Predictors of functional recovery in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies

Background. Three out of four first-episode psychosis (FEP) patients achieve clinical remission following treatment. Unfortunately, functional recovery lags behind symptomatic remission, and many individuals with FEP remain socially isolated with poor functional outcomes. Aims: To systematically compile and analyse predictors of functional recovery in FEP. Method: Systematic review and meta-analysis of peer-reviewed, longitudinal studies reporting predictors of functioning, with a minimum 12-month follow-up and at least 80% of participants diagnosed with FEP. Results: Out of 2205 citations, 274 articles were retrieved for detailed evaluation resulting in 50 eligible studies (N = 6669). Sociodemographic, clinical, physical and neuroimaging variables had little impact on long-term functioning. Conversely duration of untreated psychosis (DUP), most cognitive variables, and concurrent remission of positive and negative symptoms were independently related to functional recovery. Conclusions: These findings strongly support the rationale for early intervention in FEP. Novel treatments targeting cognitive deficits may improve functional outcomes in FEP.