relationship between longer DUP and worse outcome is stillunclear and the causality of this relationship has not yet beendemonstrated. In DUP-outcome studies most attention has beenpaid to positive symptoms and related outcome measures, such asrelapse rates, time to positive symptom response and positivesymptom remission. The relationships of DUP with other outcomedomains, such as negative symptoms have not been very welldocumented yet. In this symposium a meta-analysis will bepresented showing an association of DUP and negative symptomsat baseline and throughout 5 years of follow-up. These relation-ships are of interest in view of the potential harm untreatedpsychosis might cause to the integrity of brain function. Findingsfrom the London Institute of Psychiatry show that gray matterchange is associated with poorer outcome and long exposure toantipsychotics, while DUP did not mediate these longitudinal brainchanges. Though long DUP was associated with poor outcome, itwas not shown to be related to the rate of secondary degenerationand cortical thinning as the disease progressed. Despite the currentwide-spread implementation of early detection programs for firstepisode psychosis only few studies so far did address the effective-ness of these programs. Is it possible to reduce DUP, and if so, whatspecific ingredients do the job, and what were the achievements interms of outcome? The TIPS study from Scandinavia still is the onlyquasi-experimental study in the field, revealing some unexpectedresults, while the Birmingham, U.K. experiences with early interven-tion shed a light on practical obstacles encountered when trying toreduce DUP in an urban area.

doi:10.1016/j.schres.2010.02.140

CHAIRPERSONLex WunderinkFriesland Mental Health Services

OVERALL PANEL PROPOSAL: SPEAKER 1 ABSTRACT:SPEAKER 2 ABSTRACT: SPEAKER 3 ABSTRACT:SPEAKER 4 ABSTRACT:

REDUCING DUP IN A LARGE URBAN, MULTI-CULTURAL CITY:WHY WE NEED TO USE AND UNDERSTAND DATA ON PATHWAYSTO CARE

Max Birchwood1, Paul Patterson2, Swaran Singh3, Charlotte Connor2,Linda McCarthy2, Helen Lester41University of Birmingham, Birmingham, UK; 2Birmingham EarlyIntervention service & University of Birmingham; 3Birmingham EarlyIntervention service & University of Warwick, UK; 4Dept. Primary Care,University of Manchester, UK

Birmingham is the UK's second largest city (pop 1.2M) and in afew years time will be populated by an ethnic majority. In spite ofwell developed secondary care early intervention services for firstepisode psychosis, DUP remains stubbornly high. In this paper wepresent data on DUP from over the last 2.5 years (N∼350) and howthese are systematically linked to different ethnic groups andgeographical areas of the city. The Birmingham 'DUP problem' isessentially a problem of outliers (> 1 year DUP) and these are againover-represented in some ethnic groups , particularly the Muslimcommunity, whose pathway to care nearly always involves theMosques. I will also present data from a qualitative study of theconstruction of psychotic presentations by the Imams and otherMuslim elders and how these may be linked to delays. Our NIHR'CLAHRC' and 'ENRICH' projects will be described which aim to

reduce DUP through a focused approach to care pathways andengaging directly with Birmingham's cultural diversity.

doi:10.1016/j.schres.2010.02.141

DURATION OF UNTREATED PSYCHOSIS AND NEGATIVESYMPTOMS: HOW DO THEY RELATE?

Nynke Boonstra1,2, Lex Wunderink2, Rianne Klaassen1, SjoerdSytema1, Durk Wiersma11GGZ Friesland, Leeuwarden, Friesland, Netherlands; 2UniversityMedical Center Groningen, Groningen, Netherlands

Negative symptoms are at the core of the schizophrenia syndrome.They have been referred to as primary or deficit symptoms and they arerelated to poor functional outcome The association between duration ofuntreated psychosis (DUP) and poor outcome is overwhelming. Inrecent meta-analyses, DUP emerged as an independent predictor of thedegree of recovery from an initial episode of psychosis, independent ofpotential confounders.However the causalityof the associationbetweenDUP and poor outcome has not been proven: a later start of treatmentmight merely be a marker of other factors that contribute to pooroutcome. So far both research and clinical programsmainly focus on therelationship between DUP and positive symptoms: early detection andintervention of psychosis, aiming at reducing the DUP, are focused onearly positive symptoms and their precursors. Positive psychoticsymptoms are easier to recognize and antipsychotic treatment isdirected to reduce positive symptoms. Few studies report on therelationship between negative symptoms and DUP. It is unclear howstrong this relationship is and whether there is a longitudinal relation-ship betweenpositive and negative symptoms. If positive symptoms arecausally related to negative symptoms then short DUP and better courseof positive symptomswill be correlatedwith better course and outcomeof negative symptoms.We conducted a meta-analysis on studies of firstepisode psychosis published after December1992. We included allstudies that quantitatively assessedDUP, and assessed positive aswell asnegative psychotic symptoms by either PANSS, SAPS & SANS or BPRS atbaseline and at least one follow-up assessment at 6 months or later. Weincluded 29 studies from different countries. The main findings of thisstudy are; 1)Long DUP is associated with more severe positive andnegative symptoms throughout follow-up 2) There is no DUP x timeinteraction; the initial drawbackof longDUP is still presentat96 months.These findings might indicate that early detection programs should notexclusively focus on the detection of positive psychotic symptoms butalsoon thepresenceofnegative symptoms.Thepredictivevalueof ratingthese symptoms at an early stage, concurrent with positive symptoms,would have to be established, to determine the possibility of shifting thefocus of early intervention teams from positive symptoms only toemerging negative symptoms as well.

doi:10.1016/j.schres.2010.02.142

BRAIN CHANGES FOLLOWING THE FIRST PSYCHOTIC EPISODE:THE ROLE OF TREATMENT

Paola Dazzan, S. Reinders, K. Morgan, C. Morgan, G. Hutchison,P. Fearon, P.K. McGuire, P.B. Jones, R.M. Murray, J. LappinKings College London Institute of Psychiatry, London, UK

It remains unclear at what stage brain anatomical changes occurfollowing the first episode of psychosis, and whether they are associatedwith poorer clinical and functional outcome. Furthermore, the role of

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