Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis

Abstract

Aims and method We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. Results Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann–Whitney U = 25925, Z = −2.832, P = 0.005) and had longer hospital stays (Mann–Whitney U = 22816, Z = −4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann–Whitney U = 22 909.5, Z = −4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. Clinical implications Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

Keywords

• Autism spectrum disorders
• attention-deficit hyperactivity disorders
• neurodevelopmental disorders
• first-episode psychosis
• early intervention in psychosis