Duration of untreated psychosis and diagnostic delay in homeless patients with schizophrenia- a Copenhagen based clinical study.

Purpose: Psychiatric disorder is a well-established risk factor for homelessness, and homelessness amplifies social, physical, and mental health risks. Yet, little is known about the extent and nature of diagnostic delays, including the duration of untreated psychosis (DUP), among homeless individuals with schizophrenia. This study aimed to address that gap by examining DUP, diagnostic delays, illness trajectories, psychopathology, and substance use in this population.

Methods: We conducted an exploratory cross-sectional study of 35 homeless individuals with schizophrenia, using in-depth psychosocial interviews, standardized psychopathological assessments, and social functioning scales, incl. the Positive and Negative Syndrome Scale (PANSS) and the Examination of Anomalous Self-Experience (EASE).

Results: The sample (mean age 32.6 years; 82.9% male) included 17 patients with paranoid schizophrenia and 10 with disorganized (hebephrenic) schizophrenia; 54% had a comorbid substance use disorder (SUD). The mean DUP was 15.5 years, with an average 6.7-year delay between first psychiatric contact and formal non-substance induced psychosis diagnosis. Patients with SUD showed shorter DUP compared to those without. Psychopathological measurements - including a mean PANSS score of 71.7 and a mean EASE score of 21.3 - were comparable to other schizophrenia samples, with no major differences between patients with or without SUD.

Conclusion: Our findings indicate that the extraordinarily long DUP and diagnostic delays in this homeless sample are not explained by substance use, symptom profile, or schizophrenia subtype but point to systemic barriers in recognizing and managing severe mental illness. There is an urgent need to improve psychiatric services for homeless individuals with schizophrenia.