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Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy

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Abstract

Purpose

This study set out to investigate the patterns of referral in a sample (n = 206) of patients having first-time access to an Italian comprehensive program that targets the early detection of and early intervention on subjects at the onset of psychosis. The primary goal of the study was to investigate the duration of untreated illness (DUI) and/or the duration of untreated psychosis (DUP) in the sample since the implementation of the program.

Method

Data on pathways of referrals prospectively collected over a 11-year period, from 1999 to 2010; data referred to patients from a defined catchment area, and who met ICD-10 criteria for a first episode of a psychotic disorder (FEP) or were classified to be at ultra-high risk of psychosis (UHR) according to the criteria developed by the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne. Changes over time in the DUI and DUP were investigated in the sample.

Results

Referrals increased over time, with 20 subjects enrolled per year in the latter years of the study. A large majority of patients contacted a public or private mental health care professional along their pathway to treatment, occurring more often in FEP than in UHR patients. FEP patients who had contact with a non-psychiatric health care professional had a longer DUP. Over time, DUP and DUI did not change in FEP patients, but DUI increased, on average, in UHR patients.

Conclusions

The establishment of an EIP in a large metropolitan area led to an increase of referrals from people and agencies that are not directly involved in the mental health care system; over time, there was an increase in the number of patients with longer DUI and DUP than those who normally apply for psychiatric services.

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References

  1. Rogler LH, Cortes DE (1993) Help-seeking pathways: a unifying concept in mental health care. Am J Psychiatry 150:554–561

    PubMed  CAS  Google Scholar 

  2. Singh SP, Grange T (2006) Measuring pathways to care in first-episode psychosis: a systematic review. Schizophr Res 81:75–82

    Article  PubMed  Google Scholar 

  3. Crow TJ, MacMillan JF, Johnson AL, Johnstone EC (1986) A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry 148:120–127

    Article  PubMed  CAS  Google Scholar 

  4. McGlashan T (1999) Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biol Psychiatry 46:899–907

    Article  PubMed  CAS  Google Scholar 

  5. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and in cohorts of first-episode outcome patients—a systematic review. Arch Gen Psychiatry 62:975–983

    Article  PubMed  Google Scholar 

  6. Perkins DO, Gu H, Boteva K, Lieberman JA (2005) Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 162:1785–1804

    Article  PubMed  Google Scholar 

  7. Anderson KK, Fuhrer R, Malla AK (2010) The pathways to mental health care of first-episode psychosis patients: a systematic review. Psychol Med 40:1585–1597

    Article  PubMed  CAS  Google Scholar 

  8. McGlashan TH, Johannessen JO (1996) Early detection and intervention with schizophrenia: rationale. Schizophr Bull 22:201–222

    Article  PubMed  CAS  Google Scholar 

  9. McGorry PD, Nelson B, Amminger GP, Bechdolf A, Francey SM, Berger G, Riecher-Rössler A, Klosterkötter J, Ruhrmann S, Schultze-Lutter F, Nordentoft M, Hickie I, McGuire P, Berk M, Chen EY, Keshavan MS, Yung AR (2009) Intervention in individuals at ultra high risk for psychosis: a review and future directions. J Clin Psychiatry 70:1206–1212

    Article  PubMed  Google Scholar 

  10. Birchwood M, Lester H, McCarthy L, Jones P, Fowler D, Amos T, Freemantle N, Sharma V, Lavis A, Singh S, Marshall M (2013) The UK national evaluation of the development and impact of Early Intervention Services (the National EDEN studies): study rationale, design and baseline characteristics. Early Interv Psychiatry. doi:10.1111/eip.12007

    Google Scholar 

  11. Franz L, Carter T, Leiner AS, Bergner E, Thompson NJ, Compton MT (2010) Stigma and treatment delay in first-episode psychosis: a grounded theory study. Early Interv Psychiatry 4:47–56

    Article  PubMed  Google Scholar 

  12. Serra M, Lai A, Buizza C, Pioli R, Preti A, Masala C, Petretto DR (2013) Beliefs and attitudes among Italian high school students toward people with severe mental disorders. J Nerv Ment Dis 201:311–318

    Article  PubMed  Google Scholar 

  13. Lloyd-Evans B, Crosby M, Stockton S, Pilling S, Hobbs L, Hinton M, Johnson S (2011) Initiatives to shorten duration of untreated psychosis: systematic review. Br J Psychiatry 198:256–263

