The impact of manic symptoms in first-episode psychosis: findings from the UK National EDEN study

Steven Marwaha, Danielle Hett, Sonia Johnson, David Fowler, Joanne Hodgekins, Nick Freemantle, Paul McCrone, Linda Everard, Peter Jones, Tim Amos, Swaran Singh, Vimal Sharma, Max Birchwood

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Objective: The extant literature is inconsistent over whether manic symptoms in first-episode psychosis (FEP) impact on its development and trajectory. This study addressed the following: (1) Does Duration of Untreated Illness (DUI) and Duration of Untreated Psychosis (DUP) differ between FEP patients with and without manic symptoms? (2) Do manic symptoms in FEP have an impact on time to remission over 1 year?. Methods: We used data from the National EDEN study, a longitudinal cohort of patients with FEP accessing early intervention services (EIS) in England, which measured manic, positive and negative psychotic symptoms, depression and functioning at service entry and 1 year. Data from 913 patients with FEP (639 without manic symptoms, 237 with manic symptoms) were analysed using both general linear modelling and survival analysis. Results: Compared to FEP patients without manic symptoms, those with manic symptoms had a significantly longer DUI, though no difference in DUP. At baseline, people with manic symptoms had higher levels of positive and negative psychotic symptoms, depression and worse functioning. At 12 months, people with manic symptoms had significantly poorer functioning and more positive psychotic symptoms. The presence of manic symptoms delayed time to remission over 1 year. There was a 19% reduced rate of remission for people with manic symptoms compared to those without. Conclusions: Manic symptoms in FEP are associated with delays to treatment. This poorer trajectory persists over 1 year. They appear to be a vulnerable and under-recognised group for poor outcome and need more focussed early intervention treatment.

Original languageEnglish
Pages (from-to)358-367
Number of pages10
JournalActa Psychiatrica Scandinavica
Issue number4
Early online date16 Apr 2021
Publication statusPublished - Oct 2021


  • affective psychosis
  • duration of untreated illness
  • duration of untreated psychosis
  • early intervention services
  • first-episode psychosis
  • mania

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