The authors sought to describe patterns of health care use prior to first diagnosis of a psychotic disorder in a population-based sample.

Electronic health records and insurance claims from five large integrated health systems were used to identify 624 patients 15–29 years old who received a first diagnosis of a psychotic disorder in any care setting and to record health services received, diagnoses assigned, and medications dispensed during the previous 36 months. Patterns of utilization were compared between patients receiving a first diagnosis of a psychotic disorder and matched samples of general health system members and members receiving a first diagnosis of unipolar depression.

During the year before a first psychotic disorder diagnosis, 29% of patients had mental health specialty outpatient care, 8% had mental health inpatient care, 24% had emergency department mental health care, 29% made a primary care visit with a mental health diagnosis, and 60% received at least one mental health diagnosis (including substance use disorders). Compared with patients receiving a first diagnosis of unipolar depression, those with a first diagnosis of a psychotic disorder were modestly more likely to use all types of health services and were specifically more likely to use mental health inpatient care (odds ratio=2.96, 95% CI=1.97–4.43) and mental health emergency department care (rate ratio=3.74, 95% CI=3.39–4.53).

Most patients receiving a first diagnosis of a psychotic disorder had some indication of mental health care need during the previous year. General use of primary care or mental health services, however, does not clearly distinguish people who later receive a diagnosis of a psychotic disorder from those who later receive a diagnosis of unipolar depression. Use of inpatient or emergency department mental health care is a more specific indicator of risk.

作者试图描述在基于人群的样本中首次诊断出精神病之前的医疗保健使用方式。

电子病历和来自五个大型综合卫生系统的保险索赔被用于识别624位15-29岁的患者，他们在任何护理环境中均首次得到了精神病的诊断，并记录在此期间接受的医疗服务，分配的诊断和所分配的药物前36个月。在接受精神病性疾病首次诊断的患者与一般卫生系统成员和接受单极抑郁症首次诊断的成员的匹配样本之间，比较了使用模式。

在首次精神病诊断之前的一年中，有29％的患者接受了精神健康专科门诊治疗，有8％的患者接受了精神健康住院治疗，有24％的患者接受了急诊科精神卫生治疗，有29％的患者进行了初次就诊并进行了精神健康诊断，其中60％接受了至少一项心理健康诊断（包括药物滥用疾病）。与首次诊断为单相抑郁的患者相比，首次诊断为精神病的患者适度使用所有类型的卫生服务的可能性更高，特别是更可能使用精神卫生的住院治疗（优势比= 2.96，95％） CI = 1.97–4.43）和精神卫生急诊科护理（比率= 3.74，95％CI = 3.39–4.53）。

在上一年中，大多数首次诊断为精神病的患者都有精神保健需求的迹象。但是，一般使用初级保健或精神卫生服务并不能清楚地区分后来被诊断出患有精神病的人和后来被诊断出患有单相抑郁症的人。使用住院或急诊科的精神保健服务是更具体的风险指标。