Youth Later Diagnosed With Psychotic Disorders May Show Up in Acute Care Settings First

Most people receiving a first diagnosis of a psychotic disorder have had some indication of a mental health problem in the previous year. A study published earlier this year in AJP in Advance suggests that as many as two-thirds of adolescents and young adults who are diagnosed with psychotic disorder may have sought mental health care during the year prior to diagnosis.

While similar patterns of health care use were seen in patients who were later diagnosed with unipolar depression, the study revealed that people who would go on to develop a psychotic disorder received specialty mental health services in inpatient and emergency department settings more frequently.

Gregory Simon, M.D., M.P.H., a senior investigator with Kaiser Permanente Washington Research Institute in Seattle and colleagues reviewed the health records of members in the Colorado, Northern California, Northwest, Southern California, and Washington regions of Kaiser Permanente to identify diagnoses of first psychotic disorder made between 2007 and 2013.

They identified 624 confirmed cases among patients aged 15 to 29 during the study period. For comparison, they also collected data from 1,862 patients in the same age range who had received a diagnosis of first unipolar depression as well as 1,851 controls taken from health plan members at large who had an outpatient visit during this time for some other condition.

The authors then used health record information along with insurance claims and pharmacy records to identify any use of mental health services, psychiatric diagnoses, and/or psychiatric medication prescriptions among these participants in the 3, 12, 24, and 36 months preceding the visit during which they received their diagnosis.

The researchers found that 66 percent of patients with a first diagnosis of a psychotic disorder used some type of mental health service in the previous year compared with 49 percent among patients with a subsequent unipolar depression diagnosis and 14 percent among the health plan members at-large. In addition to service use, 60 percent of patients with a first diagnosis of psychosis received some other mental health diagnosis in the past 12 months and 42 percent received a psychotropic prescription.

Compared with patients receiving a first diagnosis of unipolar depression, those with a first diagnosis of psychosis were 2.96 times more likely to have received mental health inpatient care in the previous year, and 3.74 times more likely to have received mental health emergency department care.

These findings help paint a clearer picture of where people who may go on to develop first-episode psychosis might be first identified, Simon said. Mapping this trajectory might help identify such youth earlier, which would improve their long-term outcomes, he added. ■