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Method: We searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and Tiffany Necklace and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).

Results: Included studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the Tiffany Pendant to care on treatment delay.

Conclusions: Additional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services

Introduction

Recent efforts in psychosis research have focused on the period from the onset of psychotic symptoms to appropriate psychiatric intervention, known as the duration of untreated psychosis (DUP). Findings from literature reviews suggest that delays in the treatment of the first episode are associated with poor clinical and functional outcome, and that it may Tiffany Ring possible to reduce the duration of this delay (Norman & Malla, 2001; Melle et al. 2004; Marshall et al. 2005; Perkins et al. 2005). Although there is little consensus as to what constitutes a long DUP, it is consistently associated with lower overall functioning, more severe positive and negative symptoms, lower quality of life, and a reduced likelihood of achieving remission (Marshall et al. 2005), in addition to poor response to psychiatric treatment (Perkins et al. 2005). This evidence has sparked substantial efforts in secondary prevention and early tiffany for sale for psychosis (McGorry et al. 2007).

The emphasis on early detection and reduction of treatment delay in first-episode psychosis (FEP) has led to an interest in the modes and routes by which patients experiencing psychotic symptoms access help. These pathways to care are defined as 'the sequence of contacts with individuals and organizations prompted by the distressed person's efforts, and those of his or her significant others, to seek help' (Rogler & Cortes, 1993). Care pathways are not random, and are influenced by social, cultural, and health service factors. The pathways to care encompass not only the help-seeking behavior of the patient and family members, but also the accessibility of health services and the identification of, and response to, the symptoms of early psychosis by each contact on the pathway (tiffany bangles & Grange, 2006). This concept is of particular importance in FEP, given the poor functional and clinical outcomes associated with a long DUP (Norman & Malla, 2001; Marshall et al. 2005; Perkins et al. 2005), and the suffering endured by patients and their families. Both help-seeking and referral delays impact the length of time that psychotic symptoms go untreated, and there is evidence that referral delays may be responsible for a substantial proportion of the DUP (Norman et al. 2004; Bechard-Evans et al. 2007).