Median Duration Of Untreated Psychosis Research Articles

Patient-Level Predictors and Clinical Correlates of Duration of Untreated Psychosis Among Hospitalized First-Episode Patients

Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators. Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders. The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r = 0.23, P = .02), and poorer insight was associated with longer DUI (r = -0.24, P = .01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems. There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges.

Conceptualizing the Multifaceted Determinants of the Duration of Untreated Psychosis

The duration of untreated psychosis (DUP) construct is recognized as a predictor of early-course outcomes of individuals diagnosed with nonaffective psychotic disorders. Although a major area of early-psychosis research has been DUP as a predictor of outcomes, less is known about the potential determinants of DUP. Because the community-level median DUP may be modifiable, which is compelling evidence for the promotion of the early intervention paradigm, knowledge of determinants of DUP is critical. This review summarizes what is known of the multifaceted determinants of DUP. In general, these complex determinants can be categorized as demographic factors (e.g., ethnic minority status), premorbid and onset-related factors (such as mode of onset of psychosis), illness-related factors (exemplified by the levels of positive and negative symptoms), family-level factors (including family involvement in help-seeking and family functioning), societal factors (e.g., the beliefs and practices of ones social networks), and health services/system-level factors (including health insurance status and the efficiency of referring clinicians). Despite the great complexity, efforts to understand and conceptualize the multifaceted determinants of DUP may inform key components of early detection and intervention programs, such as mobile early detection teams and community-level informational campaigns.

Early identification of non‐remission in first‐episode psychosis in a two‐year outcome study

To identify predictors of non-remission in first-episode, non-affective psychosis. During 4 years, we recruited 301 patients consecutively. Information about first remission at 3 months was available for 299 and at 2 years for 293 cases. Symptomatic and social outcomes were assessed at 3 months, 1 and 2 years. One hundred and twenty-nine patients (43%) remained psychotic at 3 months and 48 patients (16.4%) remained psychotic over 2 years. When we compared premorbid and baseline data for the three groups, the non-remitted (n = 48), remitted for <6 months (n = 38) and for more than 6 months (n = 207), duration of untreated psychosis (DUP) was the only variable that significantly differentiated the groups (median DUP: 25.5, 14.4 and 6.0 weeks, respectively). Three months univariate predictors of non-remission were being single, longer DUP, core schizophrenia, and less excitative and more negative symptoms at baseline. Two-year predictors were younger age, being single and male, deteriorating premorbid social functioning, longer DUP and core schizophrenia. In multivariate analyses DUP, negative and excitative symptoms predicted non-remission at 3 months, but only DUP predicted at 2 years. Long DUP predicted both 3 month and 2-year non-remission rates in first-episode psychosis.

Clinical and social determinants of a longer duration of untreated psychosis of schizophrenia in a Japanese population

To measure the duration of untreated psychosis (DUP) among patients with schizophrenia in a Japanese population and to investigate clinical and social determinants of the DUP. A multicentre, retrospective study at seven medical centres in three cities (Tokyo, Toyama and Kochi) was performed. In total, 150 consecutive patients (78 men) with neuroleptic-naïve first-episode schizophrenia were investigated; their DUP and demographic, clinical and social variables were obtained from their medical charts and analysed. The intraclass correlation coefficient for the DUP was quite good (ICC = 0.849). The mean DUP of all the subjects attending the seven psychiatric services was 20.3 months, and the median DUP was 6.0 months. Fourteen patients (9.3%) had a DUP of more than 60 months, and 47 patients, or about one-third, had a DUP of more than 24 months. No significant differences in the mean DUPs were observed among the three cities. Patients who were employed or who were students had a significantly shorter DUP (14.3 months). The median DUP for those with an insidious onset of psychosis (n = 85) was 18.0 months, compared with a median of 2.0 months for those with a sudden and acute onset (n = 61). However, no other clinical or social variables examined in this study were associated with differences in the DUP. The DUP of patients with schizophrenia is relatively long in Japan. The provision and modification of psychiatric services for easy access and a system for the early recognition and detection of mental illness are needed.

