How Do Early Psychosis Services Define and Operationalize the Duration of Untreated Psychosis?

  • Mark SavillEmail author
  • Melissa Gosdin
  • Pooja Patel
  • Joy Melnikow
  • Rachel Loewy
  • Tara Niendam


Reducing the duration of untreated psychosis (DUP) is a key aim of early psychosis (EP) care. However, substantial variability in how the start and end points of DUP are defined impact its utility in clinical decision-making, and as an outcome measure. In this study, qualitative interviews were conducted with providers to assess how EP services and providers define, operationalize, and measure DUP. Twenty-five providers across 14 clinics were interviewed. Participants emphasized symptom frequency, conviction, distress caused, and impact when determining psychosis onset. DUP endpoint was typically identified as the first assessment in an episode of care that included an accurate diagnosis, leading to specialty EP treatment. Participants proposed a more structured operationalization of DUP, relative to those historically adopted in the literature. Integrating front-line provider perspectives could improve the accuracy of DUP measurement and address the heterogeneity in how the construct is operationalized across research and practice.


DUP Schizophrenia Assessment Psychosis onset Treatment initiation 



The authors would like to thank all participants who agreed to be interviewed.

Funding information

This work was supported by the National Institute of Mental Health (grant number MH018261-31, PI: Pfiffner) and the Mental Health Services Oversight and Accountability Committee (grant number 14MHSOAC010; PI: Niendam).

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest.

Supplementary material

11414_2018_9630_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19.9 kb)


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Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  1. 1.Department of Psychiatry, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Center for Healthcare Policy and ResearchUniversity of CaliforniaDavisUSA
  3. 3.Department of Psychiatry, Davis School of MedicineUniversity of CaliforniaSacramentoUSA

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