Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series?

Objective: The authors examined the duration of untreated psychosis, define d as the interval from first psychotic symptom to first psychiatric hospita lization, in a county-wide sample of first-admission inpatients who had rec eived no previous antipsychotic medication. Differences between diagnostic groups in 24-month illness course and clinical outcomes as well as relation ships between outcomes and duration of untreated psychosis were evaluated. Method: The data were derived from subjects in the Suffolk County Psychosis Project who were diagnosed at 24-month follow-up according to DSM-IV as ha ving schizophrenia or schizoaffective disorder (N=155), bipolar disorder wi th psychotic features (N=119), or major depressive disorder with psychotic features (N=75). Duration of untreated psychosis was derived from the Struc tured Clinical Interview for DSM-III-R, medical records, and information fr om significant others. Measures at 24-month follow-up included consensus ra tings of illness course, Global Assessment of Functioning Scale scores for the worst week in the month before interview, and current affective and psy chotic symptoms. Results: The median duration of untreated psychosis was 98 days for schizophrenia, 9 days for psychotic bipolar disorder, and 22 days for psychotic depression. Duration of untreated psychosis was not signific antly associated with 24-month illness course or clinical outcomes in any o f the diagnostic subgroups. Conclusions: Although these findings require re plication in other epidemiologically based first-admission samples, at face value they do not support the suggestion of a psychotoxic effect of prolon ged exposure to untreated psychosis.