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Duration of untreated psychosis and its relationship to clinical outcome^*

Departments of Psychiatry and Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada

SHÔN W. LEWIS, FRCPsych and MAX MARSHALL, MD, MRCPsych

School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester, UK

Correspondence: Ross M.G. Norman, Room 113B, WMCH Building, 392 South Street, London, Ontario N6A 4G5, Canada. E-mail: rnorman{at}uwo.ca

Declaration of interest None.

^* Based on a paper presented at the Third International Early Psychosis Conference, Copenhagen, Denmark, September 2002.

¹ We have omitted deHaan et al (2000) from our discussion because they relied entirely on reports solicited through a questionnaire in a monthly magazine for relatives of patients with schizophrenia. Such a procedure appears to allow little confidence in comparable standards for estimation being used across cases.

Background A major reason for interest in early intervention for psychotic disorders is the hypothesised relationship between longer duration of untreated psychosis (DUP) and poorer outcome of treatment.

Aims To critically examine the evidence concerning DUP being related to treatment outcome and possible mediators of any such relationship.

Method A systematic review of studies in which DUP is assessed and its relationship to treatment outcome is examined. In addition, studies relevant to possible neurotoxic effects of DUP were reviewed.

Results The research is entirely of a correlational nature and, therefore, firm conclusions regarding causation are not possible. There is, however, substantial evidence of DUP being an independent predictor of treatment outcome, particularly remission of positive symptoms, over the first year or so of treatment. Findings regarding the possible neurotoxic effects of DUP are inconsistent.

Conclusions There continues to be evidence consistent with DUP influencing aspects of treatment outcome. Non-correlational studies, such as quasi-experimental designs, could provide stronger evidence regarding causality.

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