Does treatment delay in first-episode psychosis really matter?

  title={Does treatment delay in first-episode psychosis really matter?},
  author={Susy Harrigan and Patrick D. McGorry and Helen Krstev},
  journal={Schizophrenia Research},
Background. Relatively few predictors of outcome in first-episode psychosis are potentially malleable and duration of untreated psychosis (DUP) is one. However, the degree to which DUP is mediated by other predictors of outcome is unclear. This study examines the specific effects of DUP on 12-month outcome after adjusting for effects of potential confounders and moderating variables. Method. The sample comprised 354 first-episode psychosis patients followed up 12-months after remission… 
Predictors of 10-year outcome of first-episode psychosis
Poor pre-morbid functioning, baseline symptoms, DUP and neurological soft signs at onset independently predict poor long-term outcome in first-episode psychosis.
The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders
The findings suggest that five years of specialized early intervention was most beneficial when the total duration from symptom start to treatment was shorter than 6 months, and highlight the importance of avoiding delays within the mental health service provision.
Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia
The findings underline the importance of taking account of the phenomenological overlap between measures of negative symptoms and social function when investigating the effects of DUP.
Duration of untreated psychosis: impact on 2-year outcome
There is evidence that long DUP continues to have an influence on outcome up to 2 years, and these results support ongoing efforts for early detection and intervention.
Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study
Supporting evidence is provided that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes and that DUP may specifically affect memory function and its adverse impact on verbal memory may only become evident at a later stage of the recovery process.
follow-up study of first-episode schizophrenia Duration of untreated psychosis and social function: 1-year
It is revealed that longer DUP significantly predicted more severe positive and negative symptoms and poorer social function at 1 year, independent of scores at presentation, underline the importance of taking account of the phenomenological overlap between measures.
Predictors of antipsychotic treatment response in patients with first episode schizophrenia, schizoaffective, and schizophreniform disorders
Shorter DUP and good premorbid function each independently are associated with better clinical response, including improvement in overall psychopathology and negative symptoms, and earlier antipsychotic treatment isassociated with better outcomes in first-episode schizophrenia.
Outcome measures in early psychosis
  • S. Singh
  • Medicine, Psychology
    British Journal of Psychiatry
  • 2007
The evolution of the concept of DUP is explored, the evidence for its predictive value is synthesised, the problems in measurement are highlighted, and the potential pitfalls are considered.
Factors contributing to the duration of untreated psychosis


Causes and consequences of duration of untreated psychosis in schizophrenia.
Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and relevant others, and has implications for targeting early intervention.
West London first-episode study of schizophrenia. Clinical correlates of duration of untreated psychosis.
There was little evidence of any association between either DUP or DUI and progressive deterioration in the schizophrenic illness or the development of resistance to initial drug treatment.
Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia.
Investigation of the relationship between untreated initial psychosis duration and quality of life, symptom severity, and time to remission of positive symptoms in neuroleptic-naive patients with DSM-IV schizophrenia found that earlier age at illness onset was associated with longer duration of untreated prodromal psychotic symptoms.
First-episode schizophrenia: I. Early course parameters.
Early course parameters of a Norwegian first-episode sample demonstrated strong gender differences, with male patients having significantly higher frequency of single marital status, lower educational status, schizophrenia, early age at onset, and lower Global Assessment of Functioning scores the last year before hospitalization.
Psychopathology, executive (frontal) and general cognitive impairment in relation to duration of initially untreated versus subsequently treated psychosis in chronic schizophrenia
Increasing duration of initially untreated psychosis was associated specifically with heightened accrual of prominent negative symptoms and general cognitive impairment and executive dyscontrol, though also prominent in these patients, may be ‘locked-in’ at an earlier phase of the illness.
Duration of untreated psychosis: a critical examination of the concept and its importance
Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse.
Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness.
Premorbid and onset features of first-episode schizophrenia.
Systematic characterization of the earliest manifestations of schizophrenia may be important in identifying subgroups of patients with a similar course of illness, and may ultimately facilitate diagnosis, treatment, and understanding of the pathophysiology of schizophrenia.
Have the times come for early intervention in psychosis?
  • H. Verdoux
  • Psychology, Medicine
    Acta psychiatrica Scandinavica
  • 2001
After having carefully reviewed the literature on past and ongoing studies on early intervention programmes in first-episode schizophrenia, Larsen et al. conclude that a large number of questions remained unanswered with regard to the efficacy such programmes.