Long-term Outcome Of Schizophrenia Research Articles

Impact of early negative symptom patterns on the long-term outcomes of patients with first-episode schizophrenia-spectrum disorders: A 12-year follow up study

Given the strong prognostic value of early negative symptoms (NS), understanding their associations with long-term outcomes of schizophrenia is essential. The study examined early NS patterns in trajectory, severity and variability and their association with 12-year outcomes. NS in the first 36 months after onset and the symptomatology, cognitive function, and functioning at 12 years were examined in 330 patients with first-episode schizophrenia spectrum disorders. The relationships and pathways between the outcomes at 12 years and the trajectory, severity, and variability of early NS were examined. We found that the prediction of trajectory of early NS to long-term outcomes was limited, whereas variability was negatively associated with the patient's long-term executive function, and severity was positively associated with long-term symptomatology and negatively associated with long-term functioning. Path modelling revealed that the severity and variability of early NS influenced patients’ long-term functioning via cognitive function and/or clinical symptom pathways. Our findings support the notion that severity of early NS influences the prognosis of schizophrenia and the closer examination revealed that the severity and variability of early NS are differentially associated with long-term clinical symptoms, executive function, and functional outcomes via distinct pathways.

P539. First-Episode Predictors of Long-Term Outcome in Schizophrenia

In most cases, schizophrenia goes along with progressive cognitive and psychosocial deficits that lead to grave consequences in a majority of cases. Disease trajectories can vary considerably between affected individuals, which raises a need for early predictors of long-term outcome as a major step towards personalized treatment strategies.

Psychosocial interventions in schizophrenia: Focus on guidelines.

Schizophrenia is a lifelong condition with acute exacerbations and varying degrees of functional disability. Acute and long-term treatments are based on antipsychotic drugs, even if some domains of personal and social functioning are not addressed by psychopharmacotherapy. In fact, psychosocial interventions show a positive impact on patient's functioning and clinical outcome. In addition, psychosocial interventions are significantly associated with a lower number of relapses and hospitalizations in schizophrenia. An analytical review of the International Guidelines on Psychosocial Interventions in Schizophrenia has been performed; we included the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network (SIGN) guidelines, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines, the Schizophrenia Patient Outcomes Research Team (PORT) guidelines and the American Psychiatric Association (APA) guidelines. The international guidelines recommend psychosocial interventions as supportive treatments alongside pharmaceutical or psychotherapeutic ones. More research studies need to be conducted and included in the updated version of the international guidelines to confirm the effectiveness of psychosocial interventions in the long-term outcome of schizophrenia.

Subjective health-related quality of life in community-dwelling middle-aged and older adults with early-onset schizophrenia

Background: Long-term outcome in schizophrenia remains unsatisfactory due to continued premature deaths and insufficient health treatment. Subjective quality of life (SQoL) measurements hold important information and have meaningful implications regarding ways of improving general health status. This study investigated the physical and mental SQoL and associated clinical and sociodemographic outcomes among community-dwelling middle-aged and older people with early-onset schizophrenia.Materials and methods: A cross-sectional interview study where participants residing in the Region of Southern Denmark were identified through The Danish Psychiatric Central Register. Of a total of 278 eligible individuals, 59 people aged 55–82 years old participated. The SQoL measure Medical Outcomes Short Form 36 version 2 (SF36) was used. Scores were compared by age groups with normative data for the Danish population. Associated outcomes were measured using Positive And Negative Symptom Scale Remission and others.Results: Increased mental SQoL was associated with schizophrenia in remission (adjusted B 9.43, p = .001), increased Mental Health Recovery Measure score (adjusted B 0.55, p < .001) and increased GAF score (adjusted B 0.32, p < .001). Comparing with Danish Normative data, mental SQoL was reduced (p = .001) among 55–64-year olds, but presented levels similar to the general population at ages over 65 years. Physical quality of life was similar to the general population.Conclusion: Over 65-year olds with schizophrenia seemed to have SQoL similar to their age peers in the general population. Aiming treatment at achieving state of remission or recovery would be an amenable measure toward increasing mental SQoL among middle-aged people with schizophrenia.

