INCIDENCE AND PRESENTATION OF FIRST-EPISODE PSYCHOSIS IN A POPULATION-BASED SAMPLE
Abstract
Objective
Increasing evidence supports the effectiveness of comprehensive early intervention at first onset of psychotic symptoms. Implementation of early intervention programs will require population-based data regarding overall incidence of psychotic symptoms and care settings of first presentation.
Methods
In five large healthcare systems, electronic health records data were used to identify all first occurrences of psychosis diagnoses among people aged 15 through 59 between 1/1/2007 and 12/31/2013. For a random sample of these putative cases, review of full-text medical records confirmed clinician documentation of psychotic symptoms and excluded those with documented prior diagnosis of or treatment for psychosis. Initial incidence rates (based on putative cases) and confirmation rates (from record reviews) were used to estimate true incidence according to age and setting of initial presentation.
Results
Incidence estimates based on putative cases were 126 per 100,000 per year among those aged 15 to 29 and 107 per 100,000 among those aged 30–59. Rates of chart review confirmation ranged from 84% among those aged 15–29 diagnosed in emergency department or inpatient settings to 19% among those aged 30 to 59 diagnosed in general medical outpatient visits. Estimated true incidence rates were 86 per 100,000 per year among those aged 15 to 29 and 46 per 100,000 in those aged 30 to 59.
Conclusions
Including all care settings, total incidence of first-episode psychosis is higher than previous estimates based on surveys or inpatient data. Early intervention programs must accommodate frequent presentation after age 30 and presentation in outpatient, including primary care, settings.