title: Psychopathology, executive (frontal) and general cognitive impairment in relation to duration of initially untreated versus subsequently treated psychosis in chronic schizophrenia.
abstract: BACKGROUND
  It has been suggested that the expression of 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 impairment. Executive dyscontrol, though also prominent in these patients, may be 'locked-in' at an earlier phase of the illness.
authors.affiliation: St. Davnet's Hospital, Monaghan, Ireland.
authors.forename: P J
authors.initials: PJ
authors.lastname: Scully
authors.forename: G
authors.initials: G
authors.lastname: Coakley
authors.forename: A
authors.initials: A
authors.lastname: Kinsella
authors.forename: J L
authors.initials: JL
authors.lastname: Waddington
mesh_terms: D014150:Antipsychotic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis*; D015331:Cohort Studies; D017050:Episode of Care; D005625:Frontal Lobe / Q000502:physiology*; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D007494:Ireland; D008137:Longitudinal Studies; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents