Duration of untreated psychosis in two Arab samples from Egypt and Saudi Arabia: Clinical and sociocultural correlates Mohab M. Fawzi a , Hany M. El-Amin b and Mounir H. Fawzi a a Department of Psychiatry, Faculty of Medicine, Zagazig University, Zagazig, Egypt and b Consultant Psychiatrist, Erfan Psychiatric Hospital, Jeddah, Saudi Arabia Correspondence to Mohab M. Fawzi, Faculty of Medicine, Zagazig University, Zagazig, Egypt Tel: + 161366617; fax: +20552338972; e-mail: mohabfawzi@yahoo.com Received 11 April 2011 Accepted 6 June 2011 Middle East Current Psychiatry 2011, 18:217–225 Background The duration of untreated psychosis (DUP) varies considerably across different cultures and settings. However, cross-cultural studies have mostly been either comparisons between developed and developing countries or comparisons between different ethnic groups in unicultural investigations. Studies comparing more socioculturally related countries, such as Arab countries, are required. To the best of our knowledge, no previous studies have compared DUP between Egypt and Saudi Arabia. Aims The aims of the study are to determine DUP in two samples of patients with first- episode psychosis from Egypt and Saudi Arabia; to explore the sociodemographic, clinical, and help-seeking characteristics that are associated with DUP in these two groups; to distinguish which of these sociodemographic, clinical and help-seeking correlates the DUP are shared by Egyptian and Saudi Arabian patient groups and which are more culture specific; and to test the hypothesis that severity of illness predicts the length of DUP. Methods A total of 96 (50 from Egypt and 46 from Saudi Arabia) consecutive attendees at two outpatient clinics with first-episode psychosis were assessed by semistructured interviews. In addition to the determination of DUP and help-seeking contacts, patients were assessed by the Positive and Negative Syndrome Scale. Results The mean DUP was 3.2 and 3.1 years for the Egyptian and Saudi Arabian patient groups, respectively. There were no significant differences between the two groups with regard to most of the variables studied. Variables that significantly correlated with DUPwereenteredintomultipleregressionanalyses.Thefinalmodel,whichaccounted for56.9%ofthevarianceinDUP,includedonlytwovariables:‘firstcontact’and‘mode of onset’. Conclusion In the two countries, patients with first-episode psychosis were found to have long DUP. First contact with a traditional (faith) healer and insidious mode of onset of psychosis were the two significant predictors of long DUP. Although severity of negative symptoms, as indicated by Positive and Negative Syndrome Scale negative subscale scores, was correlated with DUP, it could not be retained in the final regression model as a significant predictor. Our hypothesis that severity of illness predictslongDUPhadtoberejected.FactorsfoundtoinfluenceDUPshouldbetaken into account in early intervention initiatives. Keywords: duration of untreated psychosis, Egypt, first-episode psychosis, help-seeking, Positive and Negative Syndrome Scale, Saudi Arabia, traditional (faith) healer Middle East Curr Psychiatry 18:217–225 & 2011 Okasha Institute of Psychiatry, Ain Shams University 2090-5408 Introduction The duration of untreated psychosis (DUP), which represents the delay in initiation of treatment, is a concept of paramount importance in schizophrenia research, at least from the point of view of secondary prevention.Itsimportancebegantobeappreciatedinthe mid 1980s when the Northwick Park Study of first- episode schizophrenia found that the most important determinant of relapse was the duration of illness before starting antipsychotics [1]. Interest in the topic has increasedevenmoreinrecentyears,withagrowingsense of optimism derived from the understanding that attention to the early phases of illness could result in a substantial reduction in morbidity and lead to a better quality of life. Moreover, although there is some controversy about whether long DUP is associated with poor outcome, the weight of evidence supports an association that, although not strong, is persistent; for example,[2–5].Thus,inasystematicreviewofliterature, Original article 217 2090-5408 & 2011 Okasha Institute of Psychiatry, Ain Shams University DOI: 10.1097/01.XME.0000403822.37436.43