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The prevalence of neurodivergent conditions, such as autism and attention-deficit hyperactivity disorder (ADHD), in individuals experiencing first-episode psychosis (FEP) is significantly higher than previously thought, according to a new study by researchers at Brighton and Sussex Medical School (BSMS), London South Bank University (LSBU) and Sussex Partnership NHS Foundation Trust (SPFT).

Through a detailed evaluation of 509 individuals, researchers found that 37.7% of those with FEP were likely neurodivergent, significantly higher than the previously estimated 9%, highlighting an urgent need to reassess how these conditions are identified and managed within mental health services.

The study, led by SPFT pharmacist, FEP practitioner and LSBU visiting fellow, Nikola Nikolić, which explored neurodevelopmental traits and service usage patterns, revealed that neurodivergent individuals utilised urgent mental health services more frequently and experienced longer hospital stays compared with their non-neurodivergent counterparts.

Neurodivergent individuals were found to spend more than twice as long in mental health hospitals at a time, underscoring the greater burden they face within the mental health care system.

, Reader in Brain-Body Medicine at BSMS, Neurodevelopmental Psychiatrist and senior author on the study said: “This research emphasises the need for enhanced screening and early assessment of neurodevelopmental traits in individuals experiencing first-episode psychosis.

“Early intervention is critical to optimise psychosis management, reduce hospitalisation time and improve long-term mental health outcomes and care for neurodivergent individuals.”

What is first-episode psychosis (FEP)?

First-episode psychosis (FEP) refers to the first occurrence of psychotic symptoms, including hallucinations, delusions, and disorganised thinking, where individuals can experience a break from reality. FEP can significantly disrupt daily life and cause distress. Early intervention is essential to improve outcomes, reduce symptom severity and prevent relapse.

Key findings from the study include:

• Increased urgent care usage: Neurodivergent individuals used urgent mental health services significantly more than non-neurodivergent individuals
• Longer hospital stays: Neurodivergent individuals had longer hospital stays, with results showing they spent over twice as long in hospital compared to non-neurodivergent individuals
• Impact of early onset: Mediation analysis showed that the earlier onset of psychosis and higher use of emergency services among neurodivergent individuals contributed to their longer hospital stays.

The study's findings have important clinical implications, suggesting that the prevalence of neurodevelopmental conditions in FEP is underestimated. These individuals are more likely to experience psychosis earlier and have greater reliance on mental health services, leading to prolonged hospitalisation and higher healthcare costs.

Researchers stress the importance of early and accurate assessment of neurodevelopmental conditions in individuals with psychosis. Timely identification and intervention can improve management strategies, leading to better mental health outcomes and more efficient use of mental health services.

The full study is published in BJPsych Bulletin. .

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