DELAY TO FIRST ANTIPSYCHOTIC MEDICATION IN SCHIZOPHRENIA - IMPACT ON SYMPTOMATOLOGY AND CLINICAL COURSE OF ILLNESS

The possible adverse clinical effects of untreated psychosis in schizo phrenic patients, particularly early in the course of illness, have be en a topic of considerable interest in recent years. We examined the t iming of first administration of antipsychotic medication after the fi rst onset of psychotic symptoms in 103 patients with DSM-III-R diagnos es of schizophrenia, schizophreniform or schizoaffective disorder. Pat ients with a delay of one or more years between the onset of the first psychotic symptom and the initiation of antipsychotic treatment demon strated more severe negative symptomatology on admission to hospital a nd more severe positive symptoms and negative symptoms at discharge. T hese effects were present in both first-admission patients, in whom th e delay to treatment immediately preceded hospitalization and chronic patients with a history of multiple hospitalizations. Patients with on e or more years of untreated psychosis prior to their first antipsycho tic treatment displayed a more severe poverty syndrome at the time of admission and discharge and a more severe reality distortion syndrome at discharge from the index hospitalization. These findings were not r elated to age, premorbid functioning, duration of illness, first- vs m ultiple-episode status, or dosage of antipsychotic medication at time of admission or discharge assessment. Findings from the present study suggest that failure to initiate antipsychotic treatment early in the course of the illness may be associated with a recurrent pattern of po orer treatment response and more severe and persistent positive and ne gative symptomatology. These findings indicate the importance of early detection of illness and early initiation of antipsychotic treatment for the first psychotic symptoms of schizophrenia. (C) 1998 Elsevier S cience Ltd. All rights reserved.