title: Prospective relationship between duration of untreated psychosis and 13-year clinical outcome: a first-episode psychosis study.
abstract: BACKGROUND
  The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP-outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined.
  
  
  OBJECTIVE
  To explore the relationship between DUP and long-term symptomatic remission.
  
  
  METHODS
  This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤30days), medium (31-180days) and long (>180days) DUP groups.
  
  
  RESULTS
  The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission.
  
  
  CONCLUSIONS
  The findings support the threshold theory that DUP longer than 30days adversely impacts the long-term outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on long-term outcomes based on well-defined criteria and adequate statistical adjustment.
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong. Electronic address: jennitym@gmail.com.
authors: Jennifer Yee-Man
authors: JY
authors: Tang
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors: Wing-Chung
authors: WC
authors: Chang
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors: Christy Lai-Ming
authors: CL
authors: Hui
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors: Gloria Hoi-Yan
authors: GH
authors: Wong
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors: Sherry Kit-Wa
authors: SK
authors: Chan
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors: Edwin Ho-Ming
authors: EH
authors: Lee
authors: Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong.
authors: Wai-Song
authors: WS
authors: Yeung
authors: Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong.
authors: Chi-Keung
authors: CK
authors: Wong
authors: Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong.
authors: Wai-Nang
authors: WN
authors: Tang
authors: Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong.
authors: Wah-Fat
authors: WF
authors: Chan
authors: Department of Psychiatry, United Christian Hospital, Hospital Authority, Hong Kong.
authors: Edwin Pui-Fai
authors: EP
authors: Pang
authors: Department of Psychiatry, Castle Peak Hospital, Hospital Authority, Hong Kong.
authors: Steve
authors: S
authors: Tso
authors: Department of Psychiatry, Kowloon Hospital, Hospital Authority, Hong Kong.
authors: Roger Man-Kin
authors: RM
authors: Ng
authors: Department of Psychiatry, Kwai Chung Hospital, Hospital Authority, Hong Kong.
authors: Se-Fong
authors: SF
authors: Hung
authors: Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong.
authors: Eva Lai-Wah
authors: EL
authors: Dunn
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
authors: Pak-Chung
authors: PC
authors: Sham
authors: Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
authors: Eric Yu-Hai
authors: EY
authors: Chen
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004467:Economics; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D012372:ROC Curve; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Duration of untreated psychosis; Long-term outcome; Prospective study; Psychotic disorders; Remission; Risk factors