Schizophrenia: early treatment improves outcome

For many years, psychiatrists have argued over whether or not early intervention after a schizophrenia patient’s first episode of psychosis could improve the patient’s long-term outcome. A new study concludes that early intervention can improve outcome.

Historically, the prevailing view has been that “it just doesn’t matter when you treat a person because their clinical outcome is predetermined,” Dr. Diana O. Perkins from the University of North Carolina at Chapel Hill explained in a UNC statement.

This view, which holds that schizophrenia is the result of altered brain development that begins before birth and that treatment will not improve long-term outcome, is often referred to as the “doomed from the womb” theory. Many psychiatrists still hold this to be true, but more recent studies, including the current one, suggest that early treatment can improve outcome.

Perkins and colleagues pooled data from 43 studies addressing the question: “Does prolonged duration of untreated psychosis influence outcome?”

They report in the American Journal of Psychiatry this month that the greater the interval between the onset of psychosis and its treatment, the greater the severity of negative symptoms.

“On average, there is a delay of over a year—or longer—from the time that the symptoms of schizophrenia first emerge to the time that the person first receives treatment,” Perkins told Reuters Health. “The main result of this meta-analysis,” she added, “is that the sooner treatment is started, the better the clinical and functional outcome.”

A shorter duration of untreated psychosis was associated with greater response to standard antipsychotic treatment.

Thus, “ameliorating the symptoms of the initial psychosis may not only lessen the immediate suffering and burden of disease experienced by patients and their families,” Perkins said, “but may also improve long-term prognosis by limiting progression of the illness and preserving a person’s ability to respond to antipsychotic medication.”

SOURCE: American Journal of Psychiatry, October 2005.

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