Duration of Untreated Psychosis in First-Episode Patients

Duration of untreated psychosis (DUP) denotes the interval between the emergence of clear psychotic symptoms and the initiation of appropriate treatment. In patients experiencing a first episode of psychosis, protracted DUP correlates with more severe symptomatology, poorer social and occupational functioning, and reduced response to antipsychotic therapy. Estimates of DUP vary widely, reflecting methodological differences in onset definitions, healthcare infrastructure and cultural factors. These variations underscore the need for standardised assessment and reporting. Key determinants of extended DUP include insidious prodromal symptoms that are misattributed to stress or adolescence, barriers to help-seeking such as stigma and limited mental health literacy, and structural obstacles including inadequate early intervention services and referral pathways. The duration of the prodrome and premorbid adjustment also influence the trajectory to treatment; better premorbid functioning may delay psychosis onset but may paradoxically extend DUP by masking early signs. Reducing DUP has become a global priority, motivating the development of public education campaigns, community outreach and streamlined care pathways. Interventions target both early detection—aimed at raising awareness among families, schools and frontline professionals—and early intervention services that integrate psychoeducation, pharmacotherapy and psychosocial support. Collectively, this work highlights the critical window following psychosis onset during which timely treatment can alter long-term outcomes and emphasises the importance of culturally sensitive, accessible and youth-focused models of care.

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Duration of Untreated Psychosis in First-Episode Patients publication trend

The graph below shows the total number of articles in duration of untreated psychosis in first-episode patients across all publications each year (not limited to Nature Index journals).

Technical terms

Duration of untreated psychosis (DUP): The interval between the onset of overt psychotic symptoms and the initiation of appropriate treatment.

First-episode psychosis (FEP): The first occurrence of psychotic symptoms meeting clinical diagnostic criteria.

Prodrome: A period of subtle behavioural, cognitive or affective changes that precedes the acute onset of psychosis.

Early intervention services (EIS): Multidisciplinary programmes designed to provide rapid assessment and comprehensive treatment during first-episode psychosis.

References

1. Duration of the psychosis prodrome and its relationship to duration of untreated psychosis across all 12 DSM-IV psychotic diagnoses: Evidence for a trans-diagnostic process associated with resilience. European Neuropsychopharmacology (2023).
2. Prodromal symptoms and the duration of untreated psychosis in first episode of psychosis patients: what differences are there between early vs. adult onset and between schizophrenia vs. bipolar disorder?. European Child & Adolescent Psychiatry (2023).
3. What is the duration of untreated psychosis worldwide? - A meta-analysis of pooled mean and median time and regional trends and other correlates across 369 studies.. Psychological Medicine (2023).
4. Early intervention in psychosis services: A systematic review and narrative synthesis of barriers and facilitators to seeking access. European Psychiatry (2023).
5. Duration of Untreated Psychosis and Outcomes in First-Episode Psychosis: Systematic Review and Meta-analysis of Early Detection and Intervention Strategies. Schizophrenia Bulletin (2024).