M221. THE EFFECT OF LIFE SKILLS TRAINING ON FUNCTIONING IN SCHIZOPHRENIA: A RANDOMIZED CONTROLLED TRIAL

BackgroundThe combined use of pharmacological and non-pharmacological psychosocial interventions is seen as the most effective treatment approaches to improve the long term outcomes in schizophrenia. The psychosocial interventions aim to improve social skills, self-efficacy, being independent in activities of daily living and interpersonal communication in people diagnosed with schizophrenia. They include various approaches, such as cognitive behavioral therapy, cognitive remediation, individual, group or family therapies and life skills trainings. Life skills training approaches aim to assist individuals gain skills necessary for fulfilling their roles in the environment they live in, and consist of parts including assessment, teaching, behavioral practice, feedback, and homework, covering areas such as self-care, money management, communication and social skills, home management and community life. In this study, we planned to investigate the effects of individualized life skills training on the functionality of individuals diagnosed with schizophrenia.MethodsA total of 32 individuals diagnosed with schizophrenia were assigned randomly to the life skills training (n=15) and the control groups (n=17). The participants were assessed with the Positive and Negative Syndrome Scale (PANSS) for symptom severity, the Clinical Global Impression Scale for illness severity, improvement and response to treatment, the Katz Index of Independence in Activities of Daily Living and the Lawton – Brody Instrumental Activities of Daily Living Scale for adequacy of performance of basic activities and tasks of daily living, the Functioning Assessment Short Test and Social Functioning Scale for level of functionality before and after the scheduled interventions in both groups. The control group received a single-session awareness training to increase independence in daily living activities, and the life skills training group received individualized life skills training in 2 sessions per week for 8 weeks (i.e. 16 sessions).ResultsThe life skills training and control groups did not differ significantly on the bases of age, gender, working status, marital status, education (years), age at onset and duration of illness. The groups were similar in terms of pharmacological treatment choices. At the end of the research program, improvements were observed in the negative symptoms, general psychopathology, severity of illness and independence in basic and instrumental activities of daily living and functioning in the life skills training group as compared to the control group.DiscussionOur study showed that the training planned to improve life skills in individuals with chronic schizophrenia during the transition period from the hospital to the community environment, decreased negative symptoms and had a positive effect on general psychopathology and illness severity. Individual based life skills training, which focused less on social learning principles and aimed to increase independence in daily life, demonstrated positive effects on patient functionality. On the basis of the obtained results, it can be suggested that individualized life skills training may be an effective therapeutic method for the rehabilitation of individuals diagnosed with schizophrenia. The effect of individualized life skills training should be investigated and supported by long-term follow-up studies.

Efficacy and Tolerability of Dopamine D2 Receptor Partial Agonists Versus D2 Receptor Antagonists in Early Psychosis: A Systematic Review and Meta-Analysis

Early intervention is fundamental for better treatment response and long-term outcomes in schizophrenia. However, there is little guidance in the scientific literature on how best to choose between dopamine D2 receptor (D2R) partial agonists and D2R antagonists in treating early psychosis. In this meta-analysis, D2R partial agonists were directly compared with D2R antagonists for efficacy and tolerability in early psychosis.

Clinical and Neurobiological Predictors of Long-Term Outcome in Schizophrenia

Clinical and Neurobiological Predictors of Long-Term Outcome in Schizophrenia

Neurocognitive and Metacognitive Profiles of Intact Social Cognition in Prolonged Schizophrenia.

Social cognition (SC) appears to contribute to long-term outcomes in schizophrenia; however, little is known about whether different forms of SC are supported by the same cognitive processes. Accordingly, we examined the relationship of two domains of SC: emotion recognition (ER), using the Bell-Lysaker Emotion Recognition Test, and social inference (SI), using the Social Attribution Task-Multiple Choice, to measures of neurocognition, metacognition, theory of mind (ToM), and symptoms. Participants were 72 adults with schizophrenia in a nonacute phase. Multivariate analysis of variance and univariate analysis of variance revealed participants with intact ER had better neurocognition (MATRICS Consensus Cognitive Battery [MCCB]), metacognition (Metacognition Assessment Scale-Abbreviated), ToM (The Hinting Task), and higher emotional discomfort symptoms than participants with impaired scores. Participants with intact SI had higher MCCB visual and verbal learning and SC scores. Stepwise regressions revealed neurocognition and metacognition uniquely contribute to ER performance. Results suggest ER and SI are differentially related to cognitive processes.

Very long-term outcome of schizophrenia.

The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.

