PSYCHOPATHOLOGY, EXECUTIVE (FRONTAL) AND GENERAL COGNITIVE IMPAIRMENTIN RELATION TO DURATION OF INITIALLY UNTREATED VERSUS SUBSEQUENTLY TREATED PSYCHOSIS IN CHRONIC-SCHIZOPHRENIA

Background. It has been suggested that the expression of psychosis may reflect an active morbid process that is associated with increasingly poor outcome unless ameliorated by antipsychotic drugs. Methods. The subjects of this study were 48 in-patients with schizophrenia, many of whom had been admitted before the introduction of antipsychotic drugs to rural Irish psychiatric hospitals in the late 1950s. Each patient was assessed for positive and negative symptoms, and for general and e xecutive (frontal) cognitive function. Results. After controlling for age and for duration and continuity of subsequent antipsychotic treatm ent, current severity both of negative symptoms and of general cogniti ve impairment was predicted strongly by increasing duration of initial ly untreated psychosis; duration of illness following initiation of an tipsychotic medication failed to predict the severity thereof. Neither of these indices of illness duration predicted the severity of positi ve symptoms or of executive dyscontrol. Conclusions. Increasing durati on of initially untreated psychosis was associated specifically with h eightened accrual of prominent negative symptoms and general cognitive impairment. Executive dyscontrol, though also prominent in these pati ents, may be 'locked-in' at an earlier phase of the illness.