Clinical and social correlates of duration of untreated psychosis among adult‐onset psychosis in H ong K ong C hinese: the JCEP study
Abstract
Aim: Understanding factors that contribute to treatment delay would inform early detection and intervention strategies in psychotic disorders. However, existing data were mixed and primarily conducted among early‐onset young patients. We examined duration of untreated psychosis (DUP) and its clinical and sociodemographic correlates in a large cohort of adult‐onset patients with psychosis. Methods: A total of 360 patients with first‐onset psychosis aged 26–55 years were recruited consecutively as part of a controlled study of an early psychosis intervention service in H ong K ong C hinese. Demographic, sociodemographic and clinical characteristics relating to DUP were assessed within 4 months of onset. Results: The population had a mean onset age of 36.6 years (SD = 8.7). The mean and median DUP were 515 days (SD = 1091) and 93 days (inter‐quartile range from 20 to 382.3), respectively. Multivariate regression analysis suggested that insidious mode of onset, hospitalization, a diagnosis of schizophrenia, poorer insight and younger age at onset significantly prolonged DUP. DUP was not related to premorbid functioning, family involvement during help seeking and living alone. Conclusions: The initial period of untreated psychosis is determined by multiple factors. Whether family involvement is considered a kind of social support in shortening or prolonging DUP needs further examination. Local early intervention program for psychosis should take reference from these findings when formulating personalized plans to reduce delay.
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The relationship between insight and non-adherence may occur early in the illness.
“The relationship between insight and non-adherence may also occur early in the illness, as suggested by studies linking poor insight to a longer duration of untreated psychosis 24,25 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [24]
Cites
The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.2.261 · Cited by 21,378 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Raber, G., & Spokas, M. (2024) · doi:10.4135/9781071886229.n145 · Cited by 2,806 · see citing works
Association Between Duration of Untreated Psychosis and Outcome in Cohorts of First-Episode Patients
Marshall, M., Lewis, S. W., Lockwood, A., Drake, R., Jones, P. B., & Croudace, T. J. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.9.975 · Cited by 1,595 · see citing works
Best Estimate of Lifetime Psychiatric Diagnosis
Leckman, J. F. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290080001001 · Cited by 1,418 · see citing works
Perkins, D., Gu, H., Boteva, K., & Lieberman, J. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.10.1785 · Cited by 1,304 · see citing works
Measurement of Premorbid Adjustment in Chronic Schizophrenia
Cannon-Spoor, H. E., Potkin, S. G., & Wyatt, R. J. (1982) · Schizophrenia Bulletin · doi:10.1093/schbul/8.3.470 · Cited by 1,197 · see citing works
EPPIC: An Evolving System of Early Detection and Optimal Management
McGorry, P. D., Edwards, J., Mihalopoulos, C., Harrigan, S., & Jackson, H. J. (1996) · Schizophrenia Bulletin · doi:10.1093/schbul/22.2.305 · Cited by 936 · see citing works
Early intervention in psychosis. The critical period hypothesis.
Birchwood, M. J., Todd, P., & Jackson, C. (1998) · PubMed · Cited by 756 · see citing works
Early intervention in psychosis
Birchwood, M. J., Todd, P., & Jackson, C. (1998) · The British Journal of Psychiatry · doi:10.1192/s0007125000297663 · Cited by 682 · see citing works
IRAOS: an instrument for the assessment of onset and early course of schizophrenia
Häfner, H., Riecher‐Rössler, A., Hambrecht, M., Maurer, K., Meissner, S., Schmidtke, A., Fätkenheuer, B., Löffler, W., & der Heiden, W. A. (1992) · Schizophrenia Research · doi:10.1016/0920-9964(92)90004-o · Cited by 562 · see citing works
Early Detection and Intervention With Schizophrenia: Rationale
McGlashan, T. H., & Johannessen, J. O. (1996) · Schizophrenia Bulletin · doi:10.1093/schbul/22.2.201 · Cited by 416 · see citing works
Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course?
McGlashan, T. H. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(99)00084-0 · Cited by 373 · see citing works
Causes and consequences of duration of untreated psychosis in schizophrenia
Drake, R., Haley, C. J., Akhtar, S., & Lewis, S. W. (2000) · The British Journal of Psychiatry · doi:10.1192/bjp.177.6.511 · Cited by 347 · see citing works
First-episode Schizophrenia: I. Early Course Parameters
Larsen, T. K., McGlashan, T. H., & Moe, L. C. (1996) · Schizophrenia Bulletin · doi:10.1093/schbul/22.2.241 · Cited by 322 · see citing works
Does treatment delay in first-episode psychosis really matter?
