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Duration of untreated psychosis and its relationship to clinical outcome

  • Ross M. G. Norman (a1), Shôn W Lewis (a2) and Max Marshall (a2)

Abstract

Background

A major reason for interest in early intervention for psychotic disorders is the hypothesised relationship between longer duration of untreated psychosis (DUP) and poorer outcome of treatment.

Aims

To critically examine the evidence concerning DUP being related to treatment outcome and possible mediators of any such relationship.

Method

A systematic review of studies in which DUP is assessed and its relationship to treatment outcome is examined. In addition, studies relevant to possible neurotoxic effects of DUP were reviewed.

Results

The research is entirely of a correlational nature and, therefore, firm conclusions regarding causation are not possible. There is, however, substantial evidence of DUP being an independent predictor of treatment outcome, particularly remission of positive symptoms, over the first year or so of treatment. Findings regarding the possible neurotoxic effects of DUP are inconsistent.

Conclusions

There continues to be evidence consistent with DUP influencing aspects of treatment outcome. Non-correlational studies, such as quasi-experimental designs, could provide stronger evidence regarding causality.

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Copyright

Corresponding author

Ross M. G. Norman, Room 113B, WMCH Building, 392 South Street, London, Ontario N6A 4G5, Canada. E-mail: rnorman@uwo.ca

Footnotes

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Based on a paper presented at the Third International Early Psychosis Conference, Copenhagen, Denmark, September 2002.

Declaration of interest

None.

