Auditing first episode psychosis: giving meaning to clinical governance

People in a first episode of psychosis are receiving increasing attention. This study describes the demographic and clinical diagnostic features of a cohort of 84 cases of first episode psychosis presenting in North Derbyshire from October 1999 to October 2000. Forty-two cases falling within the schizophrenia spectrum diagnosis were identified, an incidence rate of 0.17 per 1000 population. The rate for all psychoses, including drug-induced psychoses, was 0.35 per 1000 population aged 15-64. More than 50% of the cases were from the main urban centre, which contains around one third of the population. There were high rates of substance misuse in all diagnostic groups. The majority of patients (73%) presented via their general practitioners, but 18% presented via accident and emergency (13%) or the police (5%). The median duration of untreated psychosis for the whole group was two months. Within the schizophrenia spectrum group, however, there was a wide distribution, with duration of untreated psychosis of up to 10 years. The median duration of unteated psychosis in the schizophrenia spectrum group was three months. About half the cases in this cohort were aged more than 35 (all diagnostic categories). Further work exploring the outcome in this cohort is currently under way. As the configuration of mental health services is set to change rapidly in the next few years, there is a crucial need to develop further observational studies assessing how services deliver care to people with severe mental illness.