(August 21, 2019) Methods to identify rates of first-episode psychosis in the general population are needed in order to appropriately serve high-risk individuals with an early treatment program. Without such methods, comprehensive systems that conduct outreach, assessment and treatment for individuals with first-episode psychosis, such as coordinated specialty care, cannot adequately be met.
A recently published research study in New York State utilized Medicaid records and an algorithm to estimate the incidence or occurrence of new cases of first-episode psychosis among patients. The authors verified the results of the algorithm by reviewing patient medical charts from New York’s coordinated specialty care center, OnTrackNY, and various Medicaid managed care organizations that provide services to these individuals.
The authors found an overall incidence of first diagnosis of psychosis at 272 per 100,000 per year, the equivalent of 272 new individuals with a psychosis diagnosis for every 100,000 people on Medicaid, every year. This incidence rate is considerably higher than a previous estimate that primarily utilized a privately-insured population, which the authors write is unsurprising due to the “ample research demonstrating a relationship between lower socioeconomic status and psychosis.”
The incidence rate was much higher among individuals aged 15-25 years-old compared to those who were 26-35, further indicating the need for the public mental health system to focus on high-risk populations as early as possible to prevent further disability due to untreated psychosis.
In addition, the authors found that 31% of the first diagnoses among these individuals were of affective psychosis, a disorder including symptoms of a psychotic disorder in addition to those associated with a mood disorder. Individuals with this diagnosis are not always currently included in coordinated specialty care programs. The results indicate the necessity to expand inclusion criteria of the program to meet population need, according to the authors.
Future work is still needed to perfect the algorithm to allow providers to identify cases and intervene as early as possible in real-time. However, the results are promising for utilizing these methods to identify population needs for first-episode psychosis to better allocate resources for coordinated specialty care programs. These specialty treatment programs are vital to preventing further deterioration and disability later in life for individuals showing initial symptoms of psychotic disorders by providing essential identification and treatment early on in the course of their illness.
References:
Elizabeth Sinclair
Director of Research
Treatment Advocacy Center