Long duration of untreated psychosis is associated with poorer neurocognitive and negative symptom recovery after first episode schizophrenia

Abstract

BACKGROUND: Whether the duration of untreated psychosis (DUP) is related to cognitive outcome of schizophrenia remains a contentious issue. Most cognitive studies address the effects of DUP suffers from relatively short longitudinal follow-up periods. We report the changes in cognition and negative symptoms over a three year follow-up following first episode schizophrenia and compare these changes between patients with longer DUP and patients with shorter DUP. METHODS: 93 patients with first episode schizophrenia, schizophreniform psychosis and schizoaffective disorder were followed up for a 3-year period during which regular assessment in cognitive dysfunction and symptoms were carried out. The DUP was measured with the Instrument for Retrospective Assessment of Onset of Schizophrenia (IRAOS). Cognitive assessments included visual memory, verbal memory, semantic fluency, Wisconsin Card Sorting and digits span. RESULTS: Patients with DUP of more than180 days had more impairment in visual and verbal memories, as well as more negative symptoms. These differences became more apparent with longer follow-up period (beyond the first year of the illness). In the first year, in patients with shorter DUP, negative symptoms improved whereas in patients with longer DUP, negatives symptoms actually deteriorated. This relationship remained significant after controlling for pre-morbid adjustment. CONCLUSIONS: Longer DUP is significantly associated with poorer clinical and cognitive recovery 3 years after a first episode psy chosis. The differences are not apparent during or shortly after the first episode. These findings raise the possibility that early treatment of psychosis might help to optimize neurocognitve and negative symptoms recovery.