title: The International Study on General Practitioners and Early Psychosis (IGPS).
abstract: BACKGROUND
  In much of the world, general practitioners (GPs) are the health professionals most frequently initially contacted when a young person is developing psychosis. However little is known about their expertise in assessing psychosis and its risk.
  
  
  METHODS
  To assess the diagnostic patterns and treatment practices related to psychosis of GPs working in a range of health care systems, questionnaires were mailed to 12,516 randomly selected GPs in seven countries: Canada, Australia, New Zealand, England, Norway, Austria and the Czech Republic. Sites were defined as gatekeeping or non-gatekeeping, based on the primary care health system in effect at each site. A gatekeeping system (GK) is one which mandates that patients see a GP before in order to be referred to a specialist. By contrast, in a non-gatekeeping (nGK) system, individuals can seek help directly from specialists without authorization by a GP.
  
  
  RESULTS
  Twenty-two percent (n=2784) GPs responded to the mailed questionnaire. They reported low prevalence of early psychosis seen in general practice. Using awareness of functional decline as a prognostic sign as a proxy, gatekeeping (GK) GPs were found to be superior in their knowledge of the signs and symptoms of early psychosis than were non-gatekeeping GPs. GP's with less knowledge as to early psychosis were more likely to refer individuals with suspected psychosis to specialists. GP's reported a preference for access to specialized outpatient services as compared with obtaining continuous medical education relevant to early psychosis. The duration of maintenance treatment recommended by GP's was less than that recommended in international guidelines. GP's also underestimated the risk for relapse after a first episode of psychosis.
  
  
  CONCLUSIONS
  As GPs were largely unaware of features of early psychosis, such as functional decline, this should be the target of educational programs for GP's. However, the incidence of psychosis is low and GP's express a preference for access to appropriate referral over continuing medical education. Therefore, the development of specialized services for the assessment and care of patients who are in the early stages of developing schizophrenia may be warranted.
authors.affiliation: Specialised Early Psychosis Outpatient Clinic for Adolescents and Young Adults, Psychiatric Outpatient Services Bruderholz, Bruderholz, Switzerland. andor.simon@bluewin.ch
authors.forename: Andor E
authors.initials: AE
authors.lastname: Simon
authors.forename: Helen
authors.initials: H
authors.lastname: Lester
authors.forename: Lynda
authors.initials: L
authors.lastname: Tait
authors.forename: Emanuel
authors.initials: E
authors.lastname: Stip
authors.forename: Paul
authors.initials: P
authors.lastname: Roy
authors.forename: Gretchen
authors.initials: G
authors.lastname: Conrad
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hunt
authors.forename: Irvin
authors.initials: I
authors.lastname: Epstein
authors.forename: Tor K
authors.initials: TK
authors.lastname: Larsen
authors.forename: Paul
authors.initials: P
authors.lastname: Amminger
authors.forename: David
authors.initials: D
authors.lastname: Holub
authors.forename: Barbora
authors.initials: B
authors.lastname: Wenigová
authors.forename: Mark
authors.initials: M
authors.lastname: Turner
authors.forename: Gregor E
authors.initials: GE
authors.lastname: Berger
authors.forename: Colin
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Daniel
authors.initials: D
authors.lastname: Umbricht
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011618:Psychotic Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires