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Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review.
Arch Gen Psychiatry. 2005 Sep; 62(9):975-83.AG

Abstract

CONTEXT

Duration of untreated psychosis (DUP) is the time from manifestation of the first psychotic symptom to initiation of adequate treatment. It has been postulated that a longer DUP leads to a poorer prognosis. If so, outcome might be improved through earlier detection and treatment.

OBJECTIVES

To establish whether DUP is associated with prognosis and to determine whether any association is explained by confounding with premorbid adjustment.

DATA SOURCES

The CINAHL (Cumulative Index to Nursing and Allied Health), EMBASE, MEDLINE, and PsychLIT databases were searched from their inception dates to May 2004.

STUDY SELECTION

Eligible studies reported the relationship between DUP and outcome in prospective cohorts recruited during their first episode of psychosis. Twenty-six eligible studies involving 4490 participants were identified from 11 458 abstracts, each screened by 2 reviewers.

DATA EXTRACTION

Data were extracted independently and were checked by double entry. Sensitivity analyses were conducted excluding studies that had follow-up rates of less than 80%, included affective psychoses, or did not use a standardized assessment of DUP.

DATA SYNTHESIS

Independent meta-analyses were conducted of correlational data and of data derived from comparisons of long and short DUP groups. Most data were correlational, and these showed a significant association between DUP and several outcomes at 6 and 12 months (including total symptoms, depression/anxiety, negative symptoms, overall functioning, positive symptoms, and social functioning). Long vs short DUP data showed an association between longer DUP and worse outcome at 6 months in terms of total symptoms, overall functioning, positive symptoms, and quality of life. Patients with a long DUP were significantly less likely to achieve remission. The observed association between DUP and outcome was not explained by premorbid adjustment.

CONCLUSIONS

There is convincing evidence of a modest association between DUP and outcome, which supports the case for clinical trials that examine the effect of reducing DUP.

Authors+Show Affiliations

Division of Psychiatry, University of Manchester, Manchester. max.marshall@man.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

16143729

Citation

Marshall, Max, et al. "Association Between Duration of Untreated Psychosis and Outcome in Cohorts of First-episode Patients: a Systematic Review." Archives of General Psychiatry, vol. 62, no. 9, 2005, pp. 975-83.
Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry. 2005;62(9):975-83.
Marshall, M., Lewis, S., Lockwood, A., Drake, R., Jones, P., & Croudace, T. (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry, 62(9), 975-83.
Marshall M, et al. Association Between Duration of Untreated Psychosis and Outcome in Cohorts of First-episode Patients: a Systematic Review. Arch Gen Psychiatry. 2005;62(9):975-83. PubMed PMID: 16143729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. AU - Marshall,Max, AU - Lewis,Shon, AU - Lockwood,Austin, AU - Drake,Richard, AU - Jones,Peter, AU - Croudace,Tim, PY - 2005/9/7/pubmed PY - 2005/9/15/medline PY - 2005/9/7/entrez SP - 975 EP - 83 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 62 IS - 9 N2 - CONTEXT: Duration of untreated psychosis (DUP) is the time from manifestation of the first psychotic symptom to initiation of adequate treatment. It has been postulated that a longer DUP leads to a poorer prognosis. If so, outcome might be improved through earlier detection and treatment. OBJECTIVES: To establish whether DUP is associated with prognosis and to determine whether any association is explained by confounding with premorbid adjustment. DATA SOURCES: The CINAHL (Cumulative Index to Nursing and Allied Health), EMBASE, MEDLINE, and PsychLIT databases were searched from their inception dates to May 2004. STUDY SELECTION: Eligible studies reported the relationship between DUP and outcome in prospective cohorts recruited during their first episode of psychosis. Twenty-six eligible studies involving 4490 participants were identified from 11 458 abstracts, each screened by 2 reviewers. DATA EXTRACTION: Data were extracted independently and were checked by double entry. Sensitivity analyses were conducted excluding studies that had follow-up rates of less than 80%, included affective psychoses, or did not use a standardized assessment of DUP. DATA SYNTHESIS: Independent meta-analyses were conducted of correlational data and of data derived from comparisons of long and short DUP groups. Most data were correlational, and these showed a significant association between DUP and several outcomes at 6 and 12 months (including total symptoms, depression/anxiety, negative symptoms, overall functioning, positive symptoms, and social functioning). Long vs short DUP data showed an association between longer DUP and worse outcome at 6 months in terms of total symptoms, overall functioning, positive symptoms, and quality of life. Patients with a long DUP were significantly less likely to achieve remission. The observed association between DUP and outcome was not explained by premorbid adjustment. CONCLUSIONS: There is convincing evidence of a modest association between DUP and outcome, which supports the case for clinical trials that examine the effect of reducing DUP. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/16143729/Association_between_duration_of_untreated_psychosis_and_outcome_in_cohorts_of_first_episode_patients:_a_systematic_review_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.62.9.975 DB - PRIME DP - Unbound Medicine ER -