Is it possible to detect future risk of psychosis from a patient’s primary care consultation history?



By Dr Sarah Sullivan
Research Fellow
Centre for Academic Primary Care

Psychosis is a serious and long-term mental illness. Unfortunately, for many sufferers the outcomes are poor. Many may relapse again after recovery, suffer long-term residual symptoms and have poor social functioning.

Primary care is an important part of the care pathway for patients with psychosis, so GPs need to be able to accurately identify those at high risk. The task is difficult because high-risk symptoms are frequently not specific to psychosis.

We also know that the greater the delay between someone’s first psychotic symptom and receiving specialist mental health treatment is associated with poorer outcomes. GPs play an important role in this, because most people are referred to mental health services by their GP.

In a study recently published in JAMA Network Open, we set out to find out if people had previously consulted their GP for early signs of psychosis before they received a secondary care diagnosis.

Using routine primary care data from 530 UK GP practices on 11,690 people who had received a diagnosis of psychosis and 81,793 people who had received other physical and mental health diagnoses, we looked back at the reasons the patients had visited their GP over the previous five years.

We found that people who developed psychosis visited their GP more often than people with other diagnoses. We also found that people who had received a diagnosis of psychosis had consulted their GP more often for suicidal behaviour, symptoms of ADHD, OCD, depression and mania, social isolation, blunted affect, and problems associated with cannabis and cigarette smoking.

These differences depended on the sex and age of the person and were particularly strong in young men consulting for suicidal behaviour. We also found that the frequency with which patients made these consultations increased sharply just before the date of diagnosis.

These findings counter the generally held belief that individuals with emerging psychosis do not seek help from their GP. They are important because it means that it may be possible to develop a prediction tool for risk of psychosis which is based on GP consultation data. We are working on this.

We hope that this work will generate renewed efforts by GPs to identify patients who may benefit from further assessment and treatment for psychosis.

Paper: Association of primary care consultation patterns with early signs and symptoms of psychosis. Sarah Sullivan et al. JAMA Network Open. November 2018.

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

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