Investigation of possible mechanisms by which longer duration of untreated psychosis (DUP) could influence treatment outcomes has focused primarily on evidence for neurotoxic effects. It is also possible that longer DUP has psychosocial effects, which could mediate its impact on outcomes. The evidence of relevance to such socially toxic effects is reviewed, with particular reference to the possible role of social support. There is no definite evidence for social support as a mediator of the influence of DUP, but further investigation of this issue is warranted.
JacksonHJMcGorryPD. The recognition and management of early psychosis: A preventive approach. Cambridge (GB): Cambridge University Press; 2009.
2.
McGorryPDEdwardsJMihalopoulosC, EPPIC: An evolving system of early detection and optimal management. Schizophr Bull. 1996;22(2):305–326.
3.
MarshallMLewisSLockwoodA, Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: A systematic review. Arch Gen Psychiatry. 2005;62(9):975–983.
4.
PerkinsDOGuHBotevaK, Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: A critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–1804.
5.
WyattRJ. Neuroleptics and the natural course of schizophrenia. Schizophr Bull. 1991;17(2):325–351.
6.
WyattRJApudJAPotkinS.New directions in the prevention and treatment of schizophrenia: A biological perspective. Psychiatry. 1996;59(4):357–370.
7.
GoldbergTEBurdickKEMcCormackJ, Lack of an inverse relationship between duration of untreated psychosis and cognitive function in first episode schizophrenia. Schizophr Res. 2009;107(2–3):262–266.
8.
LappinJMMorganKDMorganC, Duration of untreated psychosis and neuropsychological function in first episode psychosis. Schizophr Res. 2007;95(1–3):103–110.
9.
MallaAKBodnarMJooberR, Duration of untreated psychosis is associated with orbital-frontal grey matter volume reductions in first episode psychosis. Schizophr Res. 2011;125(1):13–20.
10.
NormanRMMallaAK. Duration of untreated psychosis: A critical examination of the concept and its importance. Psychol Med. 2001;31(3):381–400.
11.
McGlashanTH. Is active psychosis neurotoxic?Schizophr Bull. 2006;32(4):609–613.
12.
RundBR. Does active psychosis cause neurobiological pathology? A critical review of the neurotoxicity hypothesis. Psychol Med. 2014;44:1577–1590.
13.
BaronRMKennyDA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–1182.
14.
HouseJSKahnRL. Measures and concepts of social support. In: CohenSSymeSL, editors. Social support and health. San Diego (CA): Academic Press; 1985. p 83–108.
15.
ThoitsPA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52:145–161.
16.
LloydCKingRMooreL.Subjective and objective indicators of recovery in severe mental illness: A cross-sectional study. Int J Soc Psychiatry. 2010;56(3):220–229.
17.
NormanRMWindellDLynchJ, Correlates of subjective recovery in an early intervention program for psychoses. Early Interv Psychiatry. 2013;7(3):278–284.
18.
RoeDMashiach-EizenbergMLysakerPH. The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophr Res. 2011;131(1–3):133–138.
19.
Alvarez-JimenezMGleesonJFHenryLP, Prediction of a single psychotic episode: A 7.5-year, prospective study in first-episode psychosis. Schizophr Res. 2011;125(2–3):236–246.
20.
EisenstadtPMonteiroVBDinizMJ, Experience of recovery from a first-episode psychosis. Early Interv Psychiatry. 2012;6(4):476–480.
21.
WindellDNormanRM. A qualitative analysis of influences on recovery following a first episode of psychosis. Int J Soc Psychiatry. 2013;59(5):493–500.
22.
NormanRMMallaAKManchandaR, Social support and three-year symptom and admission outcomes for first episode psychosis. Schizophr Res. 2005;80(2–3):227–234.
23.
TempierRBalbuenaLLepnurmM, Perceived emotional support in remission: Results from an 18-month follow-up of patients with early episode psychosis. Soc Psychiatry Psychiatr Epidemiol. 2013;48(12):1897–1904.
24.
DavisLKurzbanSBrekkeJ.Self-esteem as a mediator of the relationship between role functioning and symptoms for individuals with severe mental illness: A prospective analysis of Modified Labeling theory. Schizophr Res. 2012;137(1–3):185–189.
25.
EricksonDHBeiserMIaconoWG, The role of social relationships in the course of first-episode schizophrenia and affective psychosis. Am J Psychiatry. 1989;146(11):1456–1461.
26.
EricksonDHBeiserMIaconoWG. Social support predicts 5-year outcome in first-episode schizophrenia. J Abnorm Psychol. 1998;107(4):681–685.
27.
NormanRMMallaAKManchandaR, Does treatment delay predict occupational functioning in first-episode psychosis?Schizophr Res. 2007;91(1–3):259–262.
