Swiss Med Wkly. 2026 Jan 6;156:4490. doi: 10.57187/s.4490.
ABSTRACT
BACKGROUND: Guidelines for diagnostic work-up in first-episode psychosis (FEP) vary worldwide. The German DGPPN S3 guidelines recommend a comprehensive work-up, including neuroimaging. However, real-world adherence to these recommendations remains unclear. This study examined guideline adherence in a Swiss tertiary psychiatric hospital.
METHODS: We conducted a retrospective cross-sectional study analysing electronic healthcare records of first-episode psychosis patients hospitalised with an ICD-10 chapter F2 diagnosis for the first time between October 2022 and September 2023. We assessed adherence to recommended mandatory DGPPN S3 assessments – neurological examinations, blood analyses, drug screening, MRI – and evaluated completion of optional assessments such as EEG and lumbar puncture.
RESULTS: A total of 68 first-episode psychosis patients were included from 364 patients screened: 44 (64.7%) were men; their median age was 29 (IQR: 23-33) years; 35 (51.5%) were involuntary admissions. Nearly all patients (n = 66 or 97.1%) received thorough neurological examinations and blood analyses, while 56 (82.4%) underwent drug screening (with 35 [44.6%] testing positive for cannabis). MRI was conducted in 38 (55.9%) cases. Non-completion of MRI was mainly due to patient refusal (n = 10 or 14.7%) or early discharge (n = 16 or 23.5%). Optional EEG and lumbar puncture were less frequently performed: in 26 (38.2%) and 4 (5.9%) patients, respectively.
CONCLUSIONS: Overall, guideline adherence was high, particularly for essential diagnostic procedures. However, only around half of the sample underwent MRI imaging, largely because of patient refusal or patient-requested discharge prior to completion of the suggested assessment. These findings highlight the need for optimised diagnostic workflows and enhanced patient education strategies to improve guideline adherence in FEP assessment.
PMID:41962128 | DOI:10.57187/s.4490