Health Services Determinants of the Duration of Untreated Psychosis Among African-American First-Episode Patients

The duration of untreated psychosis is associated with poor outcomes in multiple domains in the early course of nonaffective psychotic disorders, although relatively little is known about determinants of this critical period, particularly health services-level determinants. This study examined three hypothesized predictors of duration of untreated psychosis (lack of insurance, financial problems, and broader barriers) among urban, socioeconomically disadvantaged African Americans, while controlling for the effects of three patient-level predictors (mode of onset of psychosis, living with family versus alone or with others before hospitalization, and living above versus below the federally defined poverty level). Analyses included data from 42 patient-family member dyads from a larger sample of 109 patients with a first episode of nonaffective psychosis. The duration of untreated psychosis and all other variables were measured in a rigorous, standardized fashion in a study designed specifically to examine determinants of treatment delay. Survival analyses and Cox regression assessed the effects of the independent predictors on time from onset of psychosis to hospital admission for initial evaluation and treatment. The median duration of untreated psychosis was 24.5 weeks. When the analyses controlled for the three patient-level covariates, patients without health insurance, with financial problems, or with barriers to seeking help had a significantly longer duration of untreated psychosis. Health services-related factors, such as lack of insurance, are predictive of longer treatment delay. Efforts to eliminate uninsurance and underinsurance, as well as minimize barriers to treatment, would be beneficial for improving the prognosis of young patients with emerging nonaffective psychotic disorders.

Family-level predictors and correlates of the duration of untreated psychosis in African American first-episode patients

BackgroundLittle is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain. MethodsFrom a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazard models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP — mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level. ResultsThe median DUP was 24.5weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP. ConclusionsWhereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.

Family context and duration of untreated psychosis (DUP): Results from the Sao Paulo Study

Background Duration of untreated psychosis (DUP) depends on several factors, including socio-demographic, socioeconomic, clinical and contextual circumstances, such as availability of mental health services. Living arrangements may also play a role, especially in low- and middle-income countries, where most people who develop psychosis live with their relatives. Methods Population-based study of first-episode psychosis in São Paulo, Brazil. Participants were aged 18–64 years, lived in a defined geographic area of the city and had a first contact in life with mental health services due to a psychotic episode. Duration of untreated psychosis was defined as the period between onset of first psychotic symptom and first contact with health service due to psychosis. The median DUP was used to classify participants into short and long DUP. Psychopathology, social adjustment and psychiatric diagnoses were made with standardized assessments. Type of service sought and living arrangements were examined. Results Two hundred participants were included (52% women, 61% non-affective psychoses). The median DUP was 4.1 weeks (inter-quartile range: 1.9–11.4), and was shorter for affective psychoses. Most participants had their first contact with psychiatric emergency services. Those who did not live with a relative (children older than 18 years, parents, partner) were more likely to present long DUP (OR: 2.63; 95%CI: 0.98–7.04); p = 0.05). Conclusion The DUP in São Paulo was shorter than expected. Living arrangements may play an important role in shortening the DUP in urban centres of low- and middle income countries that have a network of mental health services.

Duration of untreated psychosis and pathways to care in patients with first‐episode psychosis in Iran

This is the first study on the duration of untreated psychosis and pathways to care among patients with first-episode psychosis in Iran as a developing country. Ninety-one patients with a first episode of non-organic psychosis admitted to a university-affiliated psychiatric hospital in Iran were assessed for duration of untreated psychosis (DUP), pathways to care and mode of onset. Median DUP was 11 weeks (mean = 52.3 weeks). Following the onset of psychosis, most patients were first seen by a psychiatrist (n = 23, 25.3%), a traditional healer (n = 21, 23.1%) or a general practitioner (n = 16, 17.6%). Most referrals to the psychiatric hospital were made by the family (n = 30, 33.1%), or health professionals (n = 29, 31.9%). Acute onset and rural place of residence were associated with shorter DUP in multivariate analysis. Median DUP was not long in an inpatient sample with first-episode psychosis, which may be due to the preponderance of affective and acute psychoses in this sample and some help-seeking or service variables.

Measurement and reporting of the duration of untreated psychosis

The aim of this study was to investigate the demographic, illness and methodological factors associated with mean and median duration of untreated psychosis (DUP). A systematic review and meta-analysis of the published studies of DUP and an examination of available DUP distributions. DUP was longer in samples with a higher proportion of patients with schizophrenia and was shorter in samples that included affective psychosis. Sex, age, and the methods of measuring the onset and end-point of DUP and the type of service in which the studies were performed did not contribute to the heterogeneity of the mean or median DUP values. Mean DUP is significantly prolonged by a small number of patients, and the median DUP is a poor indicator of the rate at which patients present. The DUP of patients with affective and non-affective psychosis should be examined separately in order to make measures of DUP more meaningful and comparable, and DUP should be reported using more comprehensive measures. We suggest a method of reporting DUP based on the rate of presentation of first-episode psychosis patients rather than the length of DUP.