Association between family history of psychiatric disorders and long-term outcome in schizophrenia – The Northern Finland Birth Cohort 1966 study

Family history of psychiatric disorders has been associated with impaired outcome in schizophrenia, but very few studies have investigated its long-term social and occupational outcome. We investigated the association of family history of psychiatric disorders, especially psychosis, with long-term social, occupational, clinical and global outcome in schizophrenia. The study sample comprises of the Northern Finland Birth Cohort 1966. Cohort members with psychosis were detected by Finnish national registers. Altogether 69 individuals with schizophrenia spectrum diagnosis participated, mean age 43, after on average 17 years since onset of illness. The information regarding family history of psychiatric disorders were gathered from registers and interviews. A Strauss-Carpenter Outcome Scale, PANSS and SOFAS were conducted to assess the outcome. Results showed that the family history of any psychiatric disorder was associated with more severe positive and emotional symptoms in PANSS. The family history of psychosis was not associated with outcomes. These findings suggest that family history of psychiatric disorders has a small association with outcome in schizophrenia. Despite family history of psychosis being a strong risk factor for schizophrenia, after years of illness it does not seem to affect outcome.

Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study

The influence of marriage on the long-term outcomes of schizophrenia is largely unknown. This study was to examine the impact of marriage on the 14-year outcomes and identify the correlates of marriage among persons with schizophrenia in rural community. All study participants with schizophrenia (n=510) were identified in 1994 in an epidemiological investigation of 123,572 people aged 15years and older and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. The Patients Follow-up Schedule (PFS) was used in 2004 and 2008. The rate of follow-up in 2008 was 95.9%. Unmarried individuals in 1994 had higher rates of homelessness and suicide, and lower rate of survival in 2004 and 2008 than those married. In 14-year follow-up, unmarried individuals were more likely to be male, to have higher level of psychiatric symptoms and lower rate of full remission of illness, and to report lower level of work functioning, as well as with fewer family members and caregiver, and lower family economic status. The predictors of being married in 2008 included being married in 1994, shorter duration of illness, being female, and lower level of education. Being married is predictive of more favorable 14-year outcomes of persons with schizophrenia in the rural community. Given that marriage can be instrumental for enhancing family-based support and caregiving, as well as improving the community tenure of persons with schizophrenia, it is important to develop programs to enhance opportunity for persons with schizophrenia to get and stay married.

From neuroleptics to neuroscience and from Pavlov to psychotherapy: more than just the "emperor's new treatments" for mental illnesses?

“The drugs don't work” was one of the hit singles from The Verve's album Urban Hymns , released in 1997. The song was written by lead singer Richard Ashcroft relating to his drug abuse, but it might well relate to the modern treatments for mental illnesses. More than half a century after neuroleptics, antidepressants, benzodiazepines, antipsychotics, behavior therapy, and cognitive treatment were introduced, it is prudent to ask whether “the drugs don't work”. During the past 50 years, the industrialized world has seen a dichotomy between loudly proclaimed therapeutic breakthroughs and rapidly rising numbers of people on disability payments because of mental illness. We hear that antipsychotic, antidepressant, and anti‐anxiety drugs as well as behavior therapy and newer treatments have radically improved what was described as a dismal fate of people suffering from mental disorders. Simultaneously, the percentage of disabled mentally ill patients in the USA has risen by more than 600% since the 1950s (Whitaker, 2010) and similar rates are seen in European countries. Most epidemiologists agree that this “epidemic” is not caused by increased incidence. Moreover, the once rapid succession of new therapeutic developments seems to have halted, at least in pharmacology, as big companies are withdrawing from research on mental disorders. How can this apparent contradiction be explained? Could it be that therapeutic progress is much less than we think or are being told? Could it be that the course of depression, anxiety, schizophrenia, or ADHD has been altered for the worse? Could it be that we cannot make therapeutic progress because the concept of mental illness and its treatment is deeply flawed? There are strong reasons to assume that all three suspicions are in fact true. So, what do we know about the efficiency of pharmacological and psychological treatments? In regard to short‐term outcomes, pharmacotherapy is clearly …

Cognitive Effects of High-Frequency rTMS in Schizophrenia Patients With Predominant Negative Symptoms: Results From a Multicenter Randomized Sham-Controlled Trial.

Cognitive impairments are one of the main contributors to disability and poor long-term outcome in schizophrenia. Proof-of-concept trials indicate that repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (DLPFC) has the potential to improve cognitive functioning. We analyzed the effects of 10-Hz rTMS to the left DLPFC on cognitive deficits in schizophrenia in a large-scale and multicenter, sham-controlled study. A total of 156 schizophrenia patients with predominant negative symptoms were randomly assigned to a 3-week intervention (10-Hz rTMS, 15 sessions, 1000 stimuli per session) with either active or sham rTMS. The Rey Auditory Verbal Learning Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Digit Span Test, and the Regensburg Word Fluency Test were administered before intervention and at day 21, 45, and 105 follow-up. From the test results, a neuropsychological composite score was computed. Both groups showed no differences in any of the outcome variables before and after intervention. Both groups improved markedly over time, but effect sizes indicate a numeric, but nonsignificant superiority of active rTMS in certain cognitive tests. Active 10-Hz rTMS applied to the left DLPFC for 3 weeks was not superior to sham rTMS in the improvement of various cognitive domains in schizophrenia patients with predominant negative symptoms. This is in contrast to previous preliminary proof-of-concept trials, but highlights the need for more multicenter randomized controlled trials in the field of noninvasive brain stimulation.

