Duration of untreated psychosis

What is the duration of untreated psychosis (DUP)?

DUP is generally determined as the time from the onset of psychotic symptoms to the initiation of treatment or first clinical presentation, when a diagnosis of first-episode psychosis may be given. Longer DUP has been associated with poorer prognosis (see the DUP and outcomes topic). As such, understanding the effects of DUP is particularly important because it is potentially modifiable.

What is the evidence for DUP?

Moderate to high quality evidence indicates the presence of an obligatory dangerousness criterion for compulsory treatment of mental illness is associated with longer DUP.  Moderate quality evidence finds people with schizophrenia or non-affective psychosis have a longer DUP (~28 weeks) than people with affective psychosis, regardless of age or sex. Longer DUP was also found in low-middle income countries than in high income countries, and Black Caribbean people have longer DUP than White people, while Black African people have shorter DUP than White people. Moderate to low quality evidence shows emergency services and inpatient units are associated with a shorter DUP than community services pathways to care.

Long-term, widespread educational campaigns covering multiple domains such as advertising, distribution of brochures, visits to GPs and schools, training seminars, and follow-up contact may reduce the length of DUP. A one-dimensional campaign approach, such as solely educating GPs, may not be as effective.

August 2020

Last updated at: 1:25 am, 12th August 2020
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