Commentary

The prognosis of most medical and surgical illnesses improves if treatment starts early. This correlation has never been shown in psychiatric illness, perhaps because identification and treatment of mental illnesses have, at least in the past, been associated with negative labelling and stigmatisation. More recently, as reported by Drake et al, many investigators, although not all,^{1, 2} have found a correlation between the DUP and short term illness prognosis: the faster the treatment, the larger the improvement. This correlation may be because the factors that delay the time between having a psychotic symptom and seeking help for it are the same ones that prevent effective treatment response. Or it may be because a lengthy period of untreated psychosis somehow impairs the brain's ability to recuperate. Whatever the case, determining the reasons for delayed treatment is important.

Psychotic symptoms are frightening for the individual and for family and friends. They interrupt school, work, and interpersonal relationships. Allowed to continue unabated, they potentially undermine self confidence, friendships, family cohesion, and academic and vocational success. The study by Drake et al is important because it identifies important correlates of delayed treatment: lack of insight, social isolation, and relatively good coping skills. The last factor must be viewed as controversial because other investigators have found that poor premorbid coping correlated with a longer DUP.³ The first 2 factors have face validity and important public health relevance. Lack of insight can be addressed by public education. Social isolation can be identified in school. It is time to develop interventions for psychosis that emphasise early detection and address the obstacles to treatment.