Duration of untreated psychosis: An important target for intervention in schizophrenia?

This article reviews the concept of duration of untreated psychosis (DUP) with special reference to schizophrenia, on the basis of clinical examples and a pilot study carried out in the county of Rogaland, Norway, in 1992-1995. Several international studies show that the duration of untreated psychosis (DUP), defined as the period of positive psychotic symptoms before treatment, is long (52-112 weeks). The results from the pilot study in Rogaland confirmed that the mean duration of untreated psychosis is long (114 weeks). In this study 43 patients with their first episode of non-affective psychosis were included. Long DUP was associated with more unemployment and decreased social and global functioning. Males had longer DUP than females, were more often single, and were more often schizophrenic and younger at onset of psychosis. In premorbid functioning males scored poorer and deteriorated faster than females, especially closer to onset. Case histories are presented to illustrate why treatment was given late in the course of illness and may suggest that patients identified earlier in the course of illness had a better prognosis. Lack of awareness of symptoms of emerging psychosis at the primary and secondary health service level may be one of the main reasons for today's practice of late intervention in schizophrenia.