Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records
Abstract Background The nature of symptoms in the prodromal period of first episode psychosis (FEP) remains unclear. The objective was to determine the patterns of symptoms recorded in primary care in the 5 years before FEP diagnosis. Methods The study was set within 568 practices contributing to a...
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doaj-6c87e1bc0185467ea6d900f5972233c52020-12-06T12:31:51ZengBMCBMC Medicine1741-70152019-12-0117111310.1186/s12916-019-1462-yPatterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health recordsYing Chen0Saeed Farooq1John Edwards2Carolyn A. Chew-Graham3David Shiers4Martin Frisher5Richard Hayward6Athula Sumathipala7Kelvin P. Jordan8School of Primary, Community and Social Care, Keele UniversitySchool of Primary, Community and Social Care, Keele UniversitySchool of Primary, Community and Social Care, Keele UniversitySchool of Primary, Community and Social Care, Keele UniversitySchool of Primary, Community and Social Care, Keele UniversitySchool of Pharmacy, Keele UniversitySchool of Primary, Community and Social Care, Keele UniversitySchool of Primary, Community and Social Care, Keele UniversitySchool of Primary, Community and Social Care, Keele UniversityAbstract Background The nature of symptoms in the prodromal period of first episode psychosis (FEP) remains unclear. The objective was to determine the patterns of symptoms recorded in primary care in the 5 years before FEP diagnosis. Methods The study was set within 568 practices contributing to a UK primary care health record database (Clinical Practice Research Datalink). Patients aged 16–45 years with a first coded record of FEP, and no antipsychotic prescription more than 1 year prior to FEP diagnosis (n = 3045) was age, gender, and practice matched to controls without FEP (n = 12,180). Fifty-five symptoms recorded in primary care in the previous 5 years, categorised into 8 groups (mood-related, ‘neurotic’, behavioural change, volition change, cognitive change, perceptual problem, substance misuse, physical symptoms), were compared between cases and controls. Common patterns of symptoms prior to FEP diagnosis were identified using latent class analysis. Results Median age at diagnosis was 30 years, 63% were male. Non-affective psychosis (67%) was the most common diagnosis. Mood-related, ‘neurotic’, and physical symptoms were frequently recorded (> 30% of patients) before diagnosis, and behavioural change, volition change, and substance misuse were also common (> 10%). Prevalence of all symptom groups was higher in FEP patients than in controls (adjusted odds ratios 1.33–112). Median time from the first recorded symptom to FEP diagnosis was 2–2.5 years except for perceptual problem (70 days). The optimal latent class model applied to FEP patients determined three distinct patient clusters: ‘no or minimal symptom cluster’ (49%) had no or few symptoms recorded; ‘affective symptom cluster’ (40%) mainly had mood-related and ‘neurotic’ symptoms; and ‘multiple symptom cluster’ (11%) consulted for three or more symptom groups before diagnosis. The multiple symptom cluster was more likely to have drug-induced psychosis, female, obese, and have a higher morbidity burden. Affective and multiple symptom clusters showed a good discriminative ability (C-statistic 0.766; sensitivity 51.2% and specificity 86.7%) for FEP, and many patients in these clusters had consulted for their symptoms several years before FEP diagnosis. Conclusions Distinctive patterns of prodromal symptoms may help alert general practitioners to those developing psychosis, facilitating earlier identification and referral to specialist care, thereby avoiding potentially detrimental treatment delay.https://doi.org/10.1186/s12916-019-1462-yFirst episode psychosisSymptom clusterGeneral practiceMedical record researchLatent class analysisEpidemiology |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ying Chen Saeed Farooq John Edwards Carolyn A. Chew-Graham David Shiers Martin Frisher Richard Hayward Athula Sumathipala Kelvin P. Jordan |
spellingShingle |
Ying Chen Saeed Farooq John Edwards Carolyn A. Chew-Graham David Shiers Martin Frisher Richard Hayward Athula Sumathipala Kelvin P. Jordan Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records BMC Medicine First episode psychosis Symptom cluster General practice Medical record research Latent class analysis Epidemiology |
author_facet |
Ying Chen Saeed Farooq John Edwards Carolyn A. Chew-Graham David Shiers Martin Frisher Richard Hayward Athula Sumathipala Kelvin P. Jordan |
author_sort |
Ying Chen |
title |
Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records |
title_short |
Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records |
title_full |
Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records |
title_fullStr |
Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records |
title_full_unstemmed |
Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records |
title_sort |
patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of uk primary care electronic health records |
publisher |
BMC |
series |
BMC Medicine |
issn |
1741-7015 |
publishDate |
2019-12-01 |
description |
Abstract Background The nature of symptoms in the prodromal period of first episode psychosis (FEP) remains unclear. The objective was to determine the patterns of symptoms recorded in primary care in the 5 years before FEP diagnosis. Methods The study was set within 568 practices contributing to a UK primary care health record database (Clinical Practice Research Datalink). Patients aged 16–45 years with a first coded record of FEP, and no antipsychotic prescription more than 1 year prior to FEP diagnosis (n = 3045) was age, gender, and practice matched to controls without FEP (n = 12,180). Fifty-five symptoms recorded in primary care in the previous 5 years, categorised into 8 groups (mood-related, ‘neurotic’, behavioural change, volition change, cognitive change, perceptual problem, substance misuse, physical symptoms), were compared between cases and controls. Common patterns of symptoms prior to FEP diagnosis were identified using latent class analysis. Results Median age at diagnosis was 30 years, 63% were male. Non-affective psychosis (67%) was the most common diagnosis. Mood-related, ‘neurotic’, and physical symptoms were frequently recorded (> 30% of patients) before diagnosis, and behavioural change, volition change, and substance misuse were also common (> 10%). Prevalence of all symptom groups was higher in FEP patients than in controls (adjusted odds ratios 1.33–112). Median time from the first recorded symptom to FEP diagnosis was 2–2.5 years except for perceptual problem (70 days). The optimal latent class model applied to FEP patients determined three distinct patient clusters: ‘no or minimal symptom cluster’ (49%) had no or few symptoms recorded; ‘affective symptom cluster’ (40%) mainly had mood-related and ‘neurotic’ symptoms; and ‘multiple symptom cluster’ (11%) consulted for three or more symptom groups before diagnosis. The multiple symptom cluster was more likely to have drug-induced psychosis, female, obese, and have a higher morbidity burden. Affective and multiple symptom clusters showed a good discriminative ability (C-statistic 0.766; sensitivity 51.2% and specificity 86.7%) for FEP, and many patients in these clusters had consulted for their symptoms several years before FEP diagnosis. Conclusions Distinctive patterns of prodromal symptoms may help alert general practitioners to those developing psychosis, facilitating earlier identification and referral to specialist care, thereby avoiding potentially detrimental treatment delay. |
topic |
First episode psychosis Symptom cluster General practice Medical record research Latent class analysis Epidemiology |
url |
https://doi.org/10.1186/s12916-019-1462-y |
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