First Episode Psychosis: Factors associated with delayed access to care in a rural Egyptian setting

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First Episode Psychosis Factors associated with
delayed access to care in a rural Egyptian setting

• Dr Mamdouh EL-Adl, Princess Marina Hospital,
  Northampton, UK.
• Dr Mohammed EL-Mahdy, AL-Azhar University, Egypt.
• Dr Musheera Anis, Mansoura General Hospital,
  Egypt.

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Aim

• To identify factors associated with delayed
  access of individuals diagnosed with First
  Episode Psychosis (FEP) to Psychiatric Care.

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Background

• FEP Growing interest over past few decades.
• DUP- Duration of Untreated Psychosis.
• - Average one year or more (McGlashan,1998).
• - Long DUP undesirable.
• Early Treatment
• - Reduces suffering (Ho et al, 2003).
• - Minimises risks (Larsen et al,1998 Wyatt et
  al, 1998).

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Method

• Study sample FEP.
• Study period 6 months.
• Study centre Psychiatric Dept., MGH.
• Study team Drs EL-Adl, EL-Mahdy Anis.
• Study toolA semi-structured interview.
• FEP cases relevant others were interviewed.

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Mansoura City

• Established 1219
• By King AL-Saleh Ayoub during his combat against
  the Crusades.
• Capital of Eldakahlia province.
• Surrounded by a large rural area.
• Population - Mansoura 2 millions.
• - Eldakahlia 5 millions.

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Service Model

• Primary care underdeveloped.
• Specialist care
• - MGH. Psych dept.
• - MUHs. Psych dept.
• - Central hospitals. No Psych. Dept.
• Mental Health Service Hospital based.

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Psychiatric Dept. at MGH

• Catchment area one million.
• Inpatient 8 beds.
• OPC 100 patients/day.
• Staff
• - Psychiatrists 2 SHO, 8 Specialists, 2
  Consultants.
• - Psychiatric Nurses 8
• - Psychologist 1
• - Social Worker 1

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Results

• Total number of cases 40
• Diagnosis - Schizophrenia 14
• - Affective disorders 16
• - Postpartum disorders 5
• - Others 5

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Diagnostic Categories
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Gender Geographical area
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Gender Age Groups
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DUP- No Gender difference in the Egyptian study.
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Factors associated with delayed access
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Cultural Factors
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Referral Sources
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Conclusion

• Cultural factors, Lack of knowledge, Stigma
  financial factors may play a significant role in
  delayed access to care.
• Public education anti-stigma programmes are
  needed.
• A community oriented MH service is important.
• Integration between Primary Secondary care is
  essential.

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Clinical implications

• Public education anti-stigma programmes are
  needed.
• Early Intervention in Psychosis has to be
  promoted.
• Exchange of experience collaborative research
  between Arab Psychiatrists in home countries
  abroad should be promoted.

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Limitations

• Sample size small.
• Service model does not guarantee that all cases
  within the catchments area are included.
• Study results may not apply to other areas in
  Egypt or other Arab countries.

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Acknowledgment

• Thanks to our patients their families who
  were extremely helpful and agreed to participate
  in this study.

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Thank You