S48 Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384

A COMPARATIVE STUDY OF PATHWAYS TO FIRST-EPISODE CARE FOR

PSYCHOSIS IN THREE ETHNIC GROUPS IN ONTARIO, CANADA:

THE AFRICAN, CARIBBEAN, & EUROPEAN PROJECT (ACE)

Kelly K. Anderson1, Nina Flora2, Manuela Ferrari2, Andrew Tuck2,

Suzanne Archie3, Sean Kidd2,4, Taryn Tang4, Kwame McKenzie2,4

1Centre for Addiction and Mental Health; 2Social and Epidemiological

Research, Centre for Addiction and Mental Health (CAMH) Toronto, Ontario,

Canada; 3Department of Psychiatry and Behavioural Neurosciences, McMaster

University, Hamilton, Ontario, Canada; 4Department of Psychiatry, University

of Toronto, Toronto Ontario, Canada

Differences in the pathways to care for ethnic minority groups are well

documented in the international literature for chronic psychiatric disorders.

Relatively less research has been done on first-episode psychosis specifi-

cally, or in a Canadian context. We recruited a sample of 171 FEP clients

of Black-African, Black-Caribbean, and White-European origin from both

hospital- and community-based early intervention programs in Toronto and

Hamilton. We compared the three ethnic groups on duration of untreated

psychosis and key indicators of the pathway to care. Compared with the

White-European group, Black-Caribbean clients had an increased likelihood

of referral from an inpatient unit to early intervention services (OR=3.33,

95% CI=1.46–7.60) and a decreased likelihood of general practitioner in-

volvement on the pathway to care (OR=0.17, 95% CI=0.07–0.46), as well as

fewer total contacts (OR=0.77, 95% CI=0.60–0.99). Black-African clients had

an increased likelihood of making contact with the emergency department

at first contact (OR=3.78, 95% CI=1.31–10.92). Differences in the duration

of untreated psychosis across the ethnic groups were not statistically sig-

nificant. Our findings suggest that there are significant differences in the

pathways to early intervention services for psychosis for clients of African-

and Caribbean-origin in our Canadian context. It is essential to gain a

comprehensive understanding of the pathways that different ethnic groups

take to early intervention services, and the reasons behind any observed

differences, to inform the development of equitable services targeting

patients in the critical early stages of psychotic disorder.

THE USE OF SOCIAL MEDIA IN EARLY PSYCHOSIS

Michael L. Birnbaum

Zucker Hillside Hospital

There have been increasing efforts to determine the factors contributing

to lengthy duration of untreated psychosis and to understand the barriers

to receiving timely and appropriate care. Possibly one of the greatest, and

least explored, contributors to treatment delay is the initial decision to

seek care. We therefore set out to elucidate the decision making process

and to identify the resources used to inform this decision. We initially

surveyed a sample of first episode patients in the Early Treatment Program,

retrospectively exploring what changes participants noted in their thoughts

and behaviors and what resources participants used to educate themselves.

Given that millions of American youth are online, sharing ideas daily, we

focused our attention on how social media is used as means of obtaining

information, communicating distress, seeking help, expressing psychotic

thought content and connecting with others. We simultaneously extracted

data from participant’s social media feeds from the day of inception going

back two years. Our preliminary data suggests that in fact youth in the early

stages of psychosis are regularly interacting with social media alongside

their healthy counterparts. Additionally, as psychotic symptoms emerge,

patterns, frequency and shared content change. Finally, we explored what

online resources might be available to information-seeking individuals as

symptoms first emerge. Using 18 hypothetical search terms developed by

Early Treatment Program staff and informed by data gathered from our

survey, we searched Google, Facebook and Twitter, and extracted the first

5 hits from each. An alarmingly few online resources encourage potentially

psychotic youth to seek professional evaluation. Given the severity and

potential destructive outcome of untreated psychosis, we must explore in-

novative and novel strategies of early identification and treatment including

changing the online experience of youth.

