Shorter duration of untreated psychosis leads to better outcomes up to 20 years

Associations of duration of untreated psychosis (DUP) with symptoms, functioning, and quality of life in the long term following first-episode psychosis can vary according to the outcome domain, reveals a study. However, such relationships continue for years in such a way that cannot be fully accounted for in terms of premorbid features or lead-time bias.

A team of investigators performed prospective, sequential follow-up studies of an epidemiologically representative first-episode psychosis incidence cohort in Ireland at 6 months and at 4, 8, 12, and 20 years (n=171).

They applied linear mixed-model analyses to determine whether prospective associations of DUP with symptoms, functioning, and quality of life were consistent or varied across psychotic illness trajectory over a 20-year period. Time, DUP quartile, and DUP quartile-by-time interaction effects were included in the evaluations.

On prospective, sequential follow-ups, positive and negative symptoms, function, and quality of life were observed, indicating distinct trajectories of improvement with regard to shorter DUP. Associations between shorter DUP and greater improvement persisted even at 20 years after the first episode of psychosis despite heterogeneity in course and relationship to premorbid features.

Trajectories of the relationship between shorter DUP and better outcome across the long-term course of psychotic illness differed between domains of psychopathology, functionality, and quality of life. However, these associations with shorter DUP were sustained for at least 20 years.

“Determining the extent to which relationships between DUP and outcome endure longitudinally across the lifetime course of psychotic illness requires prospective, systematic studies of epidemiologically representative incidence cohorts across decades,” the investigators said.