Background. It has been suggested that the expression
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 executive (frontal) cognitive function.
Results. After controlling for age and for duration and continuity
of subsequent antipsychotic
treatment, current severity both of negative symptoms and of general
cognitive impairment was
predicted strongly by increasing duration of initially untreated psychosis;
duration of illness
following initiation of antipsychotic medication failed to predict the
severity thereof. Neither of
these indices of illness duration predicted the severity of positive
symptoms or of executive dyscontrol.
Conclusions. Increasing duration of initially untreated
psychosis was associated specifically with
heightened accrual of prominent negative symptoms and general cognitive
dyscontrol, though also prominent in these patients, may be
‘locked-in’ at an earlier phase of the illness.