Harrigan, S., McGorry, P. D., & Krstev, H. (2002) · Psychological Medicine · doi:10.1017/s003329170200675x · Cited by 283 · see citing works
The Use of Culturally-Based Variables in Assessment: Studies on Loss of Face
Zane, N. W. S., & Yeh, M. (2002) · Springer eBooks · doi:10.1007/978-1-4615-0735-2_9 · Cited by 276 · see citing works
Normal and Abnormal Behavior in Chinese Culture
Kleinman, A., & Lin, T.-Y. (1981) · Springer eBooks · doi:10.1007/978-94-017-4986-2 · Cited by 256 · see citing works
First-episode schizophrenia with long duration of untreated psychosis: Pathways to care
Larsen, T. K., Johannessen, J. O., & Opjordsmoen, S. (1998) · The British Journal of Psychiatry · doi:10.1192/s0007125000297651 · Cited by 209 · see citing works
Morgan, C., Abdul-Al, R., Lappin, J., Jones, P. B., Fearon, P., Leese, M., Croudace, T. J., Morgan, K. D., Dazzan, P., Craig, T., et al. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.021303 · Cited by 200 · see citing works
Pre-morbid Adjustment and Personality in Psychosis
Foerster, A., Lewis, S. W., Owen, M. J., & Murray, R. M. (1991) · The British Journal of Psychiatry · doi:10.1192/bjp.158.2.171 · Cited by 198 · see citing works
SCHIMMELMANN, B. G., Conus, P., Cotton, S., McGorry, P. D., & Lambert, M. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.06.004 · Cited by 198 · see citing works
Premorbid and Onset Features of First-Episode Schizophrenia
Haas, G. L., & Sweeney, J. A. (1992) · Schizophrenia Bulletin · doi:10.1093/schbul/18.3.373 · Cited by 196 · see citing works
Larsen, T. K., Moe, L. C., Vibe-Hansen, L., & Johannessen, J. O. (2000) · Schizophrenia Research · doi:10.1016/s0920-9964(99)00169-3 · Cited by 193 · see citing works
Lam, T. P. (2001) · Journal of Epidemiology & Community Health · doi:10.1136/jech.55.10.762 · Cited by 189 · see citing works
Duration of untreated psychosis: impact on 2-year outcome
Addington, J., van Mastrigt, S. B., & Addington, D. E. (2004) · Psychological Medicine · doi:10.1017/s0033291703001156 · Cited by 173 · see citing works
Effect of early intervention on 5-year outcome in non-affective psychosis
Gafoor, R., Nitsch, D., McCrone, P., Craig, T., Garety, P. A., Power, P., & McGuire, P. K. (2010) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.109.066050 · Cited by 168 · see citing works
Perkins, D. O., Lieberman, J. A., Gu, H., Tohen, M. F., McEvoy, J. P., Green, A. I., Zipursky, R. B., Strakowski, S. M., Sharma, T., Kahn, R. S., et al. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.185.1.18 · Cited by 165 · see citing works
The Chinese-bilingual SCID-I/P Project: Stage 1 — Reliability for Mood Disorders and Schizophrenia
So, E., Kam, I., Leung, C. M., Chung, D. C., Liu, Z., & Fong, S. (2003) · Hong Kong journal of psychiatry · Cited by 164 · see citing works
Self-citationvan Mastrigt, S. B., & Addington, J. (2002) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0212 · Cited by 121 · see citing works
Duration of untreated psychosis and its correlates in first‐episode psychosis in Finland and Spain
Kalla, O., Aaltonen, J., Wahlström, J., Lehtinen, V., Cabeza, I. G., & de Chávez, M. G. (2002) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2002.02302.x · Cited by 95 · see citing works
Compton, M. T., Chien, V. H., Leiner, A. S., et al. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0397-y · Cited by 91 · see citing works
Duration of untreated psychosis may predict acute treatment response in first-episode schizophrenia
Üçok, A., Polat, A., Genç, A., et al. (2003) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(03)00104-3 · Cited by 85 · see citing works
The impact of family experience on the duration of untreated psychosis (DUP) in Hong Kong
Chen, E. Y. H., Dunn, E. L.-W., Miao, M. Y.-K., Yeung, W. S., Wong, C., Chan, W.-F., Chen, R. Y.-L., Chung, K., & Tang, W.-N. (2005) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-005-0908-z · Cited by 77 · see citing works
Self-citationChang, W. C., Hui, C. L. M., Tang, J. Y. ‐., Wong, G. H. Y., Chan, S. K. W., Lee, E. H. M., & Chen, E. Y. H. (2012) · Psychological Medicine · doi:10.1017/s0033291712002838 · Cited by 76 · see citing works
Self-citationMALLA, A. K., Norman, R. M. G., Manchanda, R., McLean, T. S., Harricharan, R., Cortese, L., Townsend, L. A., & Scholten, D. J. (2002) · Psychiatric Services · doi:10.1176/appi.ps.53.4.458 · Cited by 75 · see citing works
