Long-term adaptive life functioning in relation to initiation of treatmentwith antipsychotics over the lifetime trajectory of schizophrenia

Background: There is evidence that the stage of illness at which antipsycho tic treatment is initiated in schizophrenia may have consequences for its s ubsequent course, How this might relate to impaired adaptive life functioni ng in the long-term is poorly understood. Methods: Thirty-eight inpatients, many of whom had been admitted in the pre neuroleptic era, were assessed using the Social-Adaptive Functioning Evalua tion (SAFE); constituent clinical and medication phases of the lifetime tra jectory of their illnesses were then analyzed to identify predictors of SAF E score using multiple regression modeling. Results: The primary, independent predictor of SAFE score was duration of i nitially unmedicated psychosis, which accounted for 22% of variance (p <.00 1) therein. Conversely, duration of subsequently treated illness, although decades longer, failed to predict SAFE score. Conclusions: These findings are consistent with some form of "progressive" process, particularly over the first several years following the emergence of pychosis, which is associated with accrual of deficits in adaptive life functioning. Biol Psychiatry 2000;48:163-166 (C) 2000 Society of Biological Psychiatry.