Duration of untreated psychosis: a critical examination of the concept andits importance

Background. The concept of duration of untreated psychosis (DUP) has recent ly attracted much interest because of its possible relationship to treatmen t outcome and implications for preventive efforts with reference to psychot ic disorders, especially schizophrenia. In this paper we review critically the literature concerning the concept and its importance. Methods, Articles concerned with measuring DUP and those that have been sug gested to provide indirect or direct evidence of the effect of DUP on treat ment outcome are reviewed. Results. Evidence thus far suggests that DUP may be related to ease of redu cing psychotic symptoms once treatment begins for first episode patients, b ut there is no evidence of a relationship to likelihood of relapse. There h as been little investigation of the relationship of DUP to other long term outcomes such as negative symptoms and cognitive functioning neither have t he possible confounds of DUP been widely investigated or controlled. Conclusions. It is important that there should be more thorough investigati ons of DUP, its correlates, and the extent to which it does mediate any adv antages of earlier intervention.