Duration of untreated psychosis and long-term outcomes: A systematic review examining the critical window hypothesis.
Valerio Ricci, Domenico De Berardis, Giovanni Martinotti et al.
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In 30 seconds
This systematic review evaluated the relationship between duration of untreated psychosis (DUP) and long-term outcomes in approximately 9800 first-episode psychosis patients. It found that longer DUP was consistently associated with worse symptomatic outcomes at 1-2 years (median r = 0.20-0.35), but these associations weakened significantly at 5-10 years, challenging the critical window hypothesis.
Key findings
- Longer DUP correlated with worse symptomatic outcomes at 1-2 years (median r = 0.20-0.35).
- Functional outcomes showed modest associations (r = 0.15-0.25), mainly in social domains.
- Cognitive effects were minimal and inconsistent across studies.
- Neuroimaging indicated gray matter reductions, but directionality was unclear.
Why it matters
Understanding the impact of DUP on long-term outcomes is crucial for developing effective early intervention strategies in psychosis. This review highlights the need for further research to clarify the relationship between DUP and neurobiological damage.
What to keep in mind
Major limitations included retrospective DUP assessment, variable definitions, survivor bias, and inadequate confounder control.