Psychosis and Duration of Untreated Illness in North East Nigeria: Pathways to Care and Clinical Implications

Duration of untreated psychosis (DUP) is a critical predictor of clinical outcomes, and understanding pathways to care illuminates the sociocultural and structural factors that delay treatment. This study examines DUP and pathways to care among patients with first-episode psychosis presenting at Federal Teaching Hospital, Gombe, North East Nigeria. A cross-sectional design with retrospective timeline assessment will recruit 120 consecutive first-episode psychosis patients. A structured pathway to care interview will document the sequence of help-seeking contacts before first psychiatric presentation, including type of provider (traditional healer, religious leader, general practitioner, or specialist), duration at each contact, and reason for transition. DUP will be defined as the time from onset of first positive psychotic symptom to initiation of antipsychotic medication. Path analysis will examine sociodemographic and illness-related predictors of long DUP. Existing evidence from North East Nigeria suggests median DUP exceeding 24 months, driven by conflict-related disruption of health services, traditional healer utilization, and stigma. Findings will inform community awareness campaigns and early intervention pathways specific to North East Nigeria. Keywords: duration of untreated psychosis, pathways to care, first-episode psychosis, Gombe, North East Nigeria