28.
NormanRMWindellDManchandaR, Social support and functional outcomes in an early intervention program. Schizophr Res. 2012;140(1–3):37–40.
29.
RitsnerMSArbitmanMLiskerA, Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorder II. Predictive value of psychosocial factors. Qual Life Res. 2012;21(6):1075–1084.
30.
TempierRBalbuenaLGaretyP, Does assertive community outreach improve social support? Results from the Lambeth Study of early-episode psychosis. Psychiatr Serv. 2012;63(3):216–222.
31.
AddingtonJVan MastrigtSHutchinsonJ, Pathways to care: Help seeking behaviour in first episode psychosis. Acta Psychiatr Scand. 2002;106(5):358–364.
32.
AgarkarS.A case of prolonged duration of untreated psychosis: Barriers to treatment and strategies to improve the outcome. Clin Schizophr Relat Psychoses. 2012;6(1):45–48.
33.
de HaanLPetersBDingemansP, Attitudes of patients toward the first psychotic episode and the start of treatment. Schizophr Bull. 2002;28(3):431–442.
34.
JohnstoneECCrowTJJohnsonAL, The Northwick Park Study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission. Br J Psychiatry. 1986;148:115–120.
35.
LincolnCHarriganSMcGorryPD. Understanding the topography of the early psychosis pathways. An opportunity to reduce delays in treatment. Br J Psychiatry Suppl. 1998;172(33):21–25.
36.
NormanRMallaA.Pathways to care and reducing treatment delay in early psychosis. In: JacksonHJMcGorryPD, editors. The recognition and management of early psychosis: A preventive approach. Cambridge (GB): Cambridge University Press; 2009. p 161–174.
37.
LihongQShimoderaSFujitaH, Duration of untreated psychosis in a rural/suburban region of Japan. Early Interv Psychiatry. 2012;6(3):239–246.
38.
O'CallaghanETurnerNRenwickL, First episode psychosis and the trail to secondary care: Help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol. 2010;45(3):381–391.
39.
FawziMHFawziMMFouadAA. Parent abuse by adolescents with first-episode psychosis in Egypt. J Adolesc Health. 2013;53(6):730–735.
40.
MacdonaldESauerKHowieL, What happens to social relationships in early psychosis? A phenomenological study of young people's experiences. J Ment Health. 2005;14(2):129–143.
41.
TanskanenSMorantNHintonM, Service user and carer experiences of seeking help for a first episode of psychosis: A UK qualitative study. BMC Psychiatry. 2011;11:157.
42.
DrakeRJHaleyCJAkhtarS, Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry. 2000;177:511–518.
43.
KallaOAaltonenJWahlstromJ, Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain. Acta Psychiatr Scand. 2002;106(4):265–275.
44.
LarsenTKJohannessenJOOpjordsmoenS.First-episode schizophrenia with long duration of untreated psychosis. Pathways to care. Br J Psychiatry Suppl. 1998;172(33):45–52.
45.
ThorupAPetersenLJeppesenP, Social network among young adults with first-episode schizophrenia spectrum disorders: Results from the Danish OPUS trial. Soc Psychiatry Psychiatr Epidemiol. 2006;41(10):761–770.
46.
DevylderJEGearingRE. Declining social support in adolescents prior to first episode psychosis: Associations with negative and affective symptoms. Psychiatry Res. 2013;210(1):50–54.
47.
OliveiraAMMenezesPRBusattoGF, Family context and duration of untreated psychosis (DUP): Results from the Sao Paulo Study. Schizophr Res. 2010;119(1–3):124–130.
48.
PeraltaVCuestaMJMartinez-LarreaA, Duration of untreated psychotic illness: The role of premorbid social support networks. Soc Psychiatry Psychiatr Epidemiol. 2005;40(5):345–349.
49.
Ruiz-VeguillaMBarrigonMLDiazFJ, The duration of untreated psychosis is associated with social support and temperament. Psychiatry Res. 2012;200(2–3):687–692.
50.
ThomasSPNandhraHS. Early intervention in psychosis: A retrospective analysis of clinical and social factors influencing duration of untreated psychosis. Prim Care Companion J Clin Psychiatry. 2009;11(5):212–214.
51.
BarnesTRHuttonSBChapmanMJ, West London first-episode study of schizophrenia. Clinical correlates of duration of untreated psychosis. Br J Psychiatry. 2000;177:207–211.
BeckerMDiamondRSainfortF.A new patient focused index for measuring quality of life in persons with severe and persistent mental illness. Qual Life Res. 1993;2(4):239–251.
54.
