The British Journal of Psychiatry (2009) 194: 18-24. doi: 10.1192/bjp.bp.107.048942
© 2009 The Royal College of Psychiatrists
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Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis

Niall Crumlish, MRCPsych

Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, and Department of Psychiatry, Trinity College, Dublin

Peter Whitty, MD, MRCPsych, Mary Clarke, MD, MRCPI, MRCPsych, Stephen Browne, MD, MRCPsych, Moayyad Kamali, MRCPsych and Maurice Gervin, MRCPsych

Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service and Department of Psychiatry, University College, Dublin

Orfhlaith McTigue, MRCPsych

Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin

Anthony Kinsella, FIS

DELTA/DETECT Early Intervention in Psychosis Services, Dun Laoghaire, Co. Dublin

John L Waddington, DSc

Stanley Research Unit, Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin

Conall Larkin, FRCPI, FRCPsych and Eadbhard O’Callaghan, MD, DSc, FRCPI, FRCPsych

Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Department of Psychiatry, University College, Dublin, and DELTA/DETECT Early Intervention in Psychosis Services, Blackrock, Co. Dublin, Ireland

Correspondence: Eadbhard O’Callaghan, DELTA/DETECT Early Intervention in Psychosis Services, Block 5, Blackrock Business Park, Carysfort Avenue, Blackrock, Co. Dublin, Ireland. Email: eadbhard{at}gmail.com.

Declaration of interest

None. Funded by the Stanley Medical Research Institute.

Background

The critical period hypothesis proposes that deterioration occurs aggressively during the early years of psychosis, with relative stability subsequently. Thus, interventions that shorten the duration of untreated psychosis (DUP) and arrest early deterioration may have long-term benefits.

Aims

To test the critical period hypothesis by determining whether outcome in non-affective psychosis stabilises beyond the critical period and whether DUP correlates with 8-year outcome; to determine whether duration of untreated illness (DUI) has any independent effect on outcome.

Method

We recruited 118 people consecutively referred with first-episode psychosis to a prospective, naturalistic cohort study.

Results

Negative and disorganised symptoms improved between 4 and 8 years. Duration of untreated psychosis predicted remission, positive symptoms and social functioning at 8 years. Continuing functional recovery between 4 and 8 years was predicted by DUI.

Conclusions

These results provide qualified support for the critical period hypothesis. The critical period could be extended to include the prodrome as well as early psychosis.


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