Footnotes

References

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Altamura, A. C., Bassetti, R., Sassella, D., et al (2001) Duration of untreated psychosis as a predictor of outcome in first episode schizophrenia; a retrospective study. Schizophrenia Research, 52, 2936.
Amminger, G. P., Edwards, J., Brewer, W. J., et al (2002) Duration of untreated psychosis and cognitive deterioration in first-episode schizophrenia. Schizophrenia Research, 54, 223230.
Barnes, T. R. E., Hutton, S. B., Chapman, M. J., et al (2000) West London first-episode study of schizophrenia: Clinical correlates of duration of untreated psychosis. British Journal of Psychiatry, 177, 207211.
Black, K., Peters, L., Rui, Q., et al (2001) Duration of untreated psychosis predicts treatment outcome in an early psychosis program. Schizophrenia Research, 47, 215222.
Browne, S., Clarke, M., Gervin, M., et al (2000) Determinants of quality of life at first presentation with schizophrenia. British Journal of Psychiatry, 176, 173176.
Carbone, S., Harrigan, S., McGorry, P. C., et al (1999) Duration of untreated psychosis and 12-month outcome in first episode psychosis: The impact of treatment approach. Acta Psychiatrica Scandinavica, 100, 96104.
Craig, T. J., Bromet, E. J., Fenning, S., et al (2000) Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? American Journal of Psychiatry, 157, 6066.
de Haan, L., van der Gaag, M. & Wolthaus, J. (2000) Duration of untreated psychosis and the long-term course of schizophrenia. European Psychiatry, 15, 264267.
Drake, R. J., Haley, C. J., Akhtar, S., et al (2000) Causes and consequences of duration of untreated psychosis. British Journal of Psychiatry, 177, 511515.
Edwards, J., McGorry, P. D., Waddell, F. M., et al (1999) Enduring negative symptoms in first episode psychosis: Comparison of six methods using follow-up data. Schizophrenia Research, 40, 147158.
Fannon, D., Chitnis, X., Doku, V., et al (2000) Features of structural brain abnormality detected in first-episode psychosis. American Journal of Psychiatry, 157, 829834.
Haas, G. L. & Sweeney, J. A. (1992) Premorbid and onset features of first-episode schizophrenia. Schizophrenia Bulletin, 18, 373386.
Haas, G. L., Garratt, L. S. & Sweeney, J. A. (1998) Delay to first antipsychotic medication in schizophrenia: Impact on symptomatology and clinical course of illness. Journal of Psychiatric Research, 32, 559.
Hafner, H. (2000) Onset and early course as determinants of the further course of schizophrenia. Acta Psychiatrica Scandinavica, 102 (suppl. 407): 4448.
Harrigan, S., McGorry, P. D. & Krstev, H. (2003) Does treatment delay in first-episode psychosis really matter? Psychological Medicine, 33, 97110.
Ho, B.-C., Andreasen, N. C., Flaum, M., et al (2000) Untreated initial psychosis: Its relation to quality of life and symptom remission in first episode schizophrenia. American Journal of Psychiatry, 157, 808–85.
Ho, B.-C., Alicata, D., Ward, J., et al (2003) Untreated initial psychosis: Relation to cognitive deficits and brain morphology in first-episode schizophrenia. American Journal of Psychiatry, 160, 4248.
Hoff, A. L., Sakuma, M., Razi, B. K., et al (2000) Lack of association between duration of untreated illness and severity of cognitive and structural brain deficits at the first episode of schizophrenia. American Journal of Psychiatry, 157, 824828.
Johannessen, J. O., McGlashan, T. H. & Larsen, T. K., et al (2001) Early detection strategies for untreated psychosis. Schizophrenia Research, 51, 3946.
Joyce, E., Hutton, S., Mutsatsa, S., et al (2002) Executive dysfunction in first-episode schizophrenia and relationship to duration of untreated psychosis: the West London Study. British Journal of Psychiatry, 181 (suppl. 43), s38s44.
Kalla, O., Aaltonen, J., Wahlstrom, J., et al (2002) Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain. Acta Psychiatrica Scandinavica, 106, 265275.
Keshavan, M. S., Haas, G. L., Kahn, C. E., et al (1998) Superior temporal gyrus and the course of early schizophrenia: Progressive, static, or reversible? Journal of Psychiatric Research, 32, 667.
Larsen, T. K., McGlashan, T. H. & Moe, L. G. (1996) First episode schizophrenia: Early course parameters. Schizophrenia Bulletin, 22, 24256.
Larsen, T. K., Moe, L. C., Vibe-Hansen, L., et al (2000) Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first episode psychosis. Schizophrenia Research, 45, 19.
Larsen, T. K., Friss, S., Haahr, V., et al (2001) Early detection and intervention in first-episode schizophrenia: A critical review. Acta Psychiatrica Scandinavica, 103, 323334.
Linszen, D., Lenior, M., De Hann, L., et al (1998) Early intervention, untreated psychosis and the course of early schizophrenia. British Journal of Psychiatry, 172 (suppl. 33), s84s89.
Loebel, A. D., Lieberman, J. A., Alvir, J. M. M., et al (1992) Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry, 149, 11831188.
