Duration of untreated psychosis: An important target for intervention in schizophrenia?

This article reviews the concept of duration of untreated psychosis (DUP) w ith special reference to schizophrenia, on the basis of clinical examples a nd a pilot study carried out in the county of Rogaland, Norway, in 1992-199 5. Several international studies show that the duration of untreated psycho sis (DUP), defined as the period of positive psychotic symptoms before trea tment, is long (52-112 weeks). The results from the pilot study in Rogaland confirmed that the mean duration of untreated psychosis is long (114 weeks ). In this study 43 patients with their first episode of non-affective psyc hosis were included. Long DUP was associated with more unemployment and dec reased social and global functioning. Males had longer DUP than females, we re more often single, and were more often schizophrenic and younger at onse t of psychosis. In premorbid functioning males scored poorer and deteriorat ed faster than females, especially closer to onset. Case histories are pres ented to illustrate why treatment was given late in the course of illness a nd may suggest that patients identified earlier in the course of illness ha d a better prognosis. Lack of awareness of symptoms of emerging psychosis a t the primary and secondary health service level may be one of the main rea sons for today's practice of late intervention in schizophrenia.