title: Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy.
abstract: OBJECTIVE
  This study set out to investigate the patterns of referral in a sample (n = 206) of patients having first-time access to an Italian comprehensive program that targets the early detection of and early intervention on subjects at the onset of psychosis. The primary goal of the study was to investigate the duration of untreated illness (DUI) and/or the duration of untreated psychosis (DUP) in the sample since the implementation of the program.
  
  
  METHODS
  Data on pathways of referrals prospectively collected over a 11-year period, from 1999 to 2010; data referred to patients from a defined catchment area, and who met ICD-10 criteria for a first episode of a psychotic disorder (FEP) or were classified to be at ultra-high risk of psychosis (UHR) according to the criteria developed by the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne. Changes over time in the DUI and DUP were investigated in the sample.
  
  
  RESULTS
  Referrals increased over time, with 20 subjects enrolled per year in the latter years of the study. A large majority of patients contacted a public or private mental health care professional along their pathway to treatment, occurring more often in FEP than in UHR patients. FEP patients who had contact with a non-psychiatric health care professional had a longer DUP. Over time, DUP and DUI did not change in FEP patients, but DUI increased, on average, in UHR patients.
  
  
  CONCLUSIONS
  The establishment of an EIP in a large metropolitan area led to an increase of referrals from people and agencies that are not directly involved in the mental health care system; over time, there was an increase in the number of patients with longer DUI and DUP than those who normally apply for psychiatric services.
authors.affiliation: Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Via Livigno, 3, 20128, Milan, Italy, angelo.cocchi@ospedaleniguarda.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cocchi
authors.forename: Anna
authors.initials: A
authors.lastname: Meneghelli
authors.forename: Arcadio
authors.initials: A
authors.lastname: Erlicher
authors.forename: Alessia
authors.initials: A
authors.lastname: Pisano
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Cascio
authors.forename: Antonio
authors.initials: A
authors.lastname: Preti
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003156:Community Mental Health Services / Q000458:organization & administration*; D042241:Early Diagnosis; D061345:Early Medical Intervention / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents