Accelerated efforts must be made to decrease the currently limited use of both outpatient services and antipsychotic treatment among young patients with first-episode schizophrenia, according to research results published in Schizophrenia Bulletin.

Researchers conducted a retrospective analysis of de-identified administrative data claims of patients with first-episode schizophrenia to assess the role that treatment setting plays in young patients when first diagnosed. Data were from the OptumLabs Data Warehouse between January 2011 and December 2015. Researchers also measured the use of mental health services and antipsychotic use in the year following diagnosis. Investigators identified 1450 patients aged between 14 and 30 years for inclusion in the study (mean age at index diagnosis 19.8±4.0 years; 67.3% between 18-24 years; 34% women; 69.6% nonLatino white). Within the cohort, 39.4% of participants were first diagnosed with schizophrenia during an outpatient visit; 29.2% were diagnosed in an inpatient setting, 17.3% in an emergency department setting, and 8.9% in a hospital outpatient setting.

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Patients with first diagnosis in an inpatient setting were most likely to fill a prescription for an antipsychotic medication (42.7%; standard error [SE] 2.6%). Overall, the mean number of prescription fills of antipsychotic medications within the cohort was 8.3 (SE 0.3); 35.8% of patients filled 1 or more prescription (SE 1.3%). Among all patients who filled prescriptions (n=529), 31.4% had a Medication Possession Ratio of 80% or higher; according to this benchmark, these patients were adherent to their medication during the year. Among patients who filled their prescriptions within 90 days of first-episode schizophrenia (n=466), 57% discontinued their medication within 6 months, followed by an additional 15% of patients within 12 months.

Patients who were diagnosed in an emergency department setting were most likely to receive inpatient mental health services (55.6%; SE 3.3%). Among those who received inpatient mental health services, the mean number of hospital admissions was 2.4±2.1, with a mean length of stay of 5.3±4.3 days. Those diagnosed in a community-based outpatient visit were least likely to receive either mental health or emergency department services (22.6% and 36%; SE 1.8% and 2%, respectively). This group had the fewest number of inpatient mental health days (12.6; SE 1.5). Across all settings, 79.7% of patients received outpatient services, and the mean number of visits was 15.9 (SE 0.8). Nearly 1000 patients (n=942) had an outpatient contact within 90 days of first-episode schizophrenia, but 35% of that group discontinued outpatient services within 6 months, followed by an additional 30% within 12 months.

Study limitations include an inability to verify diagnoses of first-episode schizophrenia through medical review, an inability to determine if mental health services were appropriate or clinically effective, and the lack of generalizability of results to patients outside of a population of commercially insured youth.

“Our results reveal widespread missed opportunities for early evidence-based interventions that could potentially improve outcomes for young people with [first-episode schizophrenia],” the researchers concluded. “Low levels of outpatient mental health service use and antipsychotic treatment following initial diagnosis of schizophrenia provide renewed urgency to ongoing efforts to accelerate early identification and improve the coordination of treatment of young people with [first-episode schizophrenia].”

Reference
Gilmer TP, van der Ven E, Susser E, Dixon LB, Olfson M. Service use following first-episode schizophrenia among commercially insured youth [published online June 11, 2019]. Schizophr Bull. doi: 10.1093/schbul/sbz031