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

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

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  1. 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.

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

  3. 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).

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

  5. 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.

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

  7. 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

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

  9. Diagnostic Categories

  10. Gender & Geographical area

  11. Gender & Age Groups

  12. DUP- No Gender difference in the Egyptian study.

  13. Factors associated with delayed access

  14. Cultural Factors

  15. Referral Sources

  16. 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.

  17. 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.

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

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

  20. Thank You