Relationship of DUP to Pathology and Functional Outcome


The relationship of duration of untreated psychosis (DUP) to outcome is often invoked in support of early intervention. A prospective study published this week in Schizophrenia Research finds that DUP predicts poorer remission status, more severe positive and negative symptoms, and greater impairment in general functioning, social functioning and quality of life 12 years following a first episode of psychosis, but does not predict employment status (for which education was the only predictor) or independent living (for which age was the only predictor). The relationship between DUP and functional outcome was mediated, in particular, by negative symptoms.

Abstract → Hill, M., Crumlish, N., et al; Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12years. Schizophrenia Research.141 (2) 215-221, November 2012

Note from Kermit Cole, “In the News” editor:
DUP’s impact on outcome is often used to justify early medical intervention, though there is little reason to assume that DUP’s impact is purely (if at all) of a medical nature. Here, the lack of a relationship of DUP with employment, and of DUP’s impact being primarily through negative symptoms, which are by far less the target of medical interventions than positive symptoms, may give premise for questioning the presumption that medical interventions should be the focus of treatment.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. “negative symptoms” is just a con concocted by the quacks to blame the social withdrawal and despair they generate in people when they decimate lives by minting fresh mental patient with their fake labels.

    If you’re handed over to this cult, your life is essentially over in many respects. Even the most recovered still face the lifelong stigma of being branded by psychiatry’s smears.

    Then there is the terror you have to live in for the rest of your life knowing your government and society have abandoned you to be tortured at any given moment.

    It is just a religion. It’s sick to read these fools and their pathetic facsimile of a real medical journal article about a real medical disease. They are playing with lives and they don’t have a clue what they are doing.

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      • “pharmaceutical industry”? You think I care about the pharmaceutical industry 1/10th as much as I care about psychiatry’s beliefs?

        My point was that right now, in this world, depression and anxiety in the years following being made into a hardcore mental patient by psychiatry slapping a SZ or BP1 label on you, is going to be very much related to in many if not most instances to the rapid loss of social status caused by psychiatry labeling you, the social shunning done to us, so this whole argument that people become isolative and shut-ins “because” of their “disease” is just an ugly blame the victim type thing.

        And Kermit get to know me. I’m no screaming anti-corporate Occupy Wall Street leftist who thinks “pharmaceutical corporations” are the reason a fake branch of medicine is considered mainstream, oh no, it is much much much infinitely more the fault of psychiatry that millions of lives are destroyed, rather than the corporations who saw a profitable partner in this quackery.

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    • We live in the western world. Of course “untreated” refers to how long before the person’s brain is doused in tranquilizer drugs. Everybody believes having bizarre thoughts is a bona fide brain disease. This mainstream psychiatry “schizophrenia” journal wouldn’t consider for a second anything but drug treatment to be the treatment they refer to when they use the term “untreated”. Where have you been?

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    • Usually it is meant to imply a pharmaceutical intervention, and the claim is that untreated psychosis is neurotoxic. Of course, the evidence for this is arguable and even if true is explained through other means (the neurotoxic effects of stress, etc.). Evidence such as this, however, which relies on behavioral outcomes, is also easily complemented if not countered by alternative explanations that do not necessarily imply pharmaceutical intervention.
      The tricky part is delving into research inspired by a certain hypothesis or paradigm with the intention of exploring another as, yet again, we find ourselves doing here. Without a research base commensurate to the prevailing biomedical paradigm, we are limited to such subversive activity.

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