Causes and consequences of duration of untreated psychosis in schizophrenia

• Published in: British journal of psychiatry Vol. 177; no. 6; pp. 511 - 515
• Main Authors: Drake, Richard J., Haley, Clifford J., Akhtar, Shahid, Lewis, Shôn W.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.12.2000; RCP
• Subjects: Activities of daily living; Adolescent; Adult; Analysis of Variance; Coping strategies; Demography; Early intervention; England; Ethnicity; Female; Humans; Hypotheses; Interpersonal Relations; Interviews; Male; Mental disorders; Middle Aged; Patients; Prognosis; Psychiatry; Psychosis; Psychotic Disorders - complications; Psychotic Disorders - psychology; Schizophrenia; Schizophrenia - complications; Schizophrenia - therapy; Schizophrenic Psychology; Social functioning; Social interactions; Social isolation; Social networks; Social research; Treatment Outcome; Variables; Variance analysis; England
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.177.6.511

It is unclear what determines duration of untreated psychosis (DUP) in schizophrenia and why long DUP predicts poor outcome. First, to test the hypothesis that specific patterns of symptoms and social functioning acting before treatment prolong DUP. Second, to clarify the mechanisms linking DUP with recovery after treatment. Two hundred and forty-eight consecutive first admissions with schizophrenia were interviewed to assess DUP, symptoms and social functioning at admission, and symptoms were re-assessed after 6-12 weeks. Median DUP was 12 weeks. Long DUP was predicted by poor insight, social isolation and preserved coping skills, but not by demographic factors. Even allowing for all these variables, long DUP predicted poor outcome. Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and relevant others. DUP's relationship to outcome is strongest in the initial months of psychosis. This has implications for targeting early intervention.