BerkmanLFGlassT.Social integration, social networks, social support and health. In: BerkmanLFKawachiI, editors. Social epidemiology. New York (NY): Oxford University Press; 2000. p 137–173.
55.
HobfollSE. Social support: The movie. J Soc Pers Relat. 2009;26(1):93–101.
56.
VangelistiAL. Challenges in conceptualizing social support. J Soc Pers Relat. 2009;26(1):39–51.
57.
CohenSMemelsteinRKamarckT, Measuring the functional components of social support. In: SarasonIGSarasonBR, editors. Social support: Theory, research and applications. Dordrecht (NL): Martinus Nijhoff; 1985. p 73–94.
58.
BebbingtonPKuipersL.The predictive utility of expressed emotion in schizophrenia: An aggregate analysis. Psychol Med. 1994;24(3):707–718.
59.
SarasonIGSarasonBR. Social support: Mapping the construct. J Soc Pers Relat. 2009;26(1):113–120.
60.
HaberMGCohenJLLucasT, The relationship between self-reported received and perceived social support: A meta-analytic review. Am J Community Psychol. 2007;39(1–2):133–144.
61.
UchinoBN. Understanding the links between social support and physical health: A life span perspective with emphasis on the separability of perceived and received support. Perspect Psychol Sci. 2009;4:236–255.
62.
BolgerNAmarelD.Effects of social support visibility on adjustment to stress: Experimental evidence. J Pers Soc Psychol. 2007;92(3):458–475.
63.
Dunkel-SchetterCBennettTL. Differentiating the cognitive and behavioral aspects of social support. In: SarasonBRSarasonIGPierceGR, editors. Social support: An interactional view. New York (NY): John Wiley & Sons; 1990. p 267–296.
64.
GreenbergJSKnudsenKJAschbrennerKA. Prosocial family processes and the quality of life of persons with schizophrenia. Psychiatr Serv. 2006;57(12):1771–1777.
65.
IvanovicMVuleticZBebbingtonP.Expressed emotion in the families of patients with schizophrenia and its influence on the course of illness. Soc Psychiatry Psychiatr Epidemiol. 1994;29(2):61–65.
66.
LeeGBarrowcloughCLobbanF.Positive affect in the family environment protects against relapse in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol. 2014;49(3):367–376.
67.
Alvarez-JimenezMGleesonJFCottonSM, Differential predictors of critical comments and emotional over-involvement in first-episode psychosis. Psychol Med. 2010;40(1):63–72.
68.
MeneghelliAAlpiAPafumiN, Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: Results from the Programma2000 (Milan, Italy). Psychiatry Res. 2011;189(3):331–338.
69.
PattersonPBirchwoodMCochraneR.Expressed emotion as an adaptation to loss: Prospective study in first-episode psychosis. Br J Psychiatry Suppl. 2005;48:s59–s64.
70.
BentallRPKindermanPKaneyS.The self, attributional processes and abnormal beliefs: Towards a model of persecutory delusions. Behav Res Ther. 1994;32(3):331–341.
71.
GaretyPAKuipersEFowlerD, A cognitive model of the positive symptoms of psychosis. Psychol Med. 2001;31(2):189–195.
72.
KrabbendamLvan OsJ.Affective processes in the onset and persistence of psychosis. Eur Arch Psychiatry Clin Neurosci. 2005;255(3):185–189.
73.
VracotasNIyerSNJooberR, The role of self-esteem for outcome in first-episode psychosis. Int J Soc Psychiatry. 2012;58(1):41–46.
74.
WarmanDMLysakerPHLuedtkeB, Self-esteem and delusion proneness. J Nerv Ment Dis. 2010;198(6):455–457.
75.
LearyMR. Affiliation, acceptance and belonging: The pursuit of interpersonal connection. In: FiskeSTGilbertDTLindzeyG, editors. Handbook of social psychology, vol 2. Hoboken (NJ): Wiley; 2010. p 844–897.
76.
LearyMRDownsDL. Interpersonal functions of the self-esteem motive: The self-esteem system as a sociometer. In: KernisMH, editor. Efficacy, agency, and self-esteem. New York (NY): Plenum Press; 1995. p 123–144.
77.
NormanRMWindellDLynchJ, Perceived relational evaluation as a predictor of self-esteem and mood in people with a psychotic disorder. Can J Psychiatry. 2012;57(5):309–316.
78.
CacioppoJTBerntsonGGSheridanJF, Multilevel integrative analyses of human behavior: Social neuroscience and the complementing nature of social and biological approaches. Psychol Bull. 2000;126(6):829–843.
79.
ParadisoSRudraufD.Struggle for life, struggle for love and recognition: The neglected self in social cognitive neuroscience. Dialogues Clin Neurosci. 2012;14(1):65–75.
