Duration of active psychosis: a scoping review of definition, measurement, and relationship with outcomes

Background: A longer duration of untreated psychosis (DUP) is associated with poorer outcomes across a range of domains, yet this period only represents a proportion of the time individuals experience psychotic symptoms. The duration of active psychosis (DAP) concept addresses this by estimating the duration of psychosis both before and after treatment initiation. This scoping review aims to describe the literature related to this concept, with a particular focus on definition, measurement, and relationship with outcomes. Methods: A systematic search of four databases (MEDLINE, Embase, PsycINFO, CINAHL) and the grey literature was conducted. Studies that examined DAP in individuals with first-episode psychosis were eligible for inclusion. Each article was screened independently by two reviewers. Data were extracted using a deductive approach and results were analysed using qualitative content analysis. Results: The search yielded 3081 unique articles. 37 articles underwent full-text review and nine were eligible for inclusion. DAP is defined as the cumulative duration of two variables, the DUP and the duration of psychosis after treatment initiation (DAT). DAT measurement was mostly conducted prospectively, using a predetermined symptom severity threshold to define active psychosis. The limited studies to date report an association between longer DAP and worse cognitive and negative symptom outcomes, while longer DAT was associated with worse functional outcomes. Conclusions: Further research is required to determine the relationship between DAP and clinical outcomes. Establishing consensus on how to define and measure DAP is critical to enhance early identification of treatment resistance and ensure timely intervention with appropriate treatments.