These issues can only be tackled by large-scale collaborations across research consortia. Duration of Untreated Psychosis (DUP), defined as the time between the onset of psychotic symptoms continuous with the presenting episode and the onset of continuous antipsychotic medication (30 days or less if symptoms remitted) (Norman and Malla, 2001), has become established as an important measure associated with psychosis outcome. People with a first episode of psychosis experience distressing symptoms such as unusual beliefs or abnormal behaviour (positive symptoms) and/or withdrawal or loss of interest in work or school (negative symptoms). Furthermore, the negative findings were robust and not due to publication biases or to the presence of outliers. We did not restrict inclusion to any specific study design. A Stitch in Time:Psychosis… Get Help Early. At a first step, the Web of Science database by Thomson Reuters (including Web of Science, BIOSIS Citation Index and MEDLINE) and the Ovid database by Wolters Kluwer (including MEDLINE and PsycINFO) were searched. The study investigating the effect of CHR-P services20 is unique as it adopts a prospective, longitudinal design. The less time that passes between the onset of psychosis and initiation of appropriate treatment, the greater the patient’s odds of recovery. We extracted meta-analytical DUP data (see “Statistical Analysis” section) and DUP definitions (at onset and endpoint). A third benefit of CHR-P services may extend to those already identified as FEP at the time of the initial CHR-P assessment. (9)From: Penttilä M et al. 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. The flow of articles through the initial literature search, including numbers of articles screened, assessed for eligibility and included in the review, is summarized in the PRISMA plot (figure 1). O’Donoghue B, Schäfer MR, Becker J, Papageorgiou K, Amminger GP. Multiple meta-analyses clearly establish that the duration of untreated psychosis (DUP)—the time between the onset of psychosis and initiation of treatment to address the psychotic symptoms—is correlated with poor outcomes. What is the evidence for DUP and outcomes? Although several controlled interventional studies have been conducted with the aim of reducing DUP, the results are highly inconsistent and conflicting. 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. Oxford University Press is a department of the University of Oxford. The duration of untreated psychosis, or DUP, is measured as the time from the beginning of psychotic symptoms to the time a person starts treatment for those symptoms or a diagnosed condition. Within subgroup analyses indicated that the lack of DUP reduction was specific to standalone FEP services, community, healthcare professionals training or multifocus interventions. Meta-regressions were conducted on (1) complete set of studies for length of intervention, publication year, study design and control DUP, (2) n = 15 for quality of studies, definition of DUP onset and endpoint, (3) n = 14 for mean age gender, and (4) n = 10 for marital status. Meta-regression analyses. The period of time from onset of psychosis to onset of treatment is referred to as the Duration of Untreated Psychosis, or DUP. Subgroup analyses showed no differences within each subgroup, with the exception of clinical high risk services (Hedges’ g = −0.386, 95% CI = −0.726 to −0.045). When only including studies published in peer-reviewed journals, there were no significant changes (Hedges’ g = −0.07, 95% CI = −0.20 to 0.05). Sensitivity analysis did not suggest sensitivity of the meta-analytic estimate to the removal of any one study (supplementary eFigure 12), confirming the robustness of the findings. Seventy-five percent of community intervention studies combined direct contact with audiovisual promotional materials. Heterogeneity among study point estimates was assessed using Q statistics35 and the proportion of the total variability in the effect size estimates evaluated with the I2 index.35 Given the methodological heterogeneity of the included studies, random effects models36 were employed using the method of DerSimonian and Laird.37, Risk of publication bias was tested by visual inspection of funnel plots in addition to the application of the Egger regression intercept method38 and the Duval and Tweedie “trim and fill” method.39 To further assess the robustness of the results, we performed sensitivity analyses by sequentially removing each study and re-running the analysis.40, To explain any heterogeneity found, meta-regression analyses were conducted when at least 10 studies were available for the specific confounders relating to patients: mean age, gender, ethnicity (% white), marital status (proportion of married subjects), cannabis abuse/dependence (% meeting abuse/dependence criteria), alcohol abuse/dependence (% meeting abuse/dependence criteria), living status (% living independently), migrant status (% non-migrants), psychotic symptom severity at baseline (PANSS), diagnosis (% schizophrenia); relating to the study: length of intervention (months), quality of studies (see below), publication year, continent, healthcare system type (Semashko, Bismarck, market-based), study design (randomized cluster, cohort analytic, cohort), control DUP, definition of DUP onset, definition of DUP endpoint. 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