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SO492

Identifying unmet need: the clinical significance of suspected neurodivergence in first-episode psychosis

DETERMINING UNMET NEED: THE CLINICAL RELEVANCE OF SUSPECTED NEURODIVERGENCE IN FIRST EPISODE PSYCHOSIS.

Approximately 40% of people with first-episode psychosis have confirmed or suspected neurodivergence; in this group, psychosis begins approximately 9 years earlier, and hospital stays are nearly twice as long.

The study aimed to determine the prevalence of confirmed and suspected neurodivergent traits among people experiencing first-episode psychosis (FEP) in an Early Intervention in Psychosis (EIP) service adopting a neurodiversity-affirming approach, and to examine their association with healthcare utilization. In April 2023, the entire active caseload at Sussex Partnership NHS Foundation Trust (n=509, aged 14–65 years, with suspected or confirmed FEP) was audited. Neurodivergent traits were identified through clinician observation and/or screening tools (RAADS-R, AQ, WURS, ASRS, CAT-Q), and analyses included the Mann–Whitney U test, chi-square tests, and mediation analysis using Hayes PROCESS v3.5. Confirmed or suspected neurodivergence related to autism, ADHD, or both was identified in approximately 40% of the caseload (37.7% in the abstract). The confirmed and suspected neurodivergent (CSND) group had more days of acute service use (28.4 versus 20.2; p=0.011), more inpatient days (93.4 versus 32.8; p<0.001), and more admissions (1.1 versus 0.8; p<0.001) than the non-neurodivergent (NND) group; the mean length of admission was approximately twice as long in the neurodivergent group (59.6 versus 25.0 days; p<0.001). Psychosis began significantly earlier in the neurodivergent group (26.0 versus 34.9 years of age; approximately 9 years earlier; p<0.001). The mediation model demonstrated an indirect effect of neurodivergence on longer hospital stays through age at first psychotic symptoms (b=-8.86; p<0.001 and b=-1.81; p=0.032) and through emergency mental health service use (b=0.70; p=0.048 and b=6.96; p<0.001). In conclusion, the prevalence of neurodevelopmental conditions is underestimated in services that rely solely on formal diagnoses; early assessment appears critical to improving psychosis management and providing more timely, individualized EIP care.

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