title: Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12 years.
abstract: BACKGROUND
  The duration of untreated psychosis is well recognised as an independent predictor of symptomatic and functional outcome in the short term and has facilitated the development of worldwide early intervention programmes. However, the extent and mechanisms by which it might influence prognosis beyond a decade remain poorly understood.
  
  
  METHODS
  The authors examined the relationship between duration of untreated psychosis and outcome 12years after a first episode of psychosis and assessed whether its relationship with function is affected by symptoms in a prospective, 12-year follow-up of an epidemiologically-based inception cohort.
  
  
  RESULTS
  Longer duration of untreated psychosis predicted poorer remission status, more severe positive and negative symptoms, and greater impairment in general functioning, social functioning and quality of life at 12years on standardised measures, independent of other factors at baseline. It was not associated with gainful employment, for which education was the only predictor, or independent living, for which age was the only predictor. The relationship between duration of untreated psychosis and functional outcome was mediated by concurrent psychopathology, particularly negative symptoms.
  
  
  CONCLUSIONS
  These results provide qualified support for the potential long-term benefit of reduction in the duration of untreated psychosis in terms of improvement in symptoms and functional outcome. Its failure to predict real-life outcomes such as independent living and gainful employment could reflect the importance of pre-existing socio-cultural factors such as individual opportunity. The relationship between duration of untreated psychosis and negative symptoms was largely responsible for its effect on function, suggesting a possible long-term protective mechanism against disability.
authors.affiliation: Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Co., Dublin, Ireland. michelehill1@gmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Hill
authors.forename: Niall
authors.initials: N
authors.lastname: Crumlish
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke
authors.forename: Peter
authors.initials: P
authors.lastname: Whitty
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Owens
authors.forename: Laoise
authors.initials: L
authors.lastname: Renwick
authors.forename: Stephen
authors.initials: S
authors.lastname: Browne
authors.forename: Eric A
authors.initials: EA
authors.lastname: Macklin
authors.forename: Anthony
authors.initials: A
authors.lastname: Kinsella
authors.forename: Conall
authors.initials: C
authors.lastname: Larkin
authors.forename: John L
authors.initials: JL
authors.lastname: Waddington
authors.forename: Eadbhard
authors.initials: E
authors.lastname: O'Callaghan
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology; D011618:Psychotic Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D012189:Retrospective Studies; D012917:Social Adjustment; D055815:Young Adult