Duration of Untreated Psychosis, Referral Route, and Age of Onset in an Early Intervention in Psychosis Service and a Local CAMHS

The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. The median DUP across the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services.

Information Campaigns: 10 Years of Experience in the Early Treatment and Intervention in Psychosis (TIPS) Study

&lt;p&gt;This article presents an overview of the strategies developed and implemented from 1997 to 2007 in an early detection site in Norway as part of the early Treatment and Intervention in Psychosis (TIPS) study. These strategies include intensive Information Campaigns (ICs) about the signs and symptoms of psychosis and easy access to low-threshold detection teams for rapid case identification. Few, if any other studies of first-episode psychosis, have used such a system over so many years in a regular and repeated fashion. The TIPS early intervention program reduced the healthcare sector’s median duration of untreated psychosis (DUP) in first-episode schizophrenia from 15 weeks to 4.5 weeks using a combination of these easy-access detection teams and massive ICs that targeted diverse audiences. Data on 5,230 referrals are presented in this article, along with their sources of referral and the actual number of cases who were identified with a first episode of psychosis via the detection teams as the initial contact point with specialized mental health services. The TIPS study has shown that such strategies are a vital part of bringing persons with first-episode psychosis into adequate treatment earlier, thereby reducing DUP. &lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHORS&lt;/h4&gt; &lt;p&gt;Inge Joa, RN; Jan Olav Johannessen, MD; and Tor K. Larsen, MD, are with the Stavanger University Hospital, Department of Psychiatry, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway. Thomas H. McGlashan, MD, is with Yale University School of Medicine, Department of Psychiatry, New Haven, CT. &lt;/p&gt; &lt;p&gt;Ms. Joa, Dr. Johannessen, Dr. Larsen, and Dr. McGlashan have disclosed no relevant financial relationships. &lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt;&lt;li&gt;Explain the goals of the Early Treatment and Intervention in Psychosis (TIPS) study. &lt;/li&gt; &lt;li&gt;Describe the strategies employed by the TIPS study to achieve its aims, especially through the utilization of information campaigns. &lt;/li&gt; &lt;li&gt;Discuss the results of the TIPS study in terms of community median duration of untreated psychosis (DUP). &lt;/li&gt;&lt;/ol&gt;

Mode of onset of psychosis and family involvement in help-seeking as determinants of duration of untreated psychosis

The duration of untreated psychosis (DUP) is a potentially modifiable determinant of the early course of nonaffective psychotic disorders, though a paucity of research has addressed determinants of DUP. Recent data from London and Nottingham, UK indicated that a shorter DUP was predicted by: (1) an acute mode of onset, (2) employment, and (3) active involvement of at least one family member in seeking evaluation (Morgan et al. Br J Psychiatry 189:446-452, 2006). The present analysis was conducted in an effort to replicate those findings in a predominantly low-income, urban, African American sample. DUP and the three key predictors of interest were assessed using standardized procedures. All analytic plans replicated those of Morgan and colleagues (Morgan et al. Br J Psychiatry 189:446-452, 2006) to the largest extent possible. Sufficient information was available to rate DUP for 73 patients. The median DUP was 23.4 weeks. Bivariate tests, survival analysis, and Cox regression revealed that an insidious mode of onset was associated with a substantially longer DUP compared with an acute onset, and that family involvement in help-seeking was independently associated with a longer duration. While mode of onset is a reliable illness-related determinant of DUP, further research is needed on the complex ways in which family-related variables influence DUP.

The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis

The association between the duration of untreated psychosis (DUP) and outcome of schizophrenia may be confounded by other factors such as poor pre-morbid adjustment. The aim of the present study was to examine the independent contributions of DUP and of pre-morbid adjustment to the clinical and social outcomes of schizophrenia. A longitudinal, prospective, 2-year follow-up study of 423 patients with first-episode schizophrenia-spectrum psychosis was conducted. Patients were comprehensively assessed at entry, 1-year and 2-year follow-up. At entry, DUP was measured by IRAOS (an instrument for the assessment of onset and early course of schizophrenia) and pre-morbid adjustment was measured by the Pre-morbid Adjustment Scale (PAS) as 'pre-morbid social adaptation' and 'pre-morbid school adaptation'. Outcome measures included the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Social Network Schedule and social information. Multiple linear regression models were used for data analysis. The median DUP was 48 weeks, which is long compared to other studies. Longer DUP was independently associated with more psychotic symptoms at entry, 1-year and 2-year follow-up. Poorer pre-morbid social adaptation was independently associated with more negative symptoms and smaller social network at entry and 1-year follow-up. Poorer pre-morbid school adaptation was independently associated with poor vocational outcome at 1-year and 2-year follow-up. Longer DUP is associated with poorer 2-year outcome of psychosis in schizophrenia-spectrum disorders, when pre-morbid functioning and other prognostic factors are controlled for. Impaired pre-morbid development is independently associated with more negative symptoms and poorer social outcome.