Psychiatrist's adherence: a new factor in relapse prevention of schizophrenia. A randomized controlled study on relapse control through telemedicine system.

Exposure to psychotic states has detrimental effects on the long-term outcome of schizophrenia and brain integrity. Therefore, improving relapse prevention is a key component of long-term management of schizophrenia. Previous studies using continuous monitoring of an individual's early signs of relapse and adopting preventative pharmacological interventions, when early signs are detected, showed promising clinical results in terms of relapse risk reduction. This 18-month multi-centre parallel randomized controlled, open label, trial with telemedicine relapse prevention programme ITAREPS failed to show superiority of maintenance plus prodrome-based targeted medication strategy over treatment as usual. The study, marked by low investigator's adherence, confirmed that absence of pharmacological intervention at early stage of prodrome, critically influenced the risk of relapse. This and previous randomized controlled trials with telemedicine programme ITAREPS suggested that substantial improvement in relapse prevention in schizophrenia is likely to be unattainable under current clinical settings. Future preventive strategies in schizophrenia would require rapid pharmacological intervention upon occurrence of subclinical prodromal symptoms that are undetectable under conventional outpatient practice. Studies with ITAREPS suggested that integration of telemedicine relapse prevention systems and visiting nurse service might together represent practical solution capable to address those requirements. The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) presents a telemedicine solution for weekly monitoring and management of schizophrenia. This study aims to evaluate the effectiveness of the programme in reducing the number of hospitalizations during the 18-month multi-centre parallel randomized controlled, open label, trial. Outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n = 74) or control group (n = 72). In the active arm, investigators increased the antipsychotic dose upon occurrence of prodrome announced by the system. Intention-to-treat analysis showed no between-group difference in the hospitalization-free survival rate [Kaplan-Meier method; hazard ratio (HR) = 1.21, 95% confidence interval (CI): 0.56-2.61, P = 0.6). In a post hoc multivariate Cox proportional hazards model, out of 13 potential predictors, only ITAREPS-related variables (number of alerts without pharmacological intervention/HR = 1.38, P = 0.042/ and patient non-adherence with ITAREPS /HR = 1.08, P = 0.009/) increased the risk of hospitalization. In this trial ITAREPS was not effective. The results in context with previous ITAREPS studies suggest non-adherence of both psychiatrists and patients as the main reasons for the failure of this preventive strategy. Tertiary prevention in schizophrenia have to be regarded a major challenge, warranting the need for implementation of strategies with more active participation of both patient and treating psychiatrist.

Association of Family History of Psychosis with Long-term Outcome in Schizophrenia – the Northern Finland Birth Cohort 1966 Study

Introduction We have previously investigated the association between family history of psychosis and long-term outcome in schizophrenia in a systematic review and found no studies that focused on social outcome. Objectives To study effect of family history on long-term occupational, social, clinical and global outcome in schizophrenia. Aims : In this study we aimed to investigate how family history affects long-term occupational, social, clinical and global outcome in schizophrenia in a population-based cohort study. Methods Sixty nine persons with schizophrenia spectrum diagnosis from the Northern Finland Birth Cohort 1966 were examined at around 43 years of age, in average 17 years since onset of psychosis. A Strauss-Carpenter Outcome Scale –interview was conducted to gather information regarding occupational, social, clinical and global outcome. The family history of psychosis was examined based on register data and interviews. Results Seventeen (24.6%) of the schizophrenia cases had family history of psychosis. The presence of family history of psychosis did not associate statistically significantly to occupational (FH+ vs FH-: mean 24.9 vs. 28.4; p = 0.470), social (34.5 vs. 33.2; p = 0.811), clinical (29.9 vs. 33.4; p = 0.510) or global outcome (22.2 vs. 22.7; p = 0.827). Conclusions This was the first original study on effects of family history of psychosis on long-term social outcome in schizophrenia. We did not find statistically significant association between family history of psychosis and long-term outcome in schizophrenia. Since the number of subjects with family history of psychosis was quite low, a study with larger sample size is desirable.

