The Importance of Early Intervention
Psychosis is a serious mental health condition that can significantly impact a person’s life. Early detection and intervention are crucial for improving patient outcomes. In the UK, most people experiencing psychosis are referred to specialist care by their GP. However, delays in diagnosis are common and can lead to poorer outcomes.
Challenges in Primary Care
GPs often have limited experience with early psychosis detection and access to specialist services can be difficult. This highlights the need for new tools to help GPs identify individuals at risk. A recent study investigated the use of a psychosis risk algorithm, called P Risk, in primary care settings.
What is Psychosis?
Psychosis occurs when a person loses touch with reality. Symptoms can include:
- Hallucinations (seeing or hearing things that aren’t there)
- Delusions (false beliefs)
- Disordered thinking
Psychosis can be a symptom of mental illnesses like schizophrenia or bipolar disorder, but can also be triggered by trauma, stress, and substance use. Early signs of psychosis may include:
- Increased suspicion or paranoia
- Difficulty thinking clearly
- Social withdrawal
- Neglecting self-care
Developing a Psychosis Risk Prediction Algorithm
The P Risk tool uses patient information to predict the risk of psychosis. Factors considered include:
- Age
- Sex
- Ethnicity
- Socioeconomic factors
- History of mental health conditions (depression, anxiety, post-traumatic stress disorder)
- Substance use history
- Suicidal behavior
- Prescribed medications
- Number of GP consultations
The current study’s authors used the P Risk tool to calculate predictive risk, sensitivity, specificity, and likelihood ratios for various risk thresholds. The retrospective cohort study used GP electronic health records (EHRs) from UK primary care practices to validate the P Risk prognostic model. Results were compared between the development (CPRD GOLD) and validation (CRPD Aurum) datasets.
Key Findings
A total of 1,647,934 eligible patients from 727 GP practices were included in this validation study. Eligibility criteria included having at least one record of mental health consultation or mental health prescription within the study period. The outcome was there being a recorded code for a diagnosis of psychosis.
The study found that:
- Psychosis risk increased with higher P Risk scores.
- Younger age groups had the highest risk of psychosis.
- Males with depression symptoms had a higher incidence of psychosis.
- Substance use was associated with increased psychosis risk.
- The P Risk tool showed good accuracy in predicting psychosis.
Potential Benefits and Future Directions
This study suggests that the P Risk algorithm could be a valuable tool for GPs in identifying individuals at risk of psychosis. Early identification could lead to faster referrals, earlier interventions, and improved patient outcomes. Further research is needed to evaluate the tool’s effectiveness in real-world clinical settings.