Does a detection team shorten duration of untreated psychosis?

Duration of untreated psychosis (DUP) is shown to be associated with poor outcome in many domains. It has been shown that it is possible to shorten DUP when combining a detection team and an information campaign. The aim of this study was to evaluate whether DUP was shortened during the first 3 years after establishing detection teams without a concomitant information campaign. All patients included in the OPUS trial were examined with the Instrument for Retrospective Assessment of Onset of Psychosis to determine DUP. A total of 552 patients with first episode psychotic disorder (n=470) or schizotypal disorder (n=82) were included in the study. The 3-year inclusion period was divided into six consecutive periods of 6 months each. The median DUP was 52 weeks. DUP was not significantly reduced during the 3-year inclusion period, but a larger proportion of patients with symptoms below the threshold for frank psychosis were included compared with the beginning of the trial. The proportion referred from primary care remained small (8-10%) and unchanged during the inclusion period. The availability of a detection team increased the referral of patients with schizotypal disorder, but the DUP among psychotic patients remained almost unaltered throughout the period. It seems that an information campaign and possibilities for direct access and self-referral are necessary in order to shorten DUP.

Impact of duration of untreated psychosis on pre-treatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort

Introduction To assess the impact of duration of untreated psychosis (DUP) on baseline and 18-month follow-up characteristics controlling for relevant confounders in an epidemiological first-episode psychosis (FEP) cohort. Method The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 786 FEP patients from January 1998 to December 2000. Data were collected from medical files using a standardized questionnaire. Data from 636 patients were analyzed. Results Median DUP was 8.7 weeks. Longer DUP was associated with worse premorbid functioning ( p < 0.001), higher rate of schizophrenia-spectrum disorders ( p < 0.001), and younger age at onset of psychosis ( p = 0.004). Longer DUP was not associated with baseline variables but with a lower rate of remission of positive symptoms ( p < 0.001) and employment/occupation ( p < 0.001), a higher rate of persistent substance use ( p = 0.015), worse illness severity ( p < 0.001) and global functioning ( p < 0.001) at follow-up after controlling for relevant confounders, explaining approximately 5% of variance of remission of positive symptoms ( p < 0.001) in the total sample and 3% in schizophrenia-spectrum disorders excluding bipolar I disorder ( p = 0.002). Outcome was significantly worse when DUP exceeded 1–3 months. Conclusion Avoiding pitfalls of non-epidemiological studies, DUP appears to be a modest independent predictor of prognosis in the medium-term. Results support the need for assertive early detection strategies.

Mental health laws that require dangerousness for involuntary admission may delay the initial treatment of schizophrenia

A long duration of untreated psychosis (DUP) is associated with a worse prognosis, an increased risk of suicide and may be linked to serious violence. Mental health laws that require patients to be dangerous to themselves or to others before they can receive involuntary psychiatric treatment may make it more difficult to treat patients in their first episode of psychosis. The mean and median DUP reported in studies of schizophrenia related psychoses were examined. A comparison was made between the DUP reported from jurisdictions that had an obligatory dangerousness criterion (ODC) and those with other criteria for involuntary treatment. The average mean DUP in samples from jurisdictions with an ODC was 79.5 weeks, but was only 55.6 weeks in those jurisdictions that did not have an ODC (P < 0.007). Mental health laws that require the patient to be assessed as dangerous before they can receive involuntary treatment are associated with significantly longer DUP. As reducing DUP is an intervention that can improve the prognosis of schizophrenia, this finding suggests that mental health laws should be amended to allow treatment on grounds other than dangerousness, at least in the crucial first episode of psychosis.

