Review: longer duration of untreated psychosis is associated with worse outcome in people with first episode psychosis.

Does duration of untreated psychosis affect outcome for people with first episode psychosis?METHODSDesign: Systematic review with meta-analysis.Data sources: CINAHL (January 1982 to May 2004), EMBASE (January 1980 to May 2004), MEDLINE (January 1966 to May 2004), PsychLIT (January 1967 to May 2004), and the Cochrane Schizophrenia Register (2004) plus hand searches of reference lists and reviews.Study selection and analysis: Eligible studies were cohort studies of adults (16-60 years old) with first episode psychosis that assessed the association between duration of untreated psychosis and prognosis. Exclusions: follow up <50%; only assessing cognitive functioning or brain structure outcomes; not reporting duration of psychosis. Fisher Z transformation was used in calculating correlation coefficients (r) for all outcomes.Outcomes: Primary outcomes: overall symptoms (positive, negative, and neurotic symptoms combined); depression/anxiety; negative and positive symptoms; overall functioning (combination of function scores from measures such as the Global Assessment Scale and Global Assessment of Functioning scale); remission.MAIN RESULTSTwenty six studies met inclusion criteria (4490 people; mean age 28 years; 61% male; mean duration of untreated psychosis 124 weeks). Twenty studies involved people with schizophrenia or schizophrenia-like disorders. A longer period of untreated first episode psychosis was not associated with worse overall symptoms or function at presentation, but was associated with worse depression/anxiety (see http://www.ebmentalhealth.com/supplemental for table). At 6 and 12 months, a longer period of untreated psychosis was associated with more severe overall symptoms, depression/ anxiety, negative and positive symptoms, and worse overall function. People with longer duration of untreated psychosis were less likely to experience remission at 6, 12, or 24 months (OR for no remission at 6 months: 3.55, 95% CI 2.03 to 6.18; at 12 months: OR 2.75, 95% CI 1.14 to 6.64; at 24 months: OR 2.72, 95% CI 1.20 to 6.17).CONCLUSIONSLonger duration of untreated psychosis is associated with worse symptoms and functioning, and less chance of remission in people with first episode psychosis. [ABSTRACT FROM AUTHOR]