Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis.
Open accessAbstract
BACKGROUND: Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear. AIMS: To analyse the associations between DUP and long-term outcomes of schizophrenia. METHOD: A systematic literature search was performed using seven electronic databases and manual searches. Random effects weighted meta-analysis with correlation coefficients was used to pool the results. RESULTS: We identified 3493 unique publications, from which 33 samples met our predefined selection criteria. Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13-0.18). Long DUP was not associated with employment, quality of life or hospital treatment. CONCLUSIONS: The small but mostly consistent correlation between long DUP and poor outcome indicates that early intervention in psychosis may have at least subtle positive effects on the long-term course of illness.
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Our social assessment revealed a tremendous negative impact of severity of positive symptoms and crisis-associated hospitalization on patients' QoL.
“Our social assessment in turn revealed a tremendous negative impact of the severity of positive symptoms and crisis-associated hospitalization on patients’ QoL (27, 80–82).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [80]
The Results and Discussion examine duration of untreated psychosis in relation to symptoms, quality of life and hospital treatment, but do not assess whether positive-symptom severity or crisis-associated hospitalization affects quality of life. The Implications mention decreased quality of life in relation to negative and depressive symptoms, not positive symptoms; the Outcome section treats hospital admissions as a possible proxy for illness severity, not as a cause of lower quality of life. Searches for positive symptoms, hospitalization and quality of life found no passage establishing the claimed relationships. (LLM, conf=0.76)
Experimental — accuracy not yet measuredTimely and accurate diagnosis is crucial because diagnostic delay impedes the initiation of targeted treatment.
“Timely and accurate diagnosis is crucial because diagnostic delay impedes the initiation of targeted treatment.”
From Predicting Diagnostic Progression to Schizophrenia or Bipolar Disorder via Machine Learning (2025) · cites this paper as [5]
Diagnosis of schizophrenia and bipolar disorder is often delayed several years despite typical emergence in late adolescence or early adulthood.
“Despite typically emerging in late adolescence or early adulthood, diagnosis is often delayed several years.”
From Predicting Diagnostic Progression to Schizophrenia or Bipolar Disorder via Machine Learning (2025) · cites this paper as [5]
The longer the duration of untreated illness, the worse the prognosis becomes.
“Furthermore, the longer the duration of untreated illness, the worse the prognosis becomes.”
From Predicting Diagnostic Progression to Schizophrenia or Bipolar Disorder via Machine Learning (2025) · cites this paper as [5]
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- Authors
- Penttilä, M., Jääskeläinen, E., Hirvonen, N., Isohanni, M., & Miettunen, J.
- Affiliations
- Oulu University Hospital (FI)
- Corresponding author
- Isohanni, Matti
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2014-08
- Volume
- 205
- Issue
- 2
- Pages
- 88-94
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2023475151
- Cited by
- 716
- References
- 48
- Citations by year
- 2026: 48 · 2025: 60 · 2024: 60 · 2023: 66 · 2022: 67 · 2021: 71 · 2020: 69 · 2019: 85 · 2018: 63 · 2017: 48 · 2016: 47 · 2015: 25 · 2014: 5
- FWCI
- 5.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- Jalmari ja Rauha Ahokkaan Säätiö
- Pohjois-Suomen Terveydenhuollon Tukisäätiö
- Academy of Finland
- Oulun Yliopisto
- H. Lundbeck A/S
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- duration of untreated psychosis, schizophrenia, long-term outcomes, early intervention in psychosis, remission, social functioning, positive and negative symptoms, quality of life, employment, hospital treatment
- MeSH terms
- Health Services Accessibility, Humans, Prognosis, Psychotic Disorders, Schizophrenia, Time Factors
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