This is the first study of duration of untreated psychosis and pathways to care among patients with first episode psychosis in Iran.

Subjects were patients with a first episode of a nonorganic psychotic illness that were admitted to a university affiliated psychiatric hospital in Iran. Patients were assessed for duration of untreated psychosis (DUP, defined as the duration between the appearance of first symptoms of psychosis and the time when first adequate treatment is received), pathways to care (including any previous helping contacts and referrals to the hospital), and mode of illness onset.

Ninety-one patients were enrolled. Median DUP was 11 weeks, with the mean of 52.3 weeks (range: one day to 17 years). Following the onset of psychosis, most patients were first seen by a psychiatrist (n=23, 25.3%), a traditional healer (n=21, 23.1%) or a general practitioner (n=16, 17.6%). Most of the referrals to the psychiatric hospital was by the family (n=30, 33.1%), and health professionals (n= 29, 31.9%). Acute illness onset and rural place of residence were associated with shorter DUP in multivariate analysis.

DUP in this developing country setting was comparable to several others in western countries. This may be due to the preponderance of acute psychoses in this sample, and different help seeking behavior or health care system. Of special notice, family plays a significant role in the journey toward care.