    Article  PubMed  Google Scholar 

  14. Connor C, Birchwood M, Palmer C, Channa S, Freemantle N, Lester H, Patterson P, Singh S (2013) Don’t turn your back on the symptoms of psychosis: a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK. BMC Psychiatry 13(1):67. doi:10.1186/1471-244X-13-67

    Article  PubMed  Google Scholar 

  15. Malla A, Norman R, Scholten D, Manchanda R, McLean T (2005) A community intervention for early identification of first episode psychosis: impact on duration of untreated psychosis (DUP) and patient characteristics. Soc Psychiatry Psychiatr Epidemiol 40:337–344

    Article  PubMed  Google Scholar 

  16. Johannessen JO, Larsen TK, Joa I, Melle I, Friis S, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan TH (2005) Pathways to care for first-episode psychosis in an early detection health care sector: part of the Scandinavian TIPS study. Br J Psychiatry Suppl 48:s24–s28

    Article  PubMed  Google Scholar 

  17. Chong SA, Mythily S, Verma S (2005) Reducing the duration of untreated psychosis and changing help-seeking behaviour in Singapore. Soc Psychiatry Psychiatr Epidemiol 40:619–621

    Article  PubMed  Google Scholar 

  18. Joa I, Johannessen JO, Auestad B, Friis S, McGlashan T, Melle I, Opjordsmoen S, Simonsen E, Vaglum P, Larsen TK (2008) The key to reducing duration of untreated first psychosis: information campaigns. Schizophr Bull 34:466–472

    Article  PubMed  Google Scholar 

  19. Krstev H, Carbone S, Harrigan SM, Curry C, Elkins K, McGorry PD (2004) Early intervention in first-episode psychosis—the impact of a community development campaign. Soc Psychiatry Psychiatr Epidemiol 39:711–719

    Article  PubMed  Google Scholar 

  20. Power P, Iacoponi E, Reynolds N, Fisher H, Russell M, Garety P, McGuire PK, Craig T (2007) The Lambeth Early Onset Crisis Assessment Team study: general practitioner education and access to an early detection team in first-episode psychosis. Br J Psychiatry Suppl 51:s13313–s13319

    Google Scholar 

  21. Lester H, Birchwood M, Freemantle N, Michail M, Tait L (2009) REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis. Br J Gen Pract 59:e183–e190

    Article  PubMed  Google Scholar 

  22. Olsen KA, Rosenbaum B (2006) Prospective investigations of the prodromal state of schizophrenia: review of studies. Acta Psychiatr Scand 113:247–272

    Article  PubMed  CAS  Google Scholar 

  23. Simon AE, Dvorsky DN, Boesch J, Roth B, Isler E, Schueler P, Petralli C, Umbricht D (2006) Defining subjects at risk for psychosis: a comparison of two approaches. Schizophr Res 81:83–90

    Article  PubMed  Google Scholar 

  24. Phillips LJ, McGorry PD, Yuen HP, Ward J, Donovan K, Kelly D, Francey SM, Yung AR (2007) Medium term follow-up of a randomized controlled trial of interventions for young people at ultra high risk of psychosis. Schizophr Res 96:25–33

    Article  PubMed  Google Scholar 

  25. Cornblatt B, Lencz T, Smith CW, Correll CU, Auther A, Nakayama E (2003) The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophr Bull 29:633–651

    Article  PubMed  Google Scholar 

  26. Preti A, Cella M (2010) Randomized controlled trials in people at ultra high risk of psychosis: a review of treatment effectiveness. Schizophr Res 123:30–36

    Article  PubMed  Google Scholar 

  27. McGorry PD (2007) Issues for DSM-V: clinical staging: a heuristic pathway to valid nosology and safer, more eff ective treatment in psychiatry. Am J Psychiatry 164:859–860

    Article  PubMed  Google Scholar 

  28. Raballo A, Larøi F (2009) Clinical staging: a new scenario for the treatment of psychosis. Lancet 374:365–367

    Article  PubMed  Google Scholar 

  29. Addington J, Van Mastrigt S, Hutchinson J, Addington D (2002) Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatr Scand 106:358–364

    Article  PubMed  CAS  Google Scholar 

  30. Murphy J, Shevlin M, Houston J, Adamson G (2012) A population based analysis of subclinical psychosis and help-seeking behavior. Schizophr Bull 38:360–367

    Article  PubMed  Google Scholar 

  31. O’Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley SD, McWilliams S, Behan C, Fetherstone A, Kinsella A (2010) First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol 45:381–391

    Article  PubMed  Google Scholar 

  32. Cocchi A, Meneghelli A, Preti A (2008) “Programma 2000”: celebrating 10 years of activity of an Italian pilot program on early intervention in psychosis. Aust NZ J Psychiatry 42:1003–1012

