Adolescents take twice as long as adults to get treatment for psychosis

Under-18s who experience psychosis go untreated after their first psychotic symptoms for twice as long as adults, according to new research.

Psychotic symptoms, such as hallucinations or delusions, are a feature of several disorders of mental health, such as schizophrenia and bipolar disorder. Psychiatrists and clinical psychologists recognise that starting medication for psychosis early greatly improves the chances of a successful outcome, but the study reveals that teenagers are much less likely than adults to get timely access to mental health services and appropriate drug treatment.

Adolescents begin to receive antipsychotic medication on average 179 days after their first symptoms, compared with 81 days for adults.

The study also found striking differences between adolescent ethnic groups in the length of time before the start of treatment. White adolescents take much longer to begin medication, 454 days on average, compared with 99 days for black youngsters and 28 days for Asians.

Starting to have symptoms at a younger age and using cannabis were also linked to a longer spell without treatment.

The study was led by Dr Matthew Hodes, working with Dr Maria Dominguez and others at the Department of Medicine at Imperial College London. “Adolescents tend to live with their families and go to school, so we might expect them to get into treatment more quickly than adults, but in fact the opposite is true,” said Dr Hodes. “We don’t fully understand the reasons why this is.

“Our study also found that white adolescents go untreated for much longer than black and Asian adolescents. White teenagers’ psychotic symptoms were identified at earlier age but it took them a much longer period to initiate antipsychotic treatment. They are also much more likely to smoke cannabis, which might be relevant. It might be that the people around them think their symptoms are caused by cannabis, and don’t realise that they need to seek help.”

Roughly 150 new case of psychosis are diagnosed for every 1,000,000 people in England every year. Typical symptoms include hearing voices or believing in bizarre plots. Treatment normally involves antipsychotic drugs, cognitive behavioural therapy, and education for family members to help them manage problems. The majority of people affected get better within a few weeks or months of treatment.

The new study, published in Schizophrenia Research, is a result of collaboration with Dr Helen Fisher at the Institute of Psychiatry, Kings College London and Professor Sonia Johnson at University College London, and colleagues in mental health trusts.   

The study was based on data collected routinely by mental health professionals working in early onset psychosis services in mental health trusts in London between 2003 and 2009. The data included 136 people who had their first psychotic symptoms between 14 and 17 years of age and 804 people whose first psychotic symptoms started between 18 and 35 years.

“We know that starting treatment early is really important for the chances of treatment being successful,” said Dr Hodes. “We need to do more research to understand the reasons for the discrepancies we’ve seen in this study.

“We need a multi-pronged approach to help young people with psychosis get treatment more quickly. We should train people who work in primary care to help them recognise psychotic symptoms. Clinicians who work with young people need to be attentive, and should not attribute psychotic symptoms   to being young or using cannabis. We also need to make it easier for families from any ethnic background to come for help, and overcome fears and stigma attached to using mental health services.”

Reference

Dominguez, M.-d.-G., et al., Duration of untreated psychosis in adolescents: Ethnic differences and clinical profiles, Schizophrenia Research, Volume 150, Issues 2–3, November 2013, Pages 526–532 http://dx.doi.org/10.1016/j.schres.2013.08.018

The data collection aspect of the project was supported by the London Development Centre for Mental Health, with an initial pilot funded by the Islington PCT.