Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series?

Am J Psychiatry. 2000 Jan;157(1):60-6. doi: 10.1176/ajp.157.1.60.


Objective: The authors examined the duration of untreated psychosis, defined as the interval from first psychotic symptom to first psychiatric hospitalization, in a county-wide sample of first-admission inpatients who had received no previous antipsychotic medication. Differences between diagnostic groups in 24-month illness course and clinical outcomes as well as relationships between outcomes and duration of untreated psychosis were evaluated.

Method: The data were derived from subjects in the Suffolk County Psychosis Project who were diagnosed at 24-month follow-up according to DSM-IV as having schizophrenia or schizoaffective disorder (N=155), bipolar disorder with psychotic features (N=119), or major depressive disorder with psychotic features (N=75). Duration of untreated psychosis was derived from the Structured Clinical Interview for DSM-III-R, medical records, and information from significant others. Measures at 24-month follow-up included consensus ratings of illness course, Global Assessment of Functioning Scale scores for the worst week in the month before interview, and current affective and psychotic symptoms.

Results: The median duration of untreated psychosis was 98 days for schizophrenia, 9 days for psychotic bipolar disorder, and 22 days for psychotic depression. Duration of untreated psychosis was not significantly associated with 24-month illness course or clinical outcomes in any of the diagnostic subgroups.

Conclusions: Although these findings require replication in other epidemiologically based first-admission samples, at face value they do not support the suggestion of a psychotoxic effect of prolonged exposure to untreated psychosis.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / psychology
  • Cohort Studies
  • Depressive Disorder / diagnosis
  • Depressive Disorder / psychology
  • Female
  • Follow-Up Studies
  • Hospitalization*
  • Humans
  • Longitudinal Studies
  • Male
  • Outcome Assessment, Health Care*
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / psychology
  • Schizophrenia / diagnosis
  • Schizophrenic Psychology
  • Survival Analysis
  • Time Factors
  • Treatment Outcome