Numerous studies have examined the impacts of the duration of untreated psychosis (DUP) on symptomatic and functional outcomes in individuals after their first psychotic episode. While, in general, the data confirm the finding that longer delays to engage in treatment are associated with poorer outcomes, the reasons underlying this relation have been attributed to various factors that are associated with prolonged DUPs. These include the possibility that severity of illness is associated with a longer time to treatment or that increased neurotoxicity occurs during a lengthy untreated period. Alternatively, a recent paper suggests the possibility that this association could be an artifact, or a confound in the analysis termed “lead time bias,” such that longer DUPs reflect earlier detection of the illness and that this is not accounted for when assessing treatment-related long-term outcomes (
3,
4). O’Keeffe and colleagues (
5) provide important insights into the long-term relation between DUP and outcomes by longitudinally following a cohort of patients for up to 20 years after presenting for treatment with their first psychotic episode. Starting with 171 participants, patients were assessed longitudinally at 6 months and 4, 8, 12, and 20 years, with 80 subjects completing assessments for the entire 20 years. Seventy-nine percent of the sample was determined to have a nonaffective psychosis, whereas 21% were categorized with an affective psychosis. Analyses were focused on the relation between DUP and longitudinal trajectories of symptom measures, functional outcomes, and quality of life. While different time-related trajectories were found for the relations between DUP and specific outcome parameters, overall the findings demonstrated that longer DUPs were associated with poorer outcomes (i.e., positive and negative symptoms, symptoms related to functional capacity, and quality of life). Although these findings cannot address issues of causality, they are important because they demonstrate the long-term, persistent relation between DUP and outcomes. The authors suggest in their conclusion that these findings, associating prolonged DUPs to deleterious outcomes, further support the value of early intervention treatment programs. In his editorial (
6), Dr. Ashok Malla from McGill University discusses the efficacy of early intervention services, highlights the factors that contribute to prolonged DUPs, and emphasizes the potential therapeutic value of reducing DUPs in individuals with psychotic illnesses.