Duration of untreated psychotic illness

The role of premorbid social support networks
  • Victor Peralta
  • Manuel J. Cuesta
  • Alfredo Martinez-Larrea
  • Jose F. Serrano
  • Myriam Langarica



A lengthy delay often exists between the onset of psychotic symptoms and the start of appropriate treatment. However, the causes of this long delay remain poorly understood, and there is a need to search for the factors involved in such a delay in order to reduce the time of untreated psychosis. This study aimed at examining the influence of premorbid social networks on the duration of untreated psychotic illness.


One hundred subjects with a first episode of schizophrenia or related psychotic disorders never treated with antipsychotics made up the study sample. Social support was assessed by means of the Sturtees’s social support scale that comprises two subscales measuring close and diffuse social support. Duration of untreated illness was assessed according to three definitions: duration of untreated unspecific symptoms, duration of untreated psychotic symptoms, and duration of untreated continuous psychotic symptoms. We also examined the effect of putative confounding factors such as gender, residence (urban-rural), age at illness onset, years of education, and parental socio-economic status.


Correlational analysis showed that poor diffuse social support, but not poor close social support, predicted long duration of untreated illness according to the three definitions; this association being mainly due to poor work/academic support. Logistic regression analysis confirmed such an association, but it was limited to duration of continuous psychotic symptoms (unadjusted OR=3.44, 95% CI=1.51–7.83); this association persisted after adjusting for the confounding variables (adjusted OR=3.39, 95% CI=1.39–8.29). We also found that subjects with low socio-economic status were depending on the definition of duration of untreated illness considered, between 2.7 and 4.3 times more likely to present with a long duration of untreated illness.


Both poor diffuse social support and a low socio-economic status seem to be relevant factors of a prolonged duration of untreated psychosis.

Key words

psychotic disorder duration of untreated illness social networks 


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  1. 1.
    Andreasen NC, Flaum M, Arndt S (1992) The Comprehensive Assessment of Symptoms and Diagnosis. An instrument for assessing diagnosis and psychopathology. Arch Gen Psychiatry 49:615–623PubMedGoogle Scholar
  2. 2.
    Barnes TRE, Hutton SB, Chapman MJ, Mutsatsa S, Puri BK, Joyce EM (2000) West-London first-episode study of schizophrenia. Clinical correlated of duration of untreated psychosis. Br J Psychiatry 177:207–211PubMedGoogle Scholar
  3. 3.
    Beiser M, Erickson D, Fleming JAE, Iacono WG (1993) Establishing the onset of psychotic illness. Am J Psychiatry 150:1349–1354PubMedGoogle Scholar
  4. 4.
    Brugha TS, Wing JK, Brewing CR, MacCarthy B, Lesage A (1993) The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 28:218–224PubMedGoogle Scholar
  5. 5.
    Cougnard A, Kalmi E, Desage A, Misdrahi D, Abalan F, Brun-Rousseau H, Salmi LR, Verdoux H (2004) Pathways to care of first-admitted subjects with psychosis in south-western France. Psychol Med 34:267–276PubMedGoogle Scholar
  6. 6.
    Drake RJ, Haley CJ, Akhtar S, Lewis SW (2000) Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry 177:511–515CrossRefPubMedGoogle Scholar
  7. 7.
    Evert H, Harvey C, Trauer T, Herrman H (2003) The relationship between social networks and occupational and self-care functioning in people with psychosis. Soc Psychiatry Psychiatr Epidemiol 38:180–188PubMedGoogle Scholar
  8. 8.
    Fuchs J, Steinert T (2004) Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Soc Psychiatry Psychiatr Epidemiol 39:375–380PubMedGoogle Scholar
  9. 9.
    Gittelman-Klein R, Klein DF (1969) Premorbid asocial adjustment and prognosis in schizophrenia. J Psychiat Res 7:35–53PubMedGoogle Scholar
  10. 10.
    Haley CJ, Drake RJ, Bentall RP, Lewis SW (2003) Health beliefs link to duration of untreated psychosis and attitudes to later treatment in early psychosis. Soc Psychiatry Psychiatr Epidemiol 38:311–316PubMedGoogle Scholar
  11. 11.
    Ho BC, Andreasen, NC (2001) Long delays in seeking treatment for schizophrenia. Lancet 357:898–900PubMedGoogle Scholar
  12. 12.
    Hollingshead AB (1958) Two factor index of social position. New Haven, CT, Yale UniversityGoogle Scholar
  13. 13.
    Kendler KS (1997) Social support: a genetic-epidemiologic analysis. Am J Psychiatry 154:1398–1404PubMedGoogle Scholar
  14. 14.
    Larsen TK, Johannessen JO, Opjordsmoen S (1998) First-episode schizophrenia with long duration of untreated psychosis. Pathways to care. Br J Psychiatry 172(Suppl 33):45–52Google Scholar
  15. 15.
    Larsen TK, Moe LC, Vibe-Hansen L, Johannessen JO (2002) Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophr Res 45:1–9Google Scholar
  16. 16.
    MacEwan TH, Athawes RWB (1997) The Nithsdale Schizophrenia Surveys. XV. Social adjustment in schizophrenia: associations with gender, symptoms and childhood antecedents. Acta Psychiatr Scand 95:254–258PubMedGoogle Scholar
  17. 17.
    McGashan TH (1999) Duration of untreated psychosis in first episode schizophrenia: marker of determinant of course. Biol Psychiatry 46:899–907PubMedGoogle Scholar
  18. 18.
    McGorry PD, Krstev H, Harrigan S (2000) Early detection and treatment delay: implications for outcome in early psychosis. Curr Opin Psychiatry 13:37–43Google Scholar
  19. 19.
    Norman RMG, Malla AK (2001) Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med 31:381–400PubMedGoogle Scholar
  20. 20.
    Norman RMG, Malla AK, Verdi MB, Hassall LD, Fazekas C (2004) Understanding delay in treatment for first-episode psychosis. Psychol Med 34:255–266CrossRefPubMedGoogle Scholar
  21. 21.
    Sturtees PG (1980) Social support, residual adversity and depressive outcome. Br J Psychiatry 15:71–80Google Scholar
  22. 22.
    Verdoux H, Liraud F, Bergey C, Assens F, Abalan F, van Os J (2001) Is the association between duration of untreated psychosis and outcome confounded? A two year follow-up study of first-admitted patients. Schizophr Res 49:231–241CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • Victor Peralta
    • 1
  • Manuel J. Cuesta
    • 1
  • Alfredo Martinez-Larrea
    • 1
  • Jose F. Serrano
    • 1
  • Myriam Langarica
    • 1
  1. 1.Psychiatric UnitVirgen del Camino HospitalPamplonaSpain

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