Causes and consequences of duration of untreated psychosis in schizophrenia

Background It is unclear what determines duration of untreated psychosis (DUP) in schizophrenia and why long DUP predicts poor outcome. Aims First, to test the hypothesis that specific patterns of symptoms and social functioning acting before treatment prolong DUP. Second, to clarify the mechanisms linking DUP with recovery after treatment. Method Two hundred and forty-eight consecutive first admissions with schizophrenia were interviewed to assess DUP: symptoms and social functioning at admission, and symptoms were re-assessed after 6-12 weeks. Results Median DUP was 12 weeks. Long DUP was predicted by poor insight, social isolation and preserved coping skills, but not by demographic factors. Even allowing for all these variables, long DUP predicted poor outcome. Conclusions Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and relevant others. DUP's relationship to outcome is strongest in the initial months of psychosis. This has implications for targeting early intervention.