Ethnic Diversity and Pathways to Care for a First Episode of Psychosis in Ontario

Archie, Suzanne; Akhtar–Danesh, Noori; Norman, Ross; Malla, Ashok; Roy, Paul; Zipursky, Robert B.

doi:10.1093/schbul/sbn137

Cited by 89 publications

(116 citation statements)

References 63 publications

(128 reference statements)

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“…For 67.7% of our sample, help-seeking was initiated by others, most often by family members. This is consistent with other studies [23,24,25,26]. Our finding of prodromal help-seeking in 43.5% is also consistent with other studies [9,27,28,29,30,31].…”

Section: Discussionsupporting

confidence: 94%

“Lanthanic Presentation” in First-Episode Psychosis Predicts Long Service Delay: The Challenge of Detecting Masked Psychosis

Kvig

Brinchmann²,

Moe³

et al. 2017

Psychopathology

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Background/Aims: Studies of pathways to care in first-episode psychosis have documented a substantial treatment delay occurring after patients enter mental health services. An initial presentation with neurotic rather than psychotic symptoms is common in first-episode psychosis. The term “lanthanic patient” has been used to refer to patients presenting with a reason for help-seeking that is unrelated to the underlying pathology. The aim of this study is to explore whether a lanthanic presentation is related to prolonged service delay. Methods: The sample comprises 62 patients with recent-onset psychosis. Data on sociodemographic, clinical, help-seeking, and pathway indicators were collected using a comprehensive, semistructured-interview schedule. Results: Service delay accounted for more than half of the overall treatment delay. An initially presenting complaint of neurotic symptoms was related to prolonged service delay. The effect remained after controlling for other potential risk factors of service delay. Conclusion: Anomalous experiences of pleasure, desire, or motivation are common in emerging psychosis. These difficulties are often misinterpreted as complaints of depression and anxiety by health professionals. The presence of such symptoms can introduce a focal vision on the part of health care professionals on the immediate presentation rather than the underlying psychopathology, leading to the underdetection of psychosis.

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Section: Discussionsupporting

confidence: 94%

“Lanthanic Presentation” in First-Episode Psychosis Predicts Long Service Delay: The Challenge of Detecting Masked Psychosis

Kvig

Brinchmann²,

Moe³

et al. 2017

Psychopathology

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“…However, we have no data on 56 patients (20.9%) who refused to participate in the study, which could have influenced the results. However, the refusal rate was similar to that in other recent FEP studies, varying from 14.3% to 19% (Archie et al, 2010;Levy et al, 2012;Norman et al, 2011). Although the LTF group was similar in size to that in other studies and had a similar proportion of individuals with SUD, when compared to the still followed group, the loss of these patients at follow-up prevented us from describing the outcome of another 20% of the FEP population.…”

Section: Discussionsupporting

confidence: 81%

Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program

Abdel‐Baki

Ouellet‐Plamondon

Salvat

et al. 2017

Psychiatry Research

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“…33, 36 Jarvis et al 37 in Montreal found that Black patients with psychotic disorders in the ED were more likely to be brought by police or ambulance; however, their study looked at psychotic disorders generally rather than FEP specifically. These differences across different countries, and even across different jurisdictions within the same country, could reflect differences in mental health legislation and local laws.…”

Section: 33mentioning

confidence: 99%

Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

et al. 2015

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Objective: To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP). Methods:We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital-and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. Results:We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. Conclusions:Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.

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Ethnic Diversity and Pathways to Care for a First Episode of Psychosis in Ontario

Abstract: EI services should monitor the pathways to care for young people of diverse ethnic backgrounds to address any disparities in accessing care.

Cited by 89 publications

References 63 publications

“Lanthanic Presentation” in First-Episode Psychosis Predicts Long Service Delay: The Challenge of Detecting Masked Psychosis

“Lanthanic Presentation” in First-Episode Psychosis Predicts Long Service Delay: The Challenge of Detecting Masked Psychosis

Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program

Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

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