With a prevalence of 5 per 1000, the psychoses pose significant challenges to patients, their families, the NHS and Social Services. Following the closure of large old-fashioned asylums in the 1980s and 1990s, national policy dictates that consultant psychiatrists and their community mental health teams (CMHTs) take the lead in the management of psychosis in the community (‘care in the community’).
However, it would be wrong to assume that primary care has a minor role. Patients with psychosis are significant users of general practice. Given the close contact GPs enjoy with their patients (they see 70–75% of their list at least once a year), first presentations are often made in primary care. Some 25% of patients with schizophrenia only see their GP and have no contact with CMHTs. Patients with psychosis also have a significantly increased risk of physical illness with double standardised mortality ratios (SMR).
Actively engaging with patients and CMHTs, GPs can ensure those with schizophrenia, bipolar disorder and schizo-affective disorder receive timely and effective support, keeping them as well as possible and out of hospital. Apart from the stress of an acute admission, schizophrenia alone is estimated to cost 5% of the NHS inpatient budget.
Key aims for primary care include the following:
Early Detection of First Episode and Relapses
The psychoses are ‘stress–vulnerability’ models of illness, with genetic factors and social stressors both having a role in aetiology. There are ethnic variations, with higher prevalence in the African-Caribbean and black African communities as well as in the refugee population generally.
Typically presenting in late adolescence, those who develop schizophrenia often have a prodromal period during which their families and friends notice:
Uncharacteristic behaviour
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