Duration of untreated psychosis and negative symptoms — A systematic review and meta-analysis of individual patient data

Abstract

Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Background: Longer duration of untreated psychosis (DUP) is associated with poorer outcome in terms of positive symptoms, relapse rate, and time to remission. In contrast, the association with negative symptoms is less consistent. Aims: The study had three aims. First, to arrive at a more precise estimate of the correlation between DUP and negative symptoms than previous reviews, by substantially increasing the amount of available data. Second, to see whether the strength of this correlation attenuated over longer follow-up intervals. Third, to determine whether there is a relationship between DUP and changes in negative symptoms. Method: Relevant databases were searched for studies published between December 1992 and March 2009 that reported data on DUP and negative symptoms. We obtained individual patient data where possible and calculated summary correlations between DUP and negative symptoms for each study at baseline, short and long-term follow-up. We used multilevel regression analysis to examine whether the effect of DUP on negative symptoms was the greatest in the early stages of illness. Results: We included 28 non-overlapping studies from the 402 papers detected by the search strategy. After contacting the authors we obtained individual patient data from 16 of these studies involving 3339 participants. The mean DUP was 61.4 weeks (SD = 132.7, median DUP = 12.0). Shorter DUP was significantly associated with less severe negative symptoms at baseline and also at short (1-2 years) and longer term follow-up (5-8 years) (r = 0.117, 0.180 and 0.202 respectively, p b 0.001). The relationship between improvement in negative symptoms and DUP was found to be non-linear: people with a DUP shorter than 9 months showed substantially greater negative symptom reduction than those with a DUP of greater than 9 months. Conclusions: Shorter DUP is associated with less severe negative symptoms at short and long-term follow up, especially when the DUP is less than 9 months. Since there is no effective treatment for negative symptoms, reducing DUP to less than 9 months may be the best way to ameliorate them.

Association of duration of untreated psychosis and functional level, in first episode of schizophrenia attendingan outpatient clinic in Sri Lanka

“…Since DUP is known to impair the prognosis in this mental disorder, the knowledge of DUP is vital for planning rehabilitation efforts for patients with schizophrenia in Sri Lanka 1 . The found value of 35.5 months for DUP is much higher compared to 14.1 months stated in a meta-analysis of mainly western studies and 20.7 months found by a retrospective assessment in a study done in neighbouring India 11,12 . But the association of longer DUP to lower functional scores were agreeing with many of the studies from west and India 1,2,11,12 .…”

Long-term employment among people at ultra-high risk for psychosis

“…The same issue is debated in relation to first-episode psychosis and the association between long duration of untreated psychosis (DUP) and poor functional outcome (Hill et al, 2012;Cotter et al, 2016b). For example, poor insight, social isolation, negative symptoms and insidious onset contribute to long DUP and may also contribute to poor functioning (Barnes et al, 2000;Drake et al, 2000;Boonstra et al, 2012;Chang et al, 2012).…”

The course of negative symptom in first episode psychosis and the relationship with social recovery

“…DUP was defined as the interval between onset of frank psychosis and commencement of criterion antipsychotic treatment, ascertained using participant report and examination of clinical notes. Continuous data were dichotomised to create a binary DUP variable (long DUP ≥ 9 months) due to the non-linear relationship between DUP and negative symptoms (Boonstra et al, 2012). The Calgary Depression Scale (CDSS; Addington et al, 1994) was used to measure depression and the Drug Check (Kavanagh et al, 1999) to assess illicit substance use.…”