Determinants of Duration of Untreated Psychosis and the Pathway to Care in Singapore

Introduction: Delays in providing effective treatment for a patient with psychosis has significant negative effects on the outcome. This includes more hospitalizations, longer periods of inpatient care, slower and less complete recovery, and more frequent relapses. In this study, we established the Duration of Psychosis (DUP) in a sample of patients with first-episode psychosis and examined the pathways to care. Methods: The sample comprised patients presenting with first-episode psychosis to the psychiatric services of the Institute of Mental Health, Singapore, from January to December 2000. The association between the DUP and demographic, clinical and social variables was examined. Results: The DUP ranged from 0.1 to 336 months. The mean DUP was 32.6 (SD 1 /4 59.8) months, with a median of 12 months. Twenty four percent of the patients had sought consultation with a traditional healer prior to consulting a psychiatrist. The DUP of this group of patients was not significantly different from those who sought help elsewhere. Conclusions: The DUP of our patients was longer than that reported in studies done in the West. The attitudes and beliefs of family in the Asian society are likely to be crucial in the pathways to care.