Last update:
11-Nov-2004

The timely initiation of pharmacotherapy and, consequently, recognition of the “first episode of schizophrenia” are currently at the center of clinical and investigatory interest, with the goal of avoiding chronicity and its consequences. Relatively recently, there has been major focus on the manifestations in the pre-psychotic period. In this context, increasing importance has been attached to the investigation of the prognostic value of the “duration of untreated psychosis” (DUP), defined as the interval between the appearance of the first positive symptoms and the initiation of antipsychotic treatment. The protraction of DUP has been declared a “major public health issue”, although the relevant studies have produced contradictory results: correlation of DUP with an unfavorable outcome of psychosis is not a consistent finding. It has been suggested that, if and when they are observed, such correlations are not causative, but rather dependent on various demographic and clinical variables. The correlation of DUP with the outcome of psychosis, at the biological or psychological level, also poses the question of early –or, rather, timely– therapeutic intervention. This, however, should not exclude taking into account the risks of untimely psychiatric intervention, especially when such intervention rests only on the particularly unstable and controversial precursory pre-psychotic manifestations of puberty. It is evident that such intervention, which requires commensurate screening procedures for high-risk groups, or even at the level of the general population, poses major ethical issues.

Key words: "Duration of untreated psychosis", Ethics, Preventive psychiatry, Therapy and prognosis.