Invisible schizophrenia: A postal survey of the incidence and management of new cases of schizophrenia in primary care

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Abstract
Most new cases of schizophrenia are referred to hospital by general practitioners. It has been assumed that newly diagnosed schizophrenic patients pass through the filter between primary care and specialist psychiatric services with minimal delay. Little, however, is known of the incidence and initial management of schizophrenia in primary care. In this study questionnaires were sent to 175 general practitioners in Camberwell and Gloucester, enquiring after their experience of managing schizophrenia. Sixty per cent of respondents had seen an undiagnosed schizophrenic patient at some stage of their career. The general practice annual incidence rate of schizophrenia was estimated to be 12/100,000 in Gloucester and 26/100,000 in Camberwell. The large majority of patients were seen by a psychiatrist within a few weeks of general practitioner contact, but a significant minority of general practitioners sought to manage patients without making referral and prescribed psychotropic drugs before receiving an opinion. Eight per cent of patients did not see a psychiatrist.