REDUCING DURATION OF UNTREATED PSYCHOSIS: CARE PATHWAYS TO

EARLY INTERVENTION IN PSYCHOSIS SERVICES

Max Birchwood1, Charlotte Connor2, Helen Lester2, Paul Patterson2,

Nick Freemantle2, Max Marshall2, David Fowler3, Shon Lewis2,

Tim Amos2, Linda Everard2, Peter Jones4, Swaran P. Singh2

1School of Psychology, University of Birmingham; 2University of Birmingham,

Birmingham, U.K; 3University of Sussex; 4Department Psychiatry, University of

Cambridge

Interventions to reduce treatment delay in first-episode psychosis have

met with mixed results. Systematic reviews highlight the need for greater

understanding of delays within the care pathway if successful strategies are

to be developed. Our objectives were to (1) document the care-pathway

components of duration of untreated psychosis (DUP) and their link with

delays in accessing specialised early intervention services (EIS), and (2)

model the likely impact on efforts to reduce DUP of targeted changes in

the care pathway. Data for 343 individuals from the Birmingham, UK, lead

site of the National EDEN cohort study were analysed. A third of the cohort

had a DUP exceeding 6 months. The greatest contribution to DUP for the

whole cohort came from delays within mental health services, followed by

help-seeking delays. It was found that delay in reaching EIS was strongly

correlated with longer DUP. Community education and awareness cam-

paigns to reduce DUP may be constrained by later delays within mental

health services, especially access to EIS. Our methodology, based on anal-

ysis of care pathways, will have international application when devising

strategies to reduce DUP.

HELP-SEEKING AND PATHWAYS TO CARE IN THE EARLY STAGES OF

PSYCHOSIS: RESULTS FROM THE FEPSY STUDY

Anita Riecher-Rössler1, Gertraud J. Fridgen2, Jacqueline Aston3

1University of Basel; 2Bezirkskrankenhaus Landshut, Prof. Buchner; 3University

of Basel Psychiatric Clinics, Basel, Switzerland

Background: Patients with first episode psychosis (FEP) on average experi-

ence unspecific symptoms 4 to 5 years and psychotic symptoms 1 to 2 years

before they seek treatment. Untreated psychosis has negative effects on the

individuals’ social networks, vocational and educational achievements, and

duration of untreated psychosis seems to be associated with more severe

symptoms, worse treatment response, and poorer overall outcome. It is

therefore important to examine pathways to care to understand factors

contributing to delay in access to adequate care.

Methods: We examined the help-seeking behavior of 61 individuals with

an at-risk mental state for psychosis (ARMS) and 37 FEP patients in a

low-threshold health care system within the FePsy (Früherkennung von

Psychosen) early detection of psychoses study, using the Basel Interview

for Psychoses. At the same time we examined the first signs and symptoms

as perceived by the patients themselves.

Results: The mean duration of untreated illness was 3.5 years and of

untreated psychosis 12 months. 86% of all individuals had sought help of

some kind before reaching our specialized clinic. First help-seeking contact

was usually with family members or relatives (27%), close friends (18%),

office psychiatrists (14%), or general practitioners (12%). During further

course most patients consulted some health professionals before reaching

our specialized service. Help-seeking with non-medical institutions was

rare. Women had more help-seeking contacts than men before contacting

our early detection clinic. ARMS and FEP patients remembered mainly loss

of energy and difficulties concentrating as their first symptoms. Also de-

pression, social isolation, over-sensitivity and irritability, anxiety, unusual

fears, and suspiciousness were reported.

Discussion: Family, close friends and medical professionals play an im-

portant role in help-seeking, leading to specialized psychiatric care. More

efforts should be made to educate the public about symptoms of emerg-

ing psychosis and the help that can be offered. Also better strategies for

encouraging those concerned to seek help, especially young at-risk men,

should be developed.

References:[1] Fridgen GJ, Aston J, Gschwandtner U, Pflueger M, Zimmermann R, Studerus E,

Stieglitz RD, Riecher-Rössler A: Help-seeking and pathways to care in the early

stages of psychosis. Soc Psychiatry Psychiatr Epidemiol 2013;48:1033–1043