Duration of untreated psychosis predicts treatment outcome in an early psychosis program

For patients first presenting with a non-affective psychotic disorder, the duration of untreated psychosis (DUP; the time between the onset of positiv e psychotic symptoms and the initiation of appropriate treatment) varies wi dely, from a few weeks to several years. A number of studies report that a longer DUP is associated with poorer clinical outcomes. We studied DUP and its association with clinical outcomes in a group of patients with schizoph renia and related psychotic disorders treated in the naturalistic clinical setting of an early psychosis program. DUP was determined for 19 patients w ith a non-affective psychotic disorder (schizophrenia, schizoaffective diso rder or schizophreniform disorder) and no previous treatment for psychosis, by use of the IRAOS, a retrospective structured interview carried out with patients and their families. Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Function (GAF) ratings were available at baseline and 6 month follow-up. For analysis, patients were categorized into a short DUP (n = 9) or long DUP (n = 10) group. The median DUP (57 weeks) was used as the dividing point. At baseline, the two groups did not differ signific antly on positive symptoms or total PANSS ratings. However, negative sympto ms were more severe in the long DUP group at baseline (P = 0.029), and the long DUP group had a significantly higher mean rating for the passive/apath etic social withdrawal item of the PANSS (P = 0.024). At 6 month followup, the long DUP group had significantly higher ratings for positive symptoms ( P = 0.028) and had lower GAF scores (P = 0.044). Significantly more (P = 0. 033) long DUP patients had enduring positive psychotic symptoms. The result s confirm both the wide range of DUP among patients first presenting with s chizophrenia and related psychotic disorders and the association of long DU P, defined as greater than approximately 1 year, with a poorer clinical out come. This study highlights the importance of collecting data regarding DUP and supports the view that patients with a long DUP are likely to be less responsive to treatment in general and will require greater resources and m ore intensive interventions. (C) 2001 Elsevier Science B.V. All rights rese rved.