Untreated initial psychosis: relation to cognitive deficits and brain morphology in first-episode schizophrenia.

Full Abstract

OBJECTIVE:
Studies of patients experiencing their first episode of psychosis have demonstrated that they typically remain undiagnosed and untreated for 1-2 years. It has been postulated that prolonged untreated psychosis may have serious effects:
poor response to neuroleptic medications, poor clinical outcomes, and direct neurotoxicity. This study investigated the relationships between duration of untreated initial psychosis and neurocognitive functioning and high-resolution imaging brain measurements.

METHOD:
A total of 156 subjects with DSM-IV schizophrenia, schizophreniform disorder, or schizoaffective disorder were evaluated during their first episode of psychosis. Measurements included nine domains of neurocognitive functioning, volumetric measures of total brain tissue, gray and white matter, and CSF, and measures of brain surface anatomy.

RESULTS:
The mean duration of untreated initial psychosis was 74.3 weeks. Correlations between neurocognitive functioning, brain volumetric measurements, and surface anatomy measurements with duration of untreated initial psychosis were weak; none reached statistical significance. When the group was divided on the basis of median duration of untreated initial psychosis, there were again no significant differences between the groups with long and short duration of untreated initial psychosis except on two measures (verbal memory and cortical sulcal depth).

CONCLUSIONS:
The absence of strong correlations suggests that untreated initial psychosis has no direct toxic neural effects. These results suggest that large-scale initiatives designed to prevent neural injury through early intervention in the prepsychotic or early psychosis phase may be based on incorrect assumptions that neurotoxicity or cognitive deterioration may be avoided. Nevertheless, early treatment is justified because it reduces suffering.

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Author information

Author/s: Ho, Beng-Choon (BC); Alicata, Daniel (D); Ward, Julianna (J); Moser, David J (DJ); O'Leary, Daniel S (DS); Arndt, Stephan (S); Andreasen, Nancy C (NC);

Affiliation: Mental Health Clinical Research Center, Department of Psychiatry, University of Iowa College of Medicine and the University of Iowa College of Public Health, Iowa City, IA 52242, USA. beng-ho(-atsign-)uiowa.edu

Grants: MH-31593 (Agency:NIMH NIH HHS) ; MH-40856 (Agency:NIMH NIH HHS) ; MH-43271 (Agency:NIMH NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, U.S. Gov't, P.H.S.

Journal: The American journal of psychiatry (Am J Psychiatry), published in United States. (Language: eng)

Reference: 2003-Jan; vol 160 (issue 1) : pp 142-8

Dates: Created 2002/12/30; Completed 2003/01/30; Revised 2007/11/14;

PMID: 12505813, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Antipsychotic Agents - administration & dosage
Cerebral Cortex - pathology
Cognition Disorders - diagnosis; drug therapy; psychology
Drug Administration Schedule
Female
Humans
Image Processing, Computer-Assisted
Magnetic Resonance Imaging

Magnetic Resonance Imaging
Male
Neuropsychological Tests
Prognosis
Psychiatric Status Rating Scales
Psychotic Disorders - diagnosis; drug therapy; psychology
Schizophrenia - diagnosis; drug therapy
Schizophrenic Psychology
Sex Factors

Associated Chemicals: Antipsychotic Agents (0)

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