Madsen, A. L., Karle, A., Rubin, P., et al (1999) Progressive atrophy of the frontal lobes in first episode schizophrenia: Interaction with clinical course and neuroleptic treatment. Acta Psychiatrica Scandinavica, 100, 367374.
Malla, A. K. & Norman, R. M. G. (2001) Treating psychosis: Is there more to early intervention than intervening early? Canadian Journal of Psychiatry, 46, 645648.
Malla, A. K., Norman, R. M. G., McLean, T. S., et al (2001) Impact of phase-specific treatment of first episode of psychosis on Wisconsin Quality of Life Index (client version). Acta Psychiatrica Scandinavica, 103, 355361.
Malla, A. K., Norman, R. M. G., Manchanda, R., et al (2002a) One year outcome in first episode psychosis: Influence of DUP and other predictors. Schizophrenia Research, 54, 231242.
Malla, A. K., Norman, R. M. G., Manchanda, R., et al (2002b) Symptoms, cognition, treatment adherence and functional outcome in first episode psychosis. Psychological Medicine, 32, 11091119.
Malla, A. K., Takhar, J. J., Norman, R. M. G., et al (2002c) Negative symptoms in first episode non-affective psychosis. Acta Psychiatrica Scandinavica, 105, 431439.
Malla, A. K., Mittal, C., Lee, M., et al (2002d) Computerized tomography of the brain morphology of patients with first-episode schizophrenic psychosis. Journal of Psychiatry and Neuroscience, 27, 350358.
McGorry, P. D. (2000) Evaluating the importance of reducing the duration of untreated psychosis. Australian and New Zealand Journal of Psychiatry, 34 (suppl.): 51455149.
McGorry, P. D., Edwards, J., Mihalopoulos, C., et al (1996) EPPIC: An evolving system of early detection and optimal management. Schizophrenia Bulletin, 22, 305326.
McGorry, P. D., Harrigan, S. M., Amminger, P., et al (2001) Untreated initial psychosis. American Journal of Psychiatry, 158, 11611162.
Norman, R. (2002) Author's reply to Amminger et al, ‘Estimating cognitive deterioration in schizophrenia’. British Journal of Psychiatry, 181, 165.
Norman, R. M. G. & Malla, A. K. (2001) Duration of untreated psychosis: A critical examination of the concept and its importance. Psychological Medicine, 31, 381400.
Norman, R. M. G. & Malla, A. K. (2002) Examining adherence to medication and substance use as possible confounds of DUP. Journal of Nervous and Mental Disease, 190, 331334.
Norman, R. M. G., Townsend, L. & Malla, A. K. (2001) Duration of untreated psychosis and cognitive functioning in first episode patients. British Journal of Psychiatry, 179, 340345.
Pantelis, C., Velakoulis, D., McGorry, P. D., et al (2003) Neuroanatomical abnormalities before and after onset of psychosis: A cross-sectional and longitudinal MRI comparison. Lancet, 361, 281288.
Robinson, D., Woerner, M. G., Alvir, J. M. J., et al (1999) Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry, 56, 241247.
Rosnow, R. L. & Rosenthal, R. (1996) Computing contrasts, affect sizes, and counter nulls on other people's published data: General procedures for research consumers. Psychological Methods, 1, 331340.
Scully, P. J., Coakley, G., Kinsella, A., et al (1997) Psychopathology, executive (frontal) and general cognitive impairment in relation to duration of initially untreated vs. subsequently treated psychosis in chronic schizophrenia. Psychological Medicine, 27, 13031310.
Szymanski, S. R., Cannon, T. D., Gallacher, F., et al (1996) Course of treatment response in first episode and chronic schizophrenia. American Journal of Psychiatry, 153, 519525.
Velakoulis, D., Wood, S. J., Smith, D. J., et al (2001) Increased duration of illness is associated with reduced volume in right medial temporal/anterior cingulate grey matter in patients with chronic schizophrenia. Schizophrenia Bulletin, 57, 4349.
Verdoux, H., Bergey, C., Assens, F., et al (1998) Prediction of duration of psychosis before first admission. European Psychiatry, 13, 346352.
Verdoux, H., Liraud, F., Bergey, C., et al (2001) Is the assocation between duration of untreated psychosis and outcome confounded? Atwoyear follow-up study of first-admitted patients. Schizophrenia Research, 49, 231241.
Wiersma, D., Nienhuis, F. J., Slooff, C. J., et al (1998) Natural course of schizophrenic disorders: a 15-year follow-up of a Dutch incidence cohort. Schizophrenia Bulletin, 24, 7585.
Wyatt, R. J. (1991) Neuroleptics and the natural course of schizophrenia. Schizophrenia Bulletin, 17, 325351.
Zarafe, C. A., Tohen, M. & Land, M. I. (2000) First-episode schizophreniform disorder: Comparisons with first-episode schizophrenia. Schizophrenia Research, 46, 3134.

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Duration of untreated psychosis and its relationship to clinical outcome

  • Ross M. G. Norman (a1), Shôn W Lewis (a2) and Max Marshall (a2)

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Duration of untreated psychosis and its relationship to clinical outcome

  • Ross M. G. Norman (a1), Shôn W Lewis (a2) and Max Marshall (a2)
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