Background

It has been recognised for some time that care for people with schizophrenia, and similar psychotic illnesses, needs to be designed and commissioned with regard to the needs and wishes of  service users  and carers. It is therefore important that commissioners planning for new care teams, such as early intervention services (EIS), have all the information they need to understand how much of the illness there is in the population at any one time, and how many new cases there will be in the years to come as the population expands.

Without this knowledge, service  commissioners will struggle to match population needs in a sustainable way. This aim of this research, commissioned by the Department of Health, is to provide more information on the  incidence, prevalence, variability and cost of psychoses than has ever been drawn together before in the UK.

Research

A research team from the Department of Psychiatry, University of Cambridge, supported by the CLAHRC, Wellcome Trust and the Department of Health, reviewed the evidence on the incidence and prevalence of all psychotic disorders (including schizophrenia and affective psychotic disorders) in England in the last 60 years, looking at the effect of socio-demographic factors such as age, sex, ethnicity, migration, place of birth and upbringing, to determine the extent to which rates varied according to these factors over time .

Findings

The research team found that the incidence of psychotic disorders has been stable over time. With regard to age and gender, the findings were consistent with the wider international literature.

Conclusions

Given the strong genetic component that is likely  to underpin the risk of  developing psychosis, it is  unsurprising that rates in England appear to be markedly unchanged since at least 1950 even having regard to the compositional changes in the population. Consistent variation in rates by place, ethnicity, age and sex, suggest environmental factors also play a role in the onset of the disorder.

References

1. Cheng, F et al (2010) Administrative incidence  of psychosis assessed in an early intervention service in England.

2. Kirkbride JB, Stubbins C, Jones PB. Psychosis incidence through the prism of early intervention services. British Journal of Psychiatry. 2012b; 200: 156-7.

3. Kirkbride JB, Errazuriz A, Croudace TJ, Morgan C, Jackson D, Boydell J, Murray RM, Jones PB. Incidence of schizophrenia and other psychoses in England, 19502009: a systematic review and meta-analyses. PLoS One. 2012a;7(3):e31660. Epub 2012 Mar 22.

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Other links

PsyMaptic

A key output of this research has been the development of a software modelling tool called PsyMaptic, that predicts the expected incidence (number of new cases per year) of first episode psychosis in a demographic area. The need for this innovation is that previous estimates used outdated assumptions that the incidence of psychotic illness was unrelated to sociodemographic characteristics of a population; this is wrong.  PsyMaptic will enable commissioners to apply estimates to small area populations in the UK, producing the expected number of first episode psychosis in any given time period. This software will be made available as a free tool and will be particularly useful for commissioners of mental health services.

PsyMaptic went live on the internet earlier this week. It provides prediction estimates of the expected annual number of new cases of clinically-relevant first episode psychotic disorders in local authorities in England and Wales. To access the tool, please visit www.psymaptic.org and click on “prediction” in the top menu.

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