Prodromal schizophrenia in primary care: a randomised sensitisation study

Background GPs are often the first point of contact for patients with prodromal schizophrenia. Early intervention, and therefore early detection, of schizophrenia is pivotal for the further disease Course. However, recent studies have revealed that, due to its low prevalence in general practice and its insidious features, prodromal schizophrenia often remains unnoticed. Aim To test whether a repeated sensitisation method using clinical vignettes can improve diagnostic knowledge of GPs. Design of study Postal survey using anonymous questionnaires. Repeated sensitisation model using clinical vignettes. Setting GPs in three distinct regions in Switzerland covering a general population of 1.43 million. Method The study was conducted between September 2008 and October 2009. Questionnaires were sent to 1138 GPs at baseline, and at 6 and 12 months. After randomisation, 591 GPs were sensitised at 1, 3, and 5 months, while no sensitisation was carried out in the remaining 547 GPs. Results The overall response rate was 66% (750 GPs). Sensitised GPs demonstrated a highly significant increase in diagnostic knowledge at 6 and at 12 months when compared to their own baseline knowledge scores and also to non-sensitised GPs (P<0.001). In particular, awareness of insidious features, such as functional decline and social withdrawal as signs of prodromal schizophrenia, accounted for this effect. Conclusion Theoretical knowledge of prodromal schizophrenia among GPs can successfully be increased by repeated sensitisation models using clinical vignettes.