Electronic Letters to:
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eLetters: Electronic letters published:
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GP's and early intervention in psychosis
- Dr Alexis Bowers (12 May 2009)
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Re: GP's and early intervention in psychosis
- Mamdouh EL-Adl, Burke J & Karen Little (25 May 2009)
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Dr Alexis Bowers, Specialist Registrar CNWL NHS Foundation Trust
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dralexisbowers{at}hotmail.com Dr Alexis Bowers
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Dear Editor, I read with interest Dr El-Adl et al's article (Psychiatr Bull 2009; 33: 165-168) on GP experiences of patients with a first psychotic episode. Delay in the initiation of treatment in these patients has been associated with poorer long term outcomes.[1] I do, however, have a number of concerns about the reported results. The low reported incidence of new cases per year within the authors locality (100) was demonstrated by the majority (68%) of GP's seeing only one or two cases per year. I do find it difficult, given these low cell counts, to see how GP's could answer questions about initiating treatment (10%, 25%, 50% and 75% of the time)and thus conclude that GP's are unlikely to start treatment before referring to secondary care services. The information requested from the GP's regarding engagement of patients with first episode psychosis and causes of delayed referral are based on these low patient numbers and would be subject to recall bias on behalf of the GP. Getting the patient's views on barriers to mental health services would certainly have helped triangulate the data. I was also concerned that the data published was five years old and as such the current generalisability of these results could be questioned. With the NICE schizophrenia guidelines recently updated [2] and early intervention/crisis resolution teams the norm rather than the exception El Adl et al echo the view that active engagement with our primary care colleagues is paramount in ensuring these patients receive both a responsive and effective service. 1 Barnes T, Leeson V, Mutsatsa S, Watt H, Hutton S and Joyce E. Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia. BJP 2008 193: 203-209. 2 DEPARTMENT OF HEALTH (2009) Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. The Stationary Office. |
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Mamdouh EL-Adl, Consultant Psychiatrist Northamptonshire Healthcare NHS trust, Burke J & Karen Little
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mamdouhkandil{at}doctors.org.uk Mamdouh EL-Adl, et al.
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Dear editor We wish to express our thanks to Dr Bowers for the interest in our article FEP: Primary Care Experience and implications for service development (Psychiatric Bull 2009; 33: 165-168). Dr Bowers Feels that the GPs figures of seeing only one or two patients with FEP (First Episode Psychosis) every year stated by majority of GPs (68%) is rather low! This interestingly agreed with what is published by David Shiers & Helen Lister in their BMJ editorial in 2004 “Most general practitioners (GPs) see one to two new people with first-episode psychosis a year” (1). Dr Bowers view that GPs’ ability to answer questions about their prescribing trends to patients with FEP is likely to be difficult. I may disagree with Dr Bowers’ view as the low numbers does not exclude or make it difficult for GP to comment on engagement or otherwise as mentioned above. Dr Bowers’ statement about getting the patients views on barriers to mental health services would certainly have helped triangulate the data puts the idea for another study. The scope of this study was about GPs’ experience and not patients or carer’s experience. As we stated in the aim of our study: “To capture the local primary care experience of first- episode psychosis before developing a local early intervention in psychosis service” (2) Finally Dr Bowers expressed his concern about the length of time elapsed since conducting our study until it has been published. We appreciate the importance of avoiding such delay but would point out the following: (A) Clinicians with busy clinical duties need to plan the study, make the time for data analysis, writing & submitting papers, responding to reviewers and waiting after putting the publication in the queue of the papers accepted for publication until it is published. (B) The real question should be whether this delay has any impact on applicability of the study results or not. We feel if in some areas that share similarities with Northamptonshire demography, service and resources who have already adopted a service model for their EIS (Early Intervention Service), it is not too late to review their model and pick what could be considered as useful for their service as the EIS model needs to be flexible & develop over the years. If on the other hand, some areas have not yet developed their EIS model, it is not at all late. References: 1. Shiers D, Lester H. Early intervention for first episode psychosis needs greater involvement of primary care professionals for its success. BMJ 2004; 328: 1451 2. EL-Adl M, Burke J & Little K (2009) Frist Episode Pstychosis: Primary care experience and implications for service development. Psychiatric Bulletin (2009) 33: 165-168. |
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