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Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study

Division of Psychological Medicine, Institute of Psychiatry, London

RUDWAN ABDUL-AL, MPH

Department of Psychiatry, University of Cambridge

JULIA M. LAPPIN, MRCPsych

Division of Psychological Medicine, Institute of Psychiatry, London

PETER JONES, FRCPsych

Department of Psychiatry, University of Cambridge

PAUL FEARON, MRCPsych

Division of Psychological Medicine, Institute of Psychiatry, London

MORVEN LEESE, PhD

Health Services Research Department, Institute of Psychiatry, London

TIM CROUDACE, PhD

Department of Psychiatry, University of Cambridge

KEVIN MORGAN, PhD, PAOLA DAZZAN, MRCPsych, TOM CRAIG, FRCPsych, JULIAN LEFF, FRCPsych and ROBIN MURRAY, FRCPsych

Division of Psychological Medicine, Institute of Psychiatry, London, UK

Correspondence: Dr Craig Morgan, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: +44 (0)20 7848 0351; email: spjucrm{at}iop.kcl.ac.uk

Declaration of interest None.

Background Despite considerable research investigating the relationship between a long duration of untreated psychosis (DUP) and outcomes, there has been much less considering predictors of a long DUP.

Aims To investigate the clinical and social determinants of DUP in a large sample of patients with a first episode of psychosis.

Method All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined catchment areas in London and Nottingham, UK were included in the ÆSOP study. Data relating to clinical and social variables and to DUP were collected from patients, relatives and case notes.

Results An insidious mode of onset was associated with a substantially longer DUP compared with an acute onset, independent of other factors. Unemployment had a similar, if less strong, effect. Conversely, family involvement in help-seeking was independently associated with a shorter duration. There was weak evidence that durations were longer in London than in Nottingham.

Conclusions These findings suggest that DUP is influenced both by aspects of the early clinical course and by the social context.

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