    Article  Google Scholar 

  33. Meneghelli A, Cocchi A, Preti A (2010) “Programma2000”: a multi-modal pilot program on early intervention in psychosis underway in Italy since 1999. Early Interv Psychiatry 4:97–103

    Article  PubMed  Google Scholar 

  34. Yung AR, McGorry PD, McFarlane CA, Jackson HJ, Patton GC, Rakkar A (1996) Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull 22:283–303

    Article  PubMed  CAS  Google Scholar 

  35. de Girolamo G, Cozza M (2000) The Italian psychiatric reform: a 20-year perspective. Int J Law Psychiatry 23:197–214

    Article  PubMed  Google Scholar 

  36. Lora A, Barbato A, Cerati G, Erlicher A, Percudani M (2011) The mental health care system in Lombardy, Italy: access to services and pattern of care. Soc Psychiatry Psychiatr Epidemiol 47:447–454

    Article  PubMed  Google Scholar 

  37. de Girolamo G, Barbato A, Bracco R, Gaddini A, Miglio R, Morosini P, Norcio B, Picardi A, Rossi E, Rucci P, Santone G, Dell’Acqua G (2007) The characteristics and activities of acute psychiatric inpatient facilities: a national survey in Italy. Br J Psychiatry 191:170–177

    Article  PubMed  Google Scholar 

  38. Gigantesco A, Miglio R, Santone G, de Girolamo G, Bracco R, Morosini P, Norcio B, Picardi A, PROGRES group (2007) The process of care in general hospital psychiatric units: a national survey in Italy. Austr N Z J Psychiatry 41:509–518

    Article  Google Scholar 

  39. Fattore G, Percudani M, Pugnoli C, Contini A, Beecham J (2000) Mental health care in Italy: organisational structure, routine clinical activity and costs of a Community Psychiatric Service in Lombardy Region. Int J Soc Psychiatry 46:250–265

    Article  PubMed  CAS  Google Scholar 

  40. Preti A, Rucci P, Santone G, Picardi A, Miglio R, Bracco R, Norcio B, de Girolamo G, PROGES-Acute group (2009) Patterns of admission to acute psychiatric inpatient facilities: a national survey in Italy. Psychol Med 39:485–496

    Article  PubMed  CAS  Google Scholar 

  41. Lora A, Cosentino U, Gandini A, Zocchetti C (2007) Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy). Epidemiol Psichiatria 16:330–338

    Google Scholar 

  42. Preti A, Rucci P, Gigantesco A, Santone G, Picardi A, Miglio R, de Girolamo G, PROGRES-Acute group (2009) Pattern of care in patients discharged from acute psychiatric inpatient facilities: a national survey in Italy. Soc Psychiatry Psychiatr Epidemiol 44:767–776

    Article  PubMed  Google Scholar 

  43. Lora A, Conti V, Leoni O, Rivolta AL (2011) Adequacy of treatment for patients with schizophrenia spectrum disorders and affective disorders in Lombardy, Italy. Psychiatr Serv 62:1079–1084

    Article  PubMed  Google Scholar 

  44. Häfner H, Riecher–Rossler A, Hambrecht M (1992) IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophr Res 6:209–223

    Article  PubMed  Google Scholar 

  45. Maurer K, Hörrmann F, Trendler G, Schmidt M, Häfner H (2006) Früherkennung des Psychoserisikos mit dem Early Recognition Inventory (ERIraos) Beschreibung des Verfahrens und erste Ergebnisse zur Reliabilität und Validität der Checkliste [Identification of psychosis risk by the Early Recognition Inventory (ERIraos)—description of the schedules and preliminary results on reliability and validity of the checklist] [German]. Nervenheilkunde 25:11–16

    Google Scholar 

  46. Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A (1998) Health of the nation outcome scales (HoNOS): research and development. Br J Psychiatry 172:11–18

    Article  PubMed  CAS  Google Scholar 

  47. Overall JE, Gorham DE (1962) The brief psychiatric rating scale. Psychol Rep 10:799–812

    Article  Google Scholar 

  48. Roncone R, Ventura J, Impallomeni M, Falloon IR, Morosini PL, Chiaravalle E, Casacchia M (1999) Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience. Acta Psychiat Scand 100:229–236

    Article  PubMed  CAS  Google Scholar 

  49. Moos RH, McCoy L, Moos BS (2000) Global assessment of functioning (GAF) ratings: determinants and roles as predictors of 1-year treatment outcomes. J Clin Psychology 56:449–461

