Duration of untreated psychosis in first-episode schizophrenia: Marker or determinant of course?

The natural history of schizophrenia is often chronic and debilitating an e nduring fact that draws attention to the first episode and early course of the disorder when neurobiological deficits apparently form. Many recent stu dies have focused on the duration of untreated psychosis (DUP) in first-epi sode patients for reasons that are reviewed here. DUP is often months or ye ars in length, making it a major public mental health problem. Reducing DUP through early detection may be possible from a service systems perspective . This may be very important because earlier treatment not only reduces acu te psychotic symptoms, but may also improve long-term prognosis by attenuat ing the deficit processes active at this time; processes that are either si gnaled by or a product of DUP. Finally, DUP appears to influence sampling i n first-episode research in that longer DUP is associated with higher recru itment refusal rates to studies. For all of these reasons, DUP should be ad ded to the battery of descriptive variables routinely collected on all pati ents with schizophrenia, whether for treatment or research. Biol Psychiatry 1999;46:899-907 (C) 1999 Society of Biological psychiatry.