Study Suggests Incidence of First-Onset Psychosis May Exceed Prior Estimates

A detailed review of electronic health records from five large health care systems in the United States suggests that the incidence of first-onset psychotic symptoms may be higher than previous estimates, which were based on surveys or inpatient data. The findings, which revealed that nearly half of first diagnoses occurred among those aged 30 to 59, could have important implications for designing early intervention programs.

The study, published Tuesday in Psychiatric Services in Advance, suggests that the annual rate of first presentation of psychotic symptoms was approximately 86 per 100,000 among those aged 15 to 29 and 46 per 100,000 among those aged 30 to 59.

“Applied to the entire U.S. population, our incidence estimates would predict approximately 56,000 new first presentations of psychotic symptoms among those aged 15 to 29 and an additional 58,000 among those aged 30 to 59,” Gregory Simon, M.D., M.P.H., of Group Health Research Institute in Seattle and colleagues wrote.

The researchers analyzed electronic health records and insurance claims from January 2007 through December 2013 to identify all first-occurring diagnoses of psychotic symptoms among Group Health Cooperative and Kaiser Permanente (Colorado, Northern California, Southern California, and Pacific Northwest regions) health plan members aged 15 to 59. This included patients diagnosed with schizophrenia spectrum disorder, mood disorders with psychotic symptoms, and other psychotic disorders.

Exclusion of those with any diagnosis of dementia or neurodegenerative disease during the study period yielded a final sample of 37,843 putative cases over seven years. The researchers then selected a random sample of 1,500 cases (approximately 300 at each health care system) for a more detailed review to confirm the diagnosis and rule out prior diagnosis or treatment for psychotic disorder.

“Rates of chart review confirmation ranged from 84% among those aged 15 to 29 diagnosed in emergency department or inpatient mental health settings to 19% among those aged 30 to 59 diagnosed in general medical outpatient settings,” the authors wrote. “Only about one-third of first presentations occurred in emergency departments or inpatient mental health facilities, half occurred in outpatient mental health settings, and the remainder in primary care or other outpatient settings.”

They concluded, “Our findings have several important implications for the design of early intervention programs. First, the potential demand for early intervention services certainly exceeds the capacity of existing programs. Second, outreach or engagement efforts certainly cannot be limited to mental health inpatient facilities. Third, early intervention programs should consider the needs and preferences of [patients aged 30 to 59] who account for up to half of persons with new-onset psychotic symptoms.”

For related information, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis.”

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