The Lambeth Early Onset Crisis Assessment Team Study: general
                        practitioner education and access to an early detection team in
                        first-episode psychosis

Power, Paddy; Iacoponi, Eduardo; Reynolds, Nicola; Fisher, Helen L.; Russell, M; Garety, Philippa; McGuire, Philip; Craig, Tom

doi:10.1192/bjp.191.51.s133

Cited by 80 publications

(102 citation statements)

References 23 publications

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“…38 In London, England, the Lambeth Early Onset Crisis Assessment Team study included a single short training session for 17 of 23 intervention practices who also had direct access to earlyintervention services, and found intervention group GPs were more likely to refer their patients to mental health services than control group GPs who had no training and no direct access; but no difference was found in the duration of untreated psychosis between practices. 39 This study, the first to focus solely on GP education as a mechanism for increasing referrals and decreasing the duration of untreated psychosis, suggests that education alone is insufficient to make a marked difference to the rate of referral or the duration of untreated psychosis. However, training of GPs did have a significant impact on speed of access to early-intervention services.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

Lester¹,

Birchwood²,

Freemantle³

et al. 2009

Br J Gen Pract

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Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates. AimTo assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis. Design of studyStratified cluster randomised controlled trial, clustered at practice level. SettingBirmingham, England. MethodPractices with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion. Intervention practices received an educational intervention addressing GP knowledge, skills, and attitudes about first-episode psychosis. The primary outcome was the difference in the number of referrals to earlyintervention services between practices. Secondary outcomes were duration of untreated psychosis, time to recovery, use of the Mental Health Act, and GP consultation rate during the developing illness. ResultsA total of 110 of 135 eligible practices (81%) were recruited; 179 young people were referred, 97 from intervention and 82 from control practices. The relative risk of referral was not significant: 1.20 (95% confidence interval [CI] = 0.74 to 1.95; P = 0.48). No effect was observed on secondary outcomes except for 'delay in reaching early-intervention services', which was statistically significantly shorter in patients registered in intervention practices (95% CI = 83.5 to 360.5; P = 0.002). ConclusionGP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis; however, there is a suggestion that training facilitates access to the new specialist teams for early psychosis. Keywordseducation; primary health care; psychosis. INTRODUCTIONDuring the last two decades, the importance of intervening as early as possible when a young person develops a first episode of psychosis has become accepted internationally. This has been underpinned by studies demonstrating that young people with first-episode psychosis experience lengthy delays between the onset of psychotic symptoms and receipt of treatment (duration of untreated psychosis) of up to 2 years, 1-3 and that delays in accessing care are significantly associated with poorer treatment response. 4 There is a limited evidence base in this area of primary care, but GPs may be key to the identification and management of first-episode psychosis, as they are usually the first point of patient contact, 5 their involvement in the management of psychosis is associated with a reduction of the use of the Mental Health Act, 6 and they are the most common final referral agent to early-intervention services.7 However, early detection presents challenges as psychosis can take several months to emerge, 8 and may be difficult to distinguish from normal adolescent behaviour and substance misuse.9,10 There can be changes in

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Section: Comparison With Existing Literaturementioning

confidence: 99%

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

Lester¹,

Birchwood²,

Freemantle³

et al. 2009

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…General practice interventions (especially education, awareness and crucially improved access to appropriate interventions that are delivered by secondary care / other agencies), have been important elements of services that led to earlier treatment of young people with first episode psychosis in the UK and Ireland [71][72][73][74] .…”

Section: General Practice Interventions To Improve Screening and Earlmentioning

confidence: 99%

What is the role of general practice in addressing youth mental health? A discussion paper

et al. 2011

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Background. Mental and substance use disorders are a leading cause of morbidity among young people. Policy and clinical services in Ireland are endeavouring to address theses twin issues.Aims. To review the emerging literature on the role of general practice in addressing youth mental health and to discuss the implications of this literature for further research, education and service delivery.Methods. We conducted a review of 'PubMed' and a web search of relevant national / international primary / mental healthcare agencies and professional bodies.

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“…No difference, however, was found in the duration of untreated psychosis between practices. 17 The BiRmingham Early Detection In untREated psyChosis Trial (REDIRECT) was conducted in 110 GP practices and included multimodal education. Referral rates to earlyintervention services and duration of untreated psychosis did not differ between the intervention and the non-intervention groups, while training facilitated access to specialist teams.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…These studies focused on first-episode patients and did not assess the effect on diagnostic knowledge in GPs. 9,17 The present study is the first on the initial prodromal phase of schizophrenia to assess the effect of a sensitisation model in primary care, and it is also the first study in the entire field of early psychosis to apply this particular sensitisation model.…”

Section: Introductionmentioning

confidence: 99%

Prodromal schizophrenia in primary care: a randomised sensitisation study

Simon¹,

Jegerlehner²,

Müller³

et al. 2010

Br J Gen Pract

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The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis

Cited by 80 publications

References 23 publications

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

What is the role of general practice in addressing youth mental health? A discussion paper

Prodromal schizophrenia in primary care: a randomised sensitisation study

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