Editorials

keeping the body in mind Most GPs can remember being faced with a young person experiencing their first psychotic illness: the patient’s confusion, their fear, their family’s distress. Perhaps some will recall ambivalence about invoking the Mental Health Act, or contacting colleagues to cover surgery while awaiting the arrival of another doctor or the police. The shared sense of bewilderment and sadness may have been balanced by some personal relief that normal working life might soon resume after the hours, days, or maybe weeks of distress, phone calls, and visits. Psychosis affects young people. More than three-quarters of men and two-thirds of women who experience psychosis have their first episode by age 35 years; most are in their late teens and twenties.1 This has prompted the development of more ‘youth sensitive ’ early intervention services in England and, to a lesser extent, in Scotland and Wales. A 3-year package of intensive, specialist, and age-appropriate mental health care results in less traumatic engagement and improved follow-up.2,3 Lester et al, in the current issue of the BJGP, researched whether an educational intervention to raise GPs ’ awareness of presenting clinical features of first episode psychosis could encourage earlier referral.4 While few would deny the importance of improving these care pathways, the study suggests that promoting diagnostic awareness adds little by itself: GPs are already quite good at detection. What Lester et al did find was that training could facilitate collaboration between GPs and the new early intervention services, and the obstacles were more about how they worked together. Moreover, evidence is now emerging about future physical health problems for these young people. This opens an important new theme which might benefit from strengthened collaboration between specialist early intervention services and primary care, utilising the latter’s expertise in cardiovascular risk management. People with a psychotic illness (schizophrenia and bipolar disorder) die up to 25 years earlier than the general population.5 While suicide or injury causes about one-third of these premature deaths, two-thirds result from physical health’s ‘usual suspects’: cardiovascular, pulmonary, and infectious diseases.6 The Disability Rights Commission (now the Equality an