Relationship of the factor structure of psychopathology in schizophrenia to the timing of initial intervention with antipsychotics

Timing of intervention with antipsychotic medication may influence long-ter m outcome in schizophrenia in a manner that is poorly understood. This stud y evaluated psychopathology, its factor structure, and cognitive dysfunctio n in older patients with chronic schizophrenia in relation to the intervals from onset of psychosis to initiation of treatment with antipsychotics, an d from initiation of antipsychotic treatment to current assessments. The su bjects were 129 patients with schizophrenia, many of whom became ill in the preneuroleptic era. Their current psychopathology was assessed using the P ositive and Negative Syndrome Scale, and its factor structure examined usin g principal component analysis. Current general and executive cognitive fun ction was evaluated using the Mini-Mental State Examination and the Executi ve Interview, respectively. Using multiple regression modelling, increasing duration of initially unmedicated psychosis, but not the much longer durat ion of subsequently treated illness, was the primary predictor of psychomot or poverty (negative symptoms) but not of reality distortion or disorganisa tion over the three domains of psychopathology resolved; duration of initia lly unmedicated psychosis marginally predicted the severity of general, but not of executive, cognitive dysfunction. Delayed intervention with antipsy chotics appears associated with poorer long-term course in terms of increas ed severity of psychopathology in the psychomotor poverty domain. (C) 2001 Elsevier Science B.V. All rights: reserved.