Active psychosis and long-term outcomes in first-episode psychosis

Duration of untreated psychosis (DUP) is commonly used as a prognostic marker in first-episode psychosis (FEP), but it does not capture symptom persistence following antipsychotic initiation. We examined whether DUP, duration to remission ((DTR) time from antipsychotic initiation to first remission) and duration of active psychosis ((DAP) time from symptom onset to first remission, i.e. DUP + DTR) predict 10-year clinical and functional outcomes in a Chinese FEP cohort (n = 142). Both duration (months) and severity (area under the curve) indices were generated. DTR emerged as the most consistent and robust predictor, with longer and more severe post-initiation symptom persistence associated with greater symptom severity and poorer functioning. In contrast, DUP and DAP showed limited predictive value. These findings suggest that persistence of active psychosis after treatment initiation may be more clinically informative than treatment delay alone, highlighting early treatment response as a key target for improving long-term outcomes.