First Episode Is the Best Episode: Lessons and Limitations in Duration of Untreated Psychosis (DUP) and Outcome in Schizophrenia

Background: Early intervention in psychosis is an opportunity. Research ahs shown that if any thing community members can do to prevent psychosis is to report early. This has opened newer vistas for understanding the complexity of brain and behaviour in schizophrenia. At the same time it has raised the bar of expectations regarding its correlation to outcome. It finally narrows down to meaningful public campaign for awareness, which will decide success of research to clinics in schizophrenia management. Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome and provides credence to development of early intervention services. It is not quite clear if DUP works in isolation and what other factors along with DUP would determine outcome long-term outcome of schizophrenia is multifactorial in nature. The present study examines effect of DUP on outcome of schizophrenia Method: we conducted a ten years follow up study of first episode hospitalized DSM III-R schizophrenia and correlated multiple outcome criteria with DUP at Mumbai. We carefully determined onset of psychosis using criteria for appearance of positive symptoms, negative symptoms or significant social decline. Data was analyzed using SAS. Results: we analyzed 101 patients available at ten years. We found that mean DUP was higher for group, which showed Clinical recovery on GCIS [14.0(SD=8.0) months for recovered & 10.8 (SD=5.7) months in nonrecovered group p=0.091]. There is a significant difference in favour of DUP≤6 months in terms of subscales of PANSS; However DUP was not found to be significantly associated with the end point parameters of good clinical or social outcome. Conclusion: We find that DUP is just one factor in determinants of outcome. Several other psychopathological & phenomenological factors collectively play a role in determining outcome. Future research needs to be directed towards combination of determinants of outcome in early intervention of psychosis