The duration of active psychosis and relationship with early psychosis outcomes

Reducing the duration of untreated psychosis (DUP) is a key aim of early intervention in psychosis (EIP) services. While DUP accounts for a proportion of the time individuals experience psychotic symptoms, the duration of active psychosis (DAP) concept provides a broader scope by including the duration of psychosis both before and after treatment initiation. This study aimed to describe DAP in a large naturalistic cohort of people with first-episode psychosis (FEP), and explore the relationship between DAP and early psychosis outcomes.

This study involved secondary analyses of an existing dataset of consecutive cases of FEP in young people aged 15 to 24 from an EIP service in Melbourne. The duration of active psychosis after treatment initiation (DAT), limited to the first year of care, was estimated using the short form Scale for the Assessment of Positive Symptoms measured repeatedly at regular intervals. This was combined with DUP to calculate DAP. DAP was divided into four groups according to quartiles and regression analysis was used to explore the relationship between DAP and outcomes at discharge.

DAP was estimated for 749 individuals with FEP. The group with the longest DAP (>58 weeks) presented at a younger age (mean 18.6 vs mean 19.7) and had a higher proportion of females (49.7% vs 38.9%). Adjusted linear regression models demonstrated that longer DAP (>58 weeks) was a significant predictor of worse overall functioning (β = -7.07, p = .005) and negative symptom severity (β = 1.10, p = .006) at discharge from the EIP service.

Time spent in active psychosis is an important consideration beyond the initial untreated period and further research is indicated to establish the relationship between DAP and outcomes in FEP.