Chang, W. C., Tang, J. Y. ‐., Hui, C. L. M., Lam, M. M. L., Wong, G. H. Y., Chan, S. K. W., Chiu, C. P. Y., Chung, D. W. S., Law, C. W., Tso, S., et al. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2011.09.006 · Cited by 64 · see citing works
Self-citationAttitudes of Patients Toward the First Psychotic Episode and the Start of Treatment
de Haan, L., Peters, B. D., Dingemans, P. M. A. J., Wouters, L. F., & LINSZEN, D. H. (2002) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a006951 · Cited by 61 · see citing works
Early intervention and evaluation for adult‐onset psychosis: the JCEP study rationale and design
Hui, C. L. M., Chang, W. C., Chan, S. K. W., Lee, E. H. M., Tam, W., Lai, D., Wong, G. H. Y., Tang, J. Y. ‐., Li, F. W. S., Leung, K. F., et al. (2013) · Early Intervention in Psychiatry · doi:10.1111/eip.12034 · Cited by 50 · see citing works
Self-citationAssessing the cost of early intervention in psychosis: A systematic review
Amos, A. J. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412450470 · Cited by 40 · see citing works
Wong, D. F. K. (2006) · Culture Medicine and Psychiatry · doi:10.1007/s11013-006-9038-7 · Cited by 37 · see citing works
Pek, E., Mythily, S., & Chong, S. (2006) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.v35n1p24 · Cited by 34 · see citing works
A comparison of adolescent- and adult-onset first-episode, non-affective psychosis: 2-year follow-up
Langeveld, J., Joa, I., Friis, S., Hegelstad, W. T. V., Melle, I. S., Johannessen, J. O., Opjordsmoen, S., Simonsen, E. H., Vaglum, P., Auestad, B., et al. (2012) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-012-0308-9 · Cited by 30 · see citing works
Duration of untreated psychosis: An important target for intervention in schizophrenia?
Johannessen, T. K. L. J. O. (1999) · Nordic Journal of Psychiatry · doi:10.1080/080394899427089 · Cited by 30 · see citing works
Evaluating the importance of reducing the duration of untreated psychosis
McGorry, P. D. (2000) · Australian & New Zealand Journal of Psychiatry · doi:10.1046/j.1440-1614.2000.00782.x · Cited by 26 · see citing works
Economic Impact of Early Detection and Early Intervention of Psychosis
Valmaggia, L., McGuire, P. K., Fusar‐Poli, P., et al. (2012) · Current Pharmaceutical Design · doi:10.2174/138161212799316145 · Cited by 22 · see citing works
Tseng, W.-S. (2001) · Elsevier eBooks · doi:10.1016/b978-012701632-0/50073-5 · Cited by 16 · see citing works
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Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., Craig, T. J., Nordentoft, M., Srihari, V. H., Guloksuz, S., et al. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.0623 · Cited by 826 · see citing works
Self-citationLysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018) · World Psychiatry · doi:10.1002/wps.20508 · Cited by 247 · see citing works
Premorbid, clinical and cognitive correlates of primary negative symptoms in first-episode psychosis
Chang, W. C., Lau, C. F. C., Chan, S. S. I., Hui, C. L. M., Chan, S. K. W., Lee, E. H. M., Lin, J., & Chen, E. Y. H. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.05.045 · Cited by 29 · see citing works
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- Authors
- Hui, C. L., Lau, W. W., Leung, C., Chang, W., Tang, J. Y., Wong, G. H., Chan, S. K., Lee, E. H., & Chen, E. Y.
- Affiliations
- University of Hong Kong (HK)
- Corresponding author
- Hui, Christy Lai‐Ming
- ORCID
- Venue
- Early Intervention in Psychiatry
- Publisher
- Wiley
- Published
- 2013-09-30
- Volume
- 9
- Issue
- 2
- Pages
- 118-125
- ISSN
- 1751-7885 (ISSN-L)
- 1751-7893
- OpenAlex
- W2156888947
- Cited by
- 36
- References
- 46
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 4 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 3 · 2016: 5 · 2015: 2
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Early Intervention in Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- duration of untreated psychosis, first-episode psychosis, treatment delay, insidious onset, hospitalization, schizophrenia, insight, age of onset, family involvement, social support, early intervention, Hong Kong Chinese
- MeSH terms
- Adult, Female, Hong Kong, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychotic Disorders, Risk Factors, Asian People, Delayed Diagnosis
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