FIRST EPISODE PSYCHOSIS: three year review at a Psychiatry Service of a general hospital

1. FIRST EPISODE PSYCHOSIS: three year review at a Psychiatry Service of a general hospital Margarida Duarte, Joana Maia, Joana Melim, Ana Batista, Filipe Malheiro, AndreiaTarelho, CláudioLaureano margarida.ines.duarte@gmail.com Centro Hospitalar de Leiria, Portugal May 2014

2. Introduction • First episode psychosis (FEP) is a unique opportunity on the therapeutic intervention of psychotic disorders and delay in seeking treatment has a fundamental influence on the patient prognosis. It’s nowadays widely accepted that the FEP must be treated incisively and effectively in order to minimize the risk of an unfavorable evolution. • The first step in the clinical management of the FEP is the initial evaluation, including differential diagnosis: • organic psychotic disorders • substance induced psychosis • affective psychosis (mania or depression) • acute transient psychosis. The initial diagnosis should be temporary, considering the various negative consequences of a diagnosis in a too early stage, such as false expectations, stigma and little individualized treatment programs.

3. Introduction • Objective: To know the demographic and clinical data of the population of patients with psychotic symptoms covered under the jurisdiction of the Psychiatry Service of the Leiria Hospital Center, Portugal. • Method: Retrospective analysis of the discharge notes of all hospital admissions between 01/01/2011 and 31/12/2013into the Psychiatry Service of the CHL. • Statistical description of the gathered socio-demographic and clinical data of all patients with at least one hospitalization with the presence of psychotic symptoms.

4. Results Over these 3 years: 1649 hospitalizations (total of 1296 patients) • From the total, 36% of patientshad at least one hospitalization with psychotic symptoms • 45% femalevs55% male; age: 18 - 92 yearsold, average: 47 Diagnosis (total patients with psychotic symptoms)

5. Results 31% of these patients had FEP • 54% male vs 46% female • Age: 18 (femaleand male) - 80 (female: 80 vs male: 77) Average:44 (female: 49 vs male: 39) • 32% of patients with FEP had records of substance use (mainly cannabis and alcohol) • FEP with substance use: 87% of male patients and a reduction in the average age from 50 (without consumption) to 32 years old when there was consumption of psychoactive substances.

6. Results Gender Diagnosis (FEP) Age (yearsold)

7. Discussion/ conclusion • There is a high incidence of patients with psychotic symptomsin the hospital area under analysis, being worth notice the number of FEP. • The high age for the FEP may be related to the heterogeneity of the clinical episodes included in the analysis. • Substance use, more frequent in men, may have a very important role, since consumers present the FEP at an earlier age. • The high percentage of Psychosis NOS diagnostic may reflect the difficulty in making the differential diagnosis when facing a FEP, and also the practitioner’s attention while writing out the diagnosis, knowing the important impact it may have in the future. • More studies are needed, in particular to understand the clinical evolution, diagnostic stability and monitoring of these patients, particularly those identified with FEP.

8. References Neto MRL (2000). Manejo clínico do primeiro episódio psicótico. RevBrasPsiquiatr; 22(Supl I): 45-6. Del-Bem CM, Rufino A, Azevedo-Marques JM, Menezes PR. (2010). Diagnóstico diferencial de primeiro episódio psicótico: importância da abordagem otimizada nas emergências psiquiátricas. RevBrasPsiquiatr; vol 32, Sulp II. Coentre R, Levy P, Figueira ML (2011). Intervenção Precoce na Psicose Primeiro Episódio Psicótico e Período Crítico. ActaMedPort; 24: 117-126. Kessler F. Diretrizes da Associação brasileira de estudos do álcool e outras drogas (ABEAD) para o diagnóstico e tratamento de comorbidades em dependência ao álcool e outras drogas. Capítulo: Dependência química e transtornos psicóticos. Wisdow JP, Manuel JI, Drake RE (2011). Substance Use DisorderAmongPeopleWithFirst-EpisodePsychosis: A SystematicReviewofCourseandTreatment. Psychiatr Serv.Sep;62(9):1007-12. Carreiro SV, Borreg M. (2007). Psicose e consumo de substâncias. ActaMedPort; 20: 413-422. Donoghue K et al. (2014). Cannabis use, genderand age ofonsetofschizophrenia: Data fromthe AESOP study. Psychiatry Research Archie S, Boydell KM, Stasiulis E, Volpe T, Gladstone BM. (2013) Reflectionsofyoungpeoplewhohavehad a firstepisodeofpsychosis: whatattractedthem to use alcoholandillicitdrugs? EarlyIntervPsychiatry. 7(2):193-9. Marques-Teixeira J. (2000). Diagnósticos Duplos: Toxicodependências e Perturbações Psiquiátricas. Saúde Mental, Vol.2 nº 5, pp.9-16. Mochcovitch MD et al. (2012). Projeto Diretrizes. Associação Médica Brasileira. Primeiro Episódio Psicótico (PEP): Diagnóstico e Diagnóstico Diferencial. Fraser S, Hides L, Philips L, Proctor D, Lubman DI. (2012) Differentiatingfirstepisodesubstanceinducedandprimarypsychoticdisorderswithconcurrentsubstance use in youngpeople. SchizophrRes. Apr; 136(1-3): 110-5. Chand P, Thirthalli J, Murthy P. (2014). Substance use disordersamongtreatment naïve first-episodepsychosispatients. ComprPsychiatry. Jan; 55(1): 165-9. http://psicopatologiafundamental.org/uploads/files/ii_congresso_internacional/mesas_redondas/ii_con._adolescencia_e_ primeira_crise_psicotica.pdf