âKnown groupsâ validityâ is…, Cognition in bipolar versus schizophrenia, Cognition in children with bipolar disorder, Cognition in first-episode bipolar disorder, Treatments during pregnancy and breastfeeding, Treatments for bipolar versus unipolar depression, Treatments for first-episode bipolar disorder, Criminal offending, aggression and violence, Inflammation and immune system dysfunction, Positron emission tomography / single-photon emission computed tomography. These subgroups were defined by the systematic review that was conducted ahead of the meta-analysis, as indicated below. Psychometric standardization of DUP definition, improvement of study design, and implementation of preventative strategies seem the most promising avenues for reducing DUP and improving outcomes of first-episode psychosis. These analyses may be particularly informative for the implementation of early psychosis services worldwide. The quality of these tools can be measured in various ways. The conclusions presented here are based on group data, and as such individual treatment programs need to be tailored by trained clinicians. Early Psychosis: Interventions & Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kingâs College London, UK. DUP is generally determined as the time from the onset of psychotic symptoms to the initiation of treatment or first clinical presentation, when a diagnosis of first-episode psychosis may be given. Where these values were not available other complementary statistics allowing the estimation of Hedgesâ g were extracted. It shows a lack of robust evidence that specific interventions such as standalone FEP services, community interventions, healthcare professional training, and multifocus interventions are successful in accomplishing this. MAIN RESULTS. Evaluation of quality of studies was performed using a risk bias tool, an adapted version of the Newcastle Ottawa Scale33 (see supplementary eMethods 1). The definition of DUP is not precisely operationalized and still subject to variable ascertainment.16,53 Defining onset psychometrically using the PANSS or with positive symptoms using a clinical instrument was linked with a significant reduction in DUP while other definitions were not (figure 5). The period from the onset of frank psychotic symptoms to the start ofadequate treatment, the duration of untreated psychosis (DUP), varies considerablyin patients with first-episode psychosis. Retrospective examination in a first-episode psychosis sample. Dominic Oliver is supported by the UK Medical Research Council (MR/N013700/1) and Kingâs College London member of the MRC Doctoral Training Partnership in Biomedical Sciences. What is the evidence for DUP and outcomes? Articles found through these steps were then screened on the basis of title or abstract reading. There were no significant effects for the following patient-related variables: age (Î² = â0.022, P = .274), gender (Î² â¤ 0.001, P = .973), marital status (Î² = 0.006, P = .708), or for the following study-related variables: length of interventions (Î² = 0.002, P = .473; figure 3), quality of studies (Î² = 0.070, P = .396), publication year (Î² = â0.012, P = .317), continent (Q = 1.73, P = .786), healthcare system type (Q = 1.36, P = .507), study design (Q = 4.13, P = .127) or definition of DUP endpoint (Q = 1.15, P = .562) see supplementary eFigures. The duration of untreated psychosis (DUP) is defined as the time from the emergence of the first psychotic episode to the initiation of adequate treatment. However, this was very underpowered with only one study. It highlights that, although the positives for reducing DUP seem obvious, accomplishing this is difficult. Indeed, we found that the definition of the DUP was unstandardized and associated with significant heterogeneity. Moreover, when the analyses were stratified within and between the different subgroups the results were overall unchanged. Furthermore, between-subgroup analyses showed no significant differences across the 5 types of intervention (Q = 9.283, df = 4, P = .054). As part of a large early detection campaign, the present study aimed to investigate subjective experiences during the duration of untreated psychosis (DUP), or time between psychosis onset and treatment contact. These specific interventions have been varied including programs networking primary healthcare providers and public education,17 early detection programs identifying FEP patients12,18 or those at clinical high risk for psychosis (CHR-P),19,20 information workshops,21 written information in information packs, newsletters or brochures,17,22 community intervention teams and activities,18 and websites and telephone hotlines.17 Studies have typically compared service providers (standalone FEP services or standalone CHR-P services), community, healthcare professional training or multifocus (combining other types) interventions to a control group. Early intervention programs for schizophrenia and psychosis often combine many elements comprising both pharmaceutical and psychosocial therapies, and may involve enriched therapies that are tailored to an individualâs needs. social withdrawal) may also be present. Reduction of duration of untreated psychosis (DUP) is the key strategy of early interventions for improving the outcomes of first-episode psychosis. What is the duration of untreated psychosis (DUP)? DUP is generally determined as the time from the onset of psychotic symptoms to the initiation of treatment or first clinical presentation, when a diagnosis of first-episode psychosis may be given. DUP can last days, months or even years (Marshall et al., 2005). Psychosis is one of the most debilitating psychiatric conditions with limited options to improve outcomes.1 One key strategy is reducing the duration of untreated psychosis (DUP), the time from the first symptom of psychosis to the start of treatment.2 Accumulating studies have shown that a longer DUP is associated with poorer outcomes for people with first-episode psychosis (FEP), including worse positive3,4 and negative symptom4,5 severity, poorer rates of remission,4,6,7 poorer social cognition,6,8 and cognitive impairment.6,9,10 In addition to the clinical, functional, and cognitive benefits, reducing DUP is associated with reducing the social consequences of psychosis onset, such as social isolation, unemployment, homelessness, and can reduce deliberate self harm11,12 and violence toward others.12,13 Under standard care, DUP tends to be quite long, with means varying between 22 weeks and over 150 weeks,14 with high heterogeneity between patients.15 These long periods without treatment arise from several sources, both intrinsic (eg, symptom severity, patientsâ attitude) and extrinsic (eg, access to care).16 These considerations lay foundations for specialized early intervention services1 with the aim of improving early detection and facilitating pathways to care and treatment; minimizing DUP. 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