First-episode schizophrenia: do grandiosity, disorganization, and acute initial development reduce duration of...

There is growing evidence for a relationship between the duration of untreated psychosis (DUP) and the prognosis. However, determinants of the DUP have been minimally explored, as is the detailed initial temporal unfolding of untreated psychosis. In this study, in-depth interviews with 19 first-episode DSM-IV schizophrenia patients and their relatives revealed detailed phenomenology of the initial prodrome and untreated psychosis. The findings suggest that a later prodrome onset (mean age in this sample, 20.5 years), a prodrome shorter than 2 years, acute initial psychosis development, the initial presence of grandiosity and/or disorganization, and a mild level of withdrawal all may reduce treatment delay. This set of characteristics might therefore represent built-in components of psychotic illnesses related to a shortened DUP, irrespective of early intervention efforts. In other words, the DUP could partly reflect these built-in aspects of psychosis. The rate of initial (untreated) psychosis development could contribute to broaden the prevailing mode of onset concept (presently defined as the duration of the initial prodrome) to comprise both the duration and content of the initial prodrome, as well as untreated psychosis, tentatively designated as the mode of initial psychosis development.