S123. EARLY DETECTION OF PSYCHOSIS: DIAGNOSTIC TRAJECTORIES
Authors: Lindhardt Line , Lindhardt Morten , Haahr Ulrik , Halling Hastrup Lene , Simonsen Erik , Nordgaard Julie 
Published: May 2020

Abstract

Background
Psychosis and signs of severe mental disorders such as schizophrenia often emerge in adolescence. Much attention has been devoted to identifying the individuals experiencing psychosis at an early stage. Implementation of early detection services is widely acknowledged as effective in reducing treatment delays. However, little is known about the diagnostic patterns of individuals entering an early detection service regardless of the initial psychopathological evaluation.
The aim of the study is to investigate the diagnostic trajectories of individuals evaluated by an early detection of psychosis unit.

Methods
A real-life cross-sectional study coupling register data with information of diagnoses allocated by clinical evaluation in an early detection unit. All individuals clinically evaluated in the early detection unit from 2012 to 2015 were included. A Central Psychiatric Research Register was searched for lifetime allocated diagnoses. Register search allowed a minimum of one-year follow-up after evaluation. To determine the predictive ability of the early detection unit, diagnoses allocated by the initial clinical evaluation were compared to later diagnoses in psychiatric services.

Results
In total 450 individuals were clinically evaluated in the early detection unit during a period of 3 years. Previously 174 (39 %) patients had been in contact with mental healthcare services, and 28 (6.2%) had previously been diagnosed with psychosis. During follow-up, a diagnosis of psychosis was allocated in 146 (32.4%) of all evaluated individuals. In the clinical assessment by the early detection unit 107 (73.3 %) were diagnosed with psychosis.
In total 39 (14.7%) were assessed false negative for psychosis by the early detection unit, they were later diagnosed with psychosis in mental healthcare services.
The majority of psychosis diagnoses was allocated within one year after assessment in the early detection unit and half of individuals who were diagnosed with psychosis was re-diagnosed with schizophrenia (n=73).
The hazard ratio of receiving a diagnosis of psychosis subsequently in mental healthcare services in individuals diagnosed with psychosis by the early detection unit was 4.73 (95 % CI: 3.01 – 7.44, p &lt; 0.0001) compared to individuals not found psychotic by the early detection unit.

Discussion
That more than a third of the clinical evaluated has previously been help-seeking in mental healthcare system demonstrates a source of delay in treatment, suggesting that contact to other parts of mental healthcare services can delay detection of psychosis.
Of the individuals not evaluated cases of psychosis 15 % later received a diagnose of psychosis. This suggests that an important subgroup of the help-seeking individuals undergoes transition to psychosis after contact or that detection of psychosis has not been possible by evaluation in the early detection unit.
In conclusion, attention should be made to all individuals self-referred to an early detection unit, as diagnoses of psychosis is seen in the majority within the first year after contact. Also in individuals not initially suspected of psychosis.