 1103
  • [4] [Anonymous], 2014, Psychosis and schizophrenia in adults: prevention and management
  • [5] Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review
    Boldrini, Tommaso
    Tanzilli, Annalisa
    Pontillo, Maria
    Chirumbolo, Antonio
    Vicari, Stefano
    Lingiardi, Vittorio
    [J]. FRONTIERS IN PSYCHIATRY, 2019, 10
  • [6] One size fits all? What counts as quality practice in (reflexive) thematic analysis?
    Braun, Virginia
    Clarke, Victoria
    [J]. QUALITATIVE RESEARCH IN PSYCHOLOGY, 2021, 18 (03) : 328 - 352
  • [7] French P., 2014, GP GUIDANCE EARLY DE, P1
  • [8] Outreach and support in South London (OASIS), 2001-2011: Ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis
    Fusar-Poli, P.
    Byrne, M.
    Badger, S.
    Valmaggia, L. R.
    McGuire, P. K.
    [J]. EUROPEAN PSYCHIATRY, 2013, 28 (05) : 315 - 326
  • [9] Comorbid Depressive and Anxiety Disorders in 509 Individuals With an At-Risk Mental State: Impact on Psychopathology and Transition to Psychosis
    Fusar-Poli, Paolo
    Nelson, Barnaby
    Valmaggia, Lucia
    Yung, Alison R.
    McGuire, Philip K.
    [J]. SCHIZOPHRENIA BULLETIN, 2014, 40 (01) : 120 - 131
  • [10] Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis
    Hutton, P.
    Taylor, P. J.
    [J]. PSYCHOLOGICAL MEDICINE, 2014, 44 (03) : 449 - 468