Pathways to care and duration of untreated psychosis in patients with a first episode of psychosis in Italy

This study aimed to examine the pathways to care and the duration of untreated psychosis (DUP) in first-episode psychosis patients in Italy. Sociodemographic and clinical characteristics of patients were collected using an ad-hoc schedule. Pathways to care of patients were evaluated by the Nottingham Onset Schedule, administered to patients, key-relatives and key-workers. Forty patients from the Department of Psychiatry of University of Naples were recruited. Mean duration of untreated illness (DUI) was 135.9±145.9 weeks, main DUP was 27.4±26.7 weeks. First help-seeking contact, often mediated by close relatives, took place after 21.6±43.8 weeks from symptoms onset and was with general practitioners, neurologists or psychologists. Only 25% immediately referred to psychiatrists. Patients had 1.8±0.8 contacts with non-psychiatric medical professionals before referring to the mental health service, and the mean time between first contact and adequate psychiatric treatments (referral delay) was 26.6±64.1 weeks. The DUI and DUP was longer in patients with less education (p <.05) and in those with an insidious onset of symptoms (p <.01). Targeted interventions and information campaigns on at-risk populations, such as young people and their relatives, could reduce the DUP, thus improving the long-term outcome of psychotic disorders.