Demographic, socio-environmental, and substance-related predictors of duration of untreated psychosis (DUP)

Schizophr Res. 2013 Aug;148(1-3):93-8. doi: 10.1016/j.schres.2013.05.011. Epub 2013 Jun 6.

Abstract

Objective: Longer duration of untreated psychosis (DUP) is associated with poorer early-course and long-term outcomes, and is a target of early detection and intervention efforts. Given the paucity of research on childhood and adolescent stressors (e.g., maltreatment and neighborhood disorder) as potential predictors of DUP, limited research on premorbid substance use as a determinant of DUP, and inconclusive findings on the association between DUP and neurocognition, we conducted three sets of analyses to address these issues. Mode of onset of psychosis was also considered, given its established role as an illness-level correlate of DUP.

Methods: We rigorously assessed DUP and other pertinent variables in 180 predominantly African American, low-income, and socially disadvantaged first-episode psychosis patients hospitalized in five psychiatric units.

Results: Mode of onset of psychosis, prior incarceration, and the level of childhood/adolescent maltreatment were all significant independent predictors of DUP. Regarding premorbid substance use, having ever used cannabis and the amount of premorbid alcohol use were significantly associated with DUP. None of the seven neurocognitive domains assessed were even modestly, or clinically meaningfully, associated with DUP.

Conclusions: These and other findings on DUP may be informative for early detection and intervention services. For example, such services might benefit from special outreach to criminal justice settings and disadvantaged neighborhoods, and to young people likely to have a history of childhood/adolescent maltreatment and gradually developing psychotic symptoms.

Keywords: Childhood maltreatment; Duration of untreated psychosis; First-episode psychosis; Psychosis; Schizophrenia; Treatment delay.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Black or African American
  • Child
  • Child Abuse / psychology*
  • Demography*
  • Early Diagnosis
  • Female
  • Humans
  • Male
  • Poverty / psychology*
  • Predictive Value of Tests
  • Psychiatric Status Rating Scales
  • Psychotic Disorders* / diagnosis
  • Psychotic Disorders* / epidemiology
  • Psychotic Disorders* / psychology
  • Statistics as Topic
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology*
  • Surveys and Questionnaires
  • Young Adult