Duration of untreated psychosis: are we ignoring the mode of initial development?. An extensive naturalistic case study of phenomenal continuity in first-episode schizophrenia

Abstract

Duration of untreated psychosis (DUP) might affect the course and treatment outcome in schizophrenia significantly. Looking for potential determinants of DUP, researchers have mostly assessed the initial untreated psychosis in terms of plain duration, not developmental content. The present study provides empirical contributions to the discussion of phenomenal continuity throughout the entire untreated illness by pointing out continuous trajectories from prodrome to psychosis. In a series of 19 first-episode DSM-IV schizophrenia patients, we explore prodromal and untreated psychotic phenomena, and the data indicate that symptoms considered intrinsic to core psychosis phenomenology had attenuated antecedents in the prodromes, increasing continuously until treatment, whereas symptoms considered not intrinsic to core psychosis were characterized by fluctuations. Mode of initial psychosis development is proposed as a tentatively informative concept, comprising duration and content aspects of the initial prodrome and untreated psychosis.