    Article  CAS  Google Scholar 

  50. WHO (World Health Organization) (1992) Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10). WHO Press, Geneve

    Google Scholar 

  51. Birchwood M (2000) Early intervention and sustaining the management of vulnerability. Aust N Z J Psychiatry 34(Suppl):S181–S184

    PubMed  Google Scholar 

  52. Larsen TK, Johannessen JO, Opjordsmoen S (1998) First-episode schizophrenia with long duration of untreated psychosis. Pathways to care. Br J Psychiatry Suppl 172:45–52

    PubMed  CAS  Google Scholar 

  53. Häfner H, Maurer K, Löffler W, van der Heiden W, Hambrecht M, Schultze-Lutter F (2003) Modeling the early course of schizophrenia. Schizophr Bull 29:325–340

    Article  PubMed  Google Scholar 

  54. Maurer K, Hörrmann FH, Häfner H (2006) Evaluation of psychosis rsk by the schedule ERIraos. Results based on 1 year transition rates in the German schizophrenia network study. Schizophr Res 86:S19

    Article  Google Scholar 

  55. Øiesvold T, Bakkejord T, Hansen V, Nivison M, Sørgaard KW (2012) Suicidality related to first-time admissions to psychiatric hospital. Soc Psychiatry Psychiatr Epidemiol 47:419–425

    Article  PubMed  Google Scholar 

  56. Cliff N (1993) Dominance statistics: ordinal Analyses to answer ordinal questions. Psychol Bull 114:494–509

    Article  Google Scholar 

  57. Meneghelli A, Alpi A, Pafumi N, Patelli G, Preti A, Cocchi A (2011) Expressed emotion in first-episode schizophrenia and in ultra high-risk patients. Results from Programma 2000 (Milan, Italy). Psychiatry Res 189:331–338

    Article  PubMed  Google Scholar 

  58. Shin YM, Jung HY, Kim SW, Lee SH, Shin SE, Park JI, An SK, Kim YH, Chung YC (2010) A descriptive study of pathways to care of high risk for psychosis adolescents in Korea. Early Interv Psychiatry 4:119–123

    Article  PubMed  Google Scholar 

  59. Chung YC, Jung HY, Kim SW, Lee SH, Shin SE, Shin YM, Park JI, An SK, Kim YH (2010) What factors are related to delayed treatment in individuals at high risk for psychosis? Early Interv Psychiatry 4:124–131

    Article  PubMed  Google Scholar 

  60. Fridgen GJ, Aston J, Gschwandtner U, Pflueger M, Zimmermann R, Studerus E, Stieglitz RD, Riecher-Rössler A (2012) Help-seeking and pathways to care in the early stages of psychosis. Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-012-0628-0

    PubMed  Google Scholar 

  61. Norman RM, Malla AK, Manchanda R (2007) Delay in treatment for psychosis : its relation to family history. Soc Psychiatry Psychiatr Epidemiol 42:507–512

    Article  PubMed  Google Scholar 

  62. Rabinovitch M, Béchard-Evans L, Schmitz N, Joober R, Malla A (2009) Early predictors of nonadherence to antipsychotic therapy in first-episode psychosis. Can J Psychiatry 54:28–35

    PubMed  Google Scholar 

  63. Thomas SP, Nandhra HS (2009) Early intervention in psychosis: a retrospective analysis of clinical and social factors influencing duration of untreated psychosis. Prim Care Companion J Clin Psychiatry 11:212–214

    Article  PubMed  Google Scholar 

  64. Oliveira AM, Menezes PR, Busatto GF, McGuire PK, Murray RM, Scazufca M (2010) Family context and duration of untreated psychosis (DUP): results from the Sao Paulo study. Schizophr Res 119:124–130

    Article  PubMed  Google Scholar 

  65. Pescosolido BA, Gardner CB, Lubell KM (1998) How people get into mental health care services: storis of choice, coercion and ‘muddling through’ from ‘first-timers’. Soc Sci Med 46:275–286

    Article  PubMed  CAS  Google Scholar 

  66. Verdoux H, Bergey C, Assens F, Abalan F, Gonzales B, Pauillac P, Fournet O, Liraud F, Beaussier J, Gaussares C, Etchegaray B, Bourgeois M, van Os J (1998) Prediction of duration of psychosis before first admission. Eur Psychiatry 13:346–352

    Article  PubMed  CAS  Google Scholar 

  67. Magliano L, Fiorillo A, De Rosa C, Malangone C, Maj M, The National Mental Health Project Working Group (2005) Family burden in long-term diseases: a comparative study in schizophrenia vs. physical disorders. Soc Sci Med 61:313–322

