SECTION 2 PSYCHOSIS IN PRIMARY CARE

2. PSYCHOSIS IN PRIMARY CARE

A primary care clinician is likely to be the first contact a person with psychosis has with the health care system. Nearly two-thirds of young people with early psychosis make help-seeking attempts in primary care in the six months before first diagnosis (Anderson et al., 2013).

Primary care clinicians are well-positioned to help people with psychosis: • They know their patients’ medical histories and can note unusual changes from prior behavior that might otherwise go unnoticed. • They already have long-term trusting relationships with their patients. That trust is crucial when dealing with a highly stigmatized, often frightening condition. • They can use their broad medical expertise to evaluate medical causes of psychosis. • Help from a primary care clinician reduces the need for psychiatric hospitalization and aversive experiences with police and emergency medical services.

In one survey, family physicians estimated that they saw between one and two patients per year with signs and symptoms of first-episode psychosis (Simon et al., 2009). However, a study that interviewed a low-income patient population in the waiting room of a large urban practice found that as many as one in five patients (21%) reported one or more psychotic symptoms (Olfson et al., 2002). The prevalence of psychosis varies in different populations, with higher rates seen in lowincome populations experiencing more socioeconomic stressors. The Olfson study also suggests that psychosis in primary care settings may be more common than we realize.