Outcome measures in early psychosis: relevance of duration of untreated psychosis

Background Duration of untreated psychosis (DUP) is considered an important predictor of short-term clinical outcome. Aims To explore the evolution of the concept of DUP, synthesise the evidence for its predictive value, highlight the problems in measurement, and consider the potential pitfalls of using DUP as a measure of the effectiveness of early intervention services. Method A survey of recent literature was conducted. Results Several studies and two systematic reviews confirm that DUP has a robust but moderate effect on outcome in schizophrenia. Studies vary widely in how DUP is defined and measured, since identifying precise time points when psychosis emerges and remits is conceptually ambiguous and clinically difficult. Conclusions Standardised measurement of DUP is a vital first step in allowing comparisons between studies. Duration of untreated psychosis is a relevant measure only of the early detection function of early intervention services. Declaration of interest S.S. has received honoraria and educational grants from several pharmaceutical companies