Duration of untreated psychosis and functional trajectories: A 36-month analysis from EPIC-NOLA clinic, a community early intervention clinic

Psychosis can be the first indication of serious mental illness such as schizophrenia or bipolar disorder. Some literature suggests that the longer the duration of untreated psychosis (DUP), the worse the prognostic outcomes of psychosis are. At this point, there is no evidence-based intervention to reduce the DUP and therefore, DUP remains a major barrier in attempts to reduce duration of untreated serious mental illnesses. This study provides a more granular look at DUP by examining the socio-demographic and clinical characteristics of 489 patients enrolled at an early psychosis intervention clinic and their association with short vs. long DUP. We also examined the association of DUP with trajectories of functioning over 36 months derived by group trajectory modeling. Findings demonstrate that DUP was significantly associated with referral source, and that longer DUP was associated with poorer functioning during treatment at the clinic. This study also presents an innovative strategy to reduce DUP through a psychosis early detection campaign in the home community of the early psychosis intervention clinic. This illustration of an early psychosis intervention clinic working in concert with a community-based psychosis early detection campaign highlights the need for a collaborative approach to streamline pathways to specialized care for young people to reduce DUP and improve functioning of these patients. • This study examined the association between Duration of untreated psychosis (DUP) and social functioning trajectories over the 36-month period in a sample of patients enrolled in an early psychosis intervention clinic. • Group based trajectory modeling found 2 functioning trajectories across the 36 months of follow up: a high functioning group (80% of times or more employed or in school) comprised of 54% of the patients, and a low-functioning group comprised of 45.3% of patients. • Longer duration of untreated psychosis (DUP >10 months) was significantly associated with being in the low functioning group and linked to non-institutional referral sources to the clinic. • Findings underscore the need for earlier detection of psychosis and reducing the DUP. • Extending care beyond the initial 2-3 years and tailoring services to functioning levels is important in shaping long-term outcomes for individuals with psychosis.