Evidence map›Paper›PMID 32046533›Full record

ArticleThe American journal of psychiatry2020

Lead-Time Bias Confounds Association Between Duration of Untreated Psychosis and Illness Course in Schizophrenia.

Katherine G Jonas, Laura J Fochtmann, Greg Perlman, Yuan Tian, John M Kane, Evelyn J Bromet, Roman Kotov

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of psychiatry, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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  5. Proportion and predictors of remission and recovery in first-episode psychosis: Systematic review and meta-analysis.European psychiatry : the journal of the Association of European Psychiatrists · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Katherine G JonasDepartment of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).
Laura J FochtmannDepartment of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).
Greg PerlmanDepartment of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).
Yuan TianDepartment of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).
John M KaneDepartment of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).
Evelyn J BrometDepartment of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).
Roman KotovDepartment of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).

Funding

THE EPIDEMIOLOGY OF NEWLY DIAGNOSED PSYCHOTIC DISORDERSR01MH044801 · NIMH · STATE UNIVERSITY NEW YORK STONY BROOK · PI BROMET, EVELYN J · 1989 to 2007
$5.0M
Trajectories of Aging in Psychotic Disorders Over 27 YearsR01MH110434 · NIMH · STATE UNIVERSITY NEW YORK STONY BROOK · PI KOTOV, ROMAN I · 2016 to 2020
$4.5M
Trajectories of recovery from psychosis over two decadesR01MH094398 · NIMH · STATE UNIVERSITY NEW YORK STONY BROOK · PI KOTOV, ROMAN I · 2011 to 2013
$2.2M
NIMH NIH HHS R01 MH044801NIMH NIH HHS R01 MH094398NIMH NIH HHS R01 MH110434
6 · The paper itself

Abstract

objectiveAt first hospitalization, a long duration of untreated psychosis (DUP) predicts illness severity and worse treatment outcomes. The mechanism of this association, however, remains unclear. It has been hypothesized that lengthy untreated psychosis is toxic or that it reflects a more severe form of schizophrenia. Alternatively, the association may be an artifact of lead-time bias. These hypotheses are tested in a longitudinal study of schizophrenia with 2,137 observations spanning from childhood to 20 years after first admission.

methodsData were from the Suffolk County Mental Health Project. The cohort included 287 individuals with schizophrenia or schizoaffective disorder. DUP was defined as days from first psychotic symptom to first psychiatric hospitalization. Psychosocial function was assessed using the Premorbid Adjustment Scale and the Global Assessment of Functioning Scale. Psychosocial function trajectories were estimated using multilevel spline regression models adjusted for gender, occupational status, race, and antipsychotic medication.

resultsBoth long- and short-DUP patients experienced similar declines in psychosocial function, but declines occurred at different times relative to first admission. Long-DUP patients experienced most of these declines prior to first admission, while short-DUP patients experienced declines after first admission. When psychosocial function was analyzed relative to psychosis onset, DUP did not predict illness course.

conclusionsThe association between DUP and psychosocial function may be an artifact of early detection, creating the illusion that early intervention is associated with improved outcomes. In other words, DUP may be better understood as an indicator of illness stage than a predictor of course.

Indexed as

BiasSchizophrenic PsychologyAdolescentAdultAntipsychotic AgentsFemaleHospitalizationHumansLongitudinal StudiesMaleMiddle AgedPrognosisPsychotic DisordersSchizophreniaSeverity of Illness IndexTime FactorsAntipsychotic AgentsEpidemiologySchizophrenia Spectrum and Other Psychotic Disorders

Identifiers

PMID32046533
PMCPMC10754034

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.