Survey Identifies Common Barriers to Schizophrenia Diagnosis, Treatment

Despite growing evidence that early detection and care following the onset of psychosis is key to improved long-term outcomes for patients with schizophrenia, some psychiatrists predict it takes more than 3.5 years before a person with symptoms of the disorder receives the appropriate diagnosis.

This is one of several findings from a report published in October by Nielsen, which surveyed 300 psychiatrists and 300 caregivers of patients with schizophrenia on the barriers to receiving the proper treatment for the illness.

“This survey was simple, yet well thought out,” said Ira Glick, M.D., a professor emeritus of psychiatry and behavioral sciences at Stanford University School of Medicine; he was not involved with the survey. “It surveyed key people who are closest to patients with schizophrenia. Getting the perspective of these people [as it relates to treatment barriers for patients with schizophrenia] is very important,” he told Psychiatric News.

To be eligible to complete the online survey, psychiatrists had to practice in the United States and treat at least five patients with schizophrenia. Caregivers were required to have cared for someone who was diagnosed with schizophrenia for 20 years or less and was prescribed medication to help manage the symptoms of the illness. Caregivers were also to have had close contact with the patient when early signs of the disorder first appeared. Caregivers were asked 29 questions, and psychiatrists were asked 32 questions.

According to the survey, both psychiatrists and caregivers estimate it takes patients on average 2.9 years to see a psychiatrist after experiencing the first early warning signs of the disorder. Among the top reasons cited for this delay was a lack of awareness by patients and their families of the early warning signs of the disorder or understanding that they represent symptoms of a serious mental illness.

Even after a patient meets with a psychiatrist, it can take more than eight months before a definitive diagnosis of schizophrenia is made, the survey found. Of the psychiatrists interviewed, 74 percent said that “it’s common to be diagnosed with other mental illness before a diagnosis for schizophrenia.” Patients with schizophrenia may be diagnosed with nonspecified psychotic disorder (occurring 89 percent of the time prior to a schizophrenia diagnosis), substance use disorder (occurring 71 percent of the time), and bipolar disorder (occurring 71 percent of the time), according to the psychiatrists surveyed.

Fear of schizophrenia among patients and their families may also contribute to delaying the diagnosis, according to the report. Some 76 percent of psychiatrists surveyed noted that patients and their families “do not easily accept diagnosis,” according to the report.

Despite this, the majority of psychiatrists and caregivers agree that early intervention leads to better future outcomes for people with schizophrenia, and delaying intensive treatment does more harm than good.

According to Glick, who has practiced psychiatry for more than 40 years, the Nielsen report highlights two main issues—training of psychiatrists and stigma.

“We must do a better job with training psychiatrists and making sure that we all understand DSM diagnoses to help avoid misdiagnosis of schizophrenia as a mood disorder or attention-deficit disorder,” Glick said. “Also we must rid ourselves of the long-standing—and mistaken—presumption that a mood disorder will be a better prognosis for patients,” which Glick suggested serves to perpetuate the stigma associated with schizophrenia.

To help ease tensions associated with diagnosis and treatment, it is important to establish an alliance with patients and their caregivers and get the patient started on medication as early as possible, Glick said.

“Because of fear, a lot of patients and their families are unaware that early intervention leads to markedly improved outcomes,” Glick said. “It is our job to make sure that patients, caregivers, and even some psychiatrists who delay treatment know that early treatment hinders a worse prognosis.”

The study was funded by Alkermes. ■