Long-term Outcome in Schizophrenia: a Six-year Follow-up in over 1000 Patients

Background Patients with schizophrenia have lower IQ as compared to the general population. Furthermore, cognitive decline has been observed even before the onset of the first episode psychosis. Whether premorbid functioning and IQ also predict long-term remission status is not yet known. Methods 1057 patients with schizophrenia and related disorders were included in GROUP project. Premorbid Adjustment Scale (PAS), IQ and Positive and Negative Symptom Scale (PANSS) were obtained at inclusion. After 6 years 691 patients were re-examined. On 530 patients we were able to determine remission status using the PANSS remission tool. Patients were divided into two groups; those who were in remission (Rem) and those who were not (NR). Groups were compared on PAS and IQ using independent sample t-tests groups. Results Analyses revealed that patients who dropped out during the follow-up of 6 years had lower IQ, and higher PANSS scores as compared to those who were remained in the study. After 6 years 58% of patients were in remission. Remission status after 6 years was associated with IQ and premorbid adjustment in childhood and adolescence at inclusion. Conclusion Poorer premorbid adjustment and lower IQ at baseline are associated with non-remission after 6 years. This suggests that in order to improve the course and outcome of schizophrenia, one should aim to detect and intervene well before the first psychotic symptoms arise.

Duration of Untreated Psychosis and the Use of Antipsychotic Medication During the Course of Illness in the Northern Finland 1966 Birth Cohort

Introduction Long duration of untreated psychosis (DUP) predicts poor short- and long-term outcome in schizophrenia. It may also be a marker of resilience and associate with lower doses or shorter periods of using antipsychotic medication which may or may not be correlated with the association between DUP and outcome. Objectives To study the association between DUP and the use of antipsychotic medication in long-term follow-up. Aims To find out whether the delayed treatment in first-episode psychosis associates with using less antipsychotic medication during the course of illness Methods In the prospective Northern Finland 1966 Birth Cohort length of DUP and information on lifetime use of antipsychotic medication for 60 individuals with schizophrenia was assessed from medical records from the first episode until age 34 years. Association between length of DUP and cumulative dose-years of antipsychotics was analysed using linear regression analysis. Logarithmic transformations of DUP and dose years were used. Results Mean DUP was 227 days (SD 359) and mean of cumulative dose years was 2.41 (SD 1.29). Symptoms measured using PANSS ranged from 30 to 122, mean 53 (SD 21). Duration of untreated psychosis did not associate with the use of antipsychotic medication (beta = −0.124, p = 0.343). Conclusions There was no evidence of an association between DUP and the use of antipsychotic medication. Although long DUP has long-term association with poor outcome, it does not have an association with the use of antipsychotic medication based on the population-based long-term follow-up.

The Role of Substance Abuse in Prediction of Long-term Outcome of Schizophrenia – Systematic Review and Meta-analysis

Background Alcohol and other substance use problems are common among individuals with schizophrenia. Objectives Many of the previous studies have focused on clinical comorbidity, not on longitudinal design. Aims The aim of this study was to investigate if premorbid or early substance use predicts long-term clinical and social course in schizophrenia. Methods A systematic review to identify potentially relevant studies was conducted. Studies with a follow-up period of at least two years were included. Following outcomes were studied: negative, positive and total symptoms, clinical remission, hospitalizations, social functioning, employment, and global outcome. Spearman's correlations were used to summarize results, negative correlations indicating poorer outcome with substance use. Results The search identified 10776 unique potentially relevant articles of which 25 studies met our inclusion criteria. The meta-analysis included 5 to 13 studies in each outcome category. Moderate to high heterogeneity was found between studies in each outcome group. In meta-analysis, substance use associated modestly with outcome. All the associations were non-significant and correlations between −0.06 and 0.09. Non-significant findings are explained by the fact that the original studies found often opposite results, indicating both worse and better long-term outcome for early substance users. Conclusions Although comorbid substance use associates with poorer outcome in schizophrenia, the early substance use has only a modest effect on long-term outcome. This difference to studies on current comorbidity may indicate that those who continue substance abuse have poor outcome, e.g. due to poor treatment adherence, whereas those who stop the abuse may have relatively good outcome.

S.02.03 Long-term outcome in schizophrenia: a six-year follow-up in over 1000 patients

For a considerable part of the political opposition in Russia, elections have been something to be watched from the sidelines. While opposition candidates are formally blocked for legal-administrative reasons, they have repeatedly claimed that registration refusals are politically motivated and that election committees apply the law differently depending on the candidates' political affiliation. By analyzing the perceptions of double standards as well as actual enforcement practice and structural incentives, this article identifies the core mechanics of this quasi-legal mechanism of political pre-election filtering in Russian elections.

Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis.

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. To analyse the associations between DUP and long-term outcomes of schizophrenia. 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. 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. 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.