Untreated initial psychosis: Its relation to quality of life and symptom remission in first-episode schizophrenia

Objective: Previous studies have suggested that there may be an association between longer duration of untreated psychosis and poor outcome in schizop hrenia. These studies have been interpreted as providing evidence that untr eated psychosis may constitute an "active morbid process" that is "toxic" t o the brain. If untreated psychosis is neurotoxic, this would form a strong basis for early intervention in schizophrenia. Method: Seventy-four neuroleptic-naive patients with DSM-IV schizophrenia w ere evaluated 6 months after their first inpatient hospitalization. The aut hors examined the relationship between untreated initial psychosis duration (measured from onset of fi rst symptom as well as from onset of full posit ive syndrome) and quality of life, symptom severity, and time to remission of positive symptoms. Results: Earlier age at illness onset was associated with longer duration o f untreated prodromal psychotic symptoms. There were no significant gender differences in duration of untreated initial psychosis, nor were there any significant associations between untreated initial psychosis duration and p remorbid functioning. After controlling for the effects of age at onset, th e duration of untreated initial psychosis did not significantly impair subs equent quality of life, symptom severity, or remission of positive symptoms . Conclusions: Duration of untreated initial psychosis was not: prognostic of poor outcome early in the course of schizophrenia. Biological measures of neurotoxicity are needed to examine the "toxic psychosis" hypothesis more d irectly.