Volume reduction of the left planum temporale gray matter associated with long duration of untreated psychosis in schizophrenia: A preliminary report

A longer duration of untreated psychosis (DUP) in schizophrenia is reported to lead to a poorer clinical outcome, possibly reflecting a neurodegenerative process after the onset of overt psychosis. However, the effect of DUP on brain morphology in schizophrenia is still poorly understood. In this study, we used magnetic resonance imaging to investigate the relation between DUP and volumetric measurements for the superior temporal sub-regions (Heschl's gyrus, planum temporale, and caudal superior temporal gyrus), the medial temporal lobe structures (hippocampus and amygdala), and the frontal lobe regions (prefrontal area and anterior cingulate gyrus) in a sample of 38 schizophrenia patients (20 males and 18 females) whose illness duration was less than five years. We found a significant negative correlation between DUP and the volume of gray matter in the left planum temporale even after controlling for age, age at illness onset, and duration and dosage of neuroleptic medication. There was no such correlation for the other brain regions including each sub-region of the prefrontal cortex (the superior frontal gyrus, middle frontal gyrus, inferior frontal gyrus, ventral medial prefrontal cortex, orbitofrontal cortex, and straight gyrus). When subjects were divided into two groups around the median DUP, the long-DUP group had a significantly smaller planum temporale gray matter than the short-DUP group. These findings may reflect a progressive pathological process in the gray matter of the left planum temporale during the initial untreated phase of schizophrenia, whereas abnormalities in the medial temporal regions might be, as has been suggested from previous longitudinal findings, relatively static at least during the early course of the illness.

New knowledge and new hope to people with emerging mental disorders

New knowledge and new hope to people with emerging mental disorders

Pathways to Care in a New Zealand Firstepisode of Psychosis Cohort

To present the clinical and sociodemographic characteristics of patients referred to a New Zealand early intervention for psychosis service and to describe the pathways to care for these patients. Clinical and sociodemographic characteristics were examined in 200 patients consecutively admitted to an early psychosis service over a 5-year period. Assessment measures included DSM-IV diagnosis, the Quality of Life Scale, Positive and Negative Syndrome Scale and information on pathways to care. The majority of patients were young (mean age = 22.35), single (90.1%), male (72.5%), of New Zealand European descent (63.7%), living in the parental home (60.2%) and on a government benefit (60.2%). Overall, 40.8% of patients were initially diagnosed with a schizophrenia spectrum disorder, 36.4% with a mood disorder and 22.8% were classified as 'other psychoses' (substance-induced psychosis, brief psychotic disorder, etc.). Those with a schizophrenia spectrum disorder had a median duration of untreated psychosis of 120 days compared with 29 days for other diagnoses. Overall, 64.1% of referrals came from the Inpatient Service, 36.3% of patients had a compulsory admission under the Mental Health Act, and 41.8% had contact with police in 6 months prior to referral to the service. No differences in inpatient admission rates, police involvement or compulsory admission were evident for ethnicity or diagnosis. The pathways to care, clinical and sociodemographic descriptors of the present sample are somewhat different to those previously reported in international cohorts. This reflects the inclusion of patients with affective psychoses, the age range of 18-30 years and New Zealand's distinctive healthcare system. Examination of the sociodemographic characteristics and pathways to care in the present cohort suggests that service reconfigurations are required to optimize the experience of inpatient admission, given the substantial proportion of clients with non-schizophrenia spectrum disorders that present acutely for treatment.

Prolonged duration of untreated psychosis in nonaffective first-episode psychotic disorders compared to other psychoses

Introduction. While the consequences of the duration of untreated psychosis (DUP) represent an active area of research, less attention has been focused on the determinants of the DUP. This analysis assessed several potential determinants of the DUP from a practice-based survey. Method. Data on selected patients in their first treatment episode for psychotic symptoms were obtained from 104 practicing physicians. Patients with a long DUP (n=31), defined as >4 weeks, were compared to patients with a short DUP (≤4 weeks, n=28). Results. The long-DUP group had a higher percentage of patients with nonaffective psychotic disorders (58%) compared to the short-DUP group (29%). The median DUP among those with nonaffective psychotic disorders was 8 weeks, compared to 3 weeks among those with other psychotic disorders. The long-DUP group had a higher percentage of patients rated as uncertain about or denying a mental illness (55% compared to 25% in the short-DUP group). The presence of negative symptoms approached significance in terms of differentiating between the two groups, with 66% of the long-DUP group having negative symptoms compared to 39% of the short-DUP group. When three variables (nonaffective psychotic disorder versus other psychoses, insight, and negative symptoms) were entered into a logistic regression model, only diagnostic category remained an independently significant predictor. Conclusion. In this practice-based sample, patients with nonaffective psychotic disorders were more likely to have a longer DUP than patients who developed psychotic symptoms in the context of mood disorders, substance use disorders, or other disorders.