    Article  PubMed  Google Scholar 

  68. Gerson R, Davidson L, Booty A, McGlashan T, Malespina D, Pincus HA, Corcoran C (2009) Families’ experience with seeking treatment for recent-onset psychosis. Psychiatr Serv 60:812–816

    Article  PubMed  Google Scholar 

  69. Bhugra D, Harding C, Lippett R (2004) Pathways into care and satisfaction with primary care for black patients in South London. J Ment Health 13:171–183

    Article  Google Scholar 

  70. Compton MT (2005) Barriers to initial outpatient treatment engagement following first hospitalization for a first episode of nonaffective psychosis: a descriptive case series. J Psychiatr Pract 11:62–69

    Article  PubMed  Google Scholar 

  71. Levine SZ (2008) Population-based examination of the relationship between type of first admission for schizophrenia and outcomes. Psychiatr Serv 59:1470–1473

    Article  PubMed  Google Scholar 

  72. Bechard-Evans L, Schmitz N, Abadi S, Joober R, King S, Malla A (2007) Determinants of help-seeking and system related components of delay in the treatment of first-episode psychosis. Schizophr Res 96:206–214

    Article  PubMed  Google Scholar 

  73. McFarlane WR, Cook WL, Downing D, Verdi MB, Woodberry KA, Ruff A (2010) Portland identification and early referral: a community-based system for identifying and treating youths at high risk of psychosis. Psychiatr Serv 61:512–515

    Article  PubMed  Google Scholar 

  74. Platz C, Umbricht DS, Cattapan-Ludewig K, Dvorsky D, Arbach D, Brenner HD, Simon AE (2006) Help-seeking pathways in early psychosis. Soc Psychiatry Psychiatr Epidemiol 41:967–974

    Article  PubMed  Google Scholar 

  75. Iyer SN, Boekestyn L, Cassidy CM, King S, Joober R, Malla AK (2008) Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories. Psychol Med 38:1147–1156

    Article  PubMed  CAS  Google Scholar 

  76. Boonstra N, Sterk B, Wunderink L, Sytema S, De Haan L, Wiersma D (2012) Association of treatment delay, migration and urbanicity in psychosis. Eur Psychiatry 27:500–505

    Article  PubMed  CAS  Google Scholar 

  77. Fuchs J, Steinert T (2004) Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Soc Psychiatry Psychiatr Epidemiol 39:375–380

    Article  PubMed  Google Scholar 

  78. de Girolamo G, Bassi M, Neri G, Ruggeri M, Santone G, Picardi A (2007) The current state of mental health care in Italy: problems, perspectives, and lessons to learn. Eur Arch Psychiatry Clin Neurosci 257:83–91

    Article  PubMed  Google Scholar 

  79. Compton MT, Ramsay CE, Shim RS, Goulding SM, Gordon TL, Weiss PS, Druss BG (2009) Health services determinants of the duration of untreated psychosis among African-American first-episode patients. Psychiatr Serv 60:1489–1494

    Article  PubMed  Google Scholar 

  80. Yap MB, Wright A, Jorm AF (2011) The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help. Soc Psychiatry Psychiatr Epidemiol 46:1257–1265

    Article  PubMed  Google Scholar 

  81. Joa I, Johannessen JO, Auestad B, Friis S, Opjordsmoen S, Simonsen E, Vaglum P, McGlashan T, Larsen TK (2007) Effects on referral patterns of reducing intensive informational campaigns about first-episode psychosis. Early Interv Psychiatry 1:340–345

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank all the members of Programma2000 who contributed to the collection of data. Programma2000 is entirely financed by a grant from the Lombardy Regional Health Authority (Italy). The Lombardy Regional Health Authority had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Dr Maria T. Cascio was the recipient of a Grant of the Regione Sardegna (Grant no. T2-MAB-A2008-138). The Regione Sardegna had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. No other forms of financial support were received for this study.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Via Livigno, 3, 20128, Milan, Italy

    Angelo Cocchi, Anna Meneghelli, Arcadio Erlicher, Alessia Pisano & Maria Teresa Cascio

  2. Centro Medico Genneruxi, via Costantinopoli 42, 09129, Cagliari, Italy

    Antonio Preti

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  1. Angelo Cocchi
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Correspondence to Antonio Preti.

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Cocchi, A., Meneghelli, A., Erlicher, A. et al. Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy. Soc Psychiatry Psychiatr Epidemiol 48, 1905–1916 (2013). https://doi.org/10.1007/s00127-013-0736-5

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