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Duration of untreated psychosis: impact on 2‐year outcome

Evidence demonstrating the predictive value of a long duration of untreated psychosis (DUP) remains equivocal. We assessed the impact of DUP on outcome over a 2‐year period in 203 first episode patients in an early psychosis programme. Symptoms (PANSS) were assessed every 3 months and functional outcome (QOL), neurocognitive functioning and relapse rates were assessed annually. Median DUP was 26 weeks, mean DUP was 80 weeks, mean log10 DUP was 23 weeks. Long DUP was significantly associated with positive symptoms (P < 0.001), and quality of life (P < 0.01) in the first year. Since there are no strong a priori grounds for a ‘cutoff’ level for long DUP, we compared those who were in remission (i.e. no positive symptom score greater than 3 on the PANSS) with those who had failed to achieve remission by 6 months. Results were that those who had failed to achieve remission of positive symptoms after 6 months of a comprehensive treatment approach had a significantly longer DUP (P < 0.001). Thus, in this sample of first episode subjects receiving optimal treatment DUP was associated with a poorer recovery.