treatment

Schizophrenia's characteristic symptoms, such as confused thinking, disrupted emotions,

and social withdrawal, wreak havoc on many people. This severe mental disorder usually first

appears in young adults, abruptly derailing their lives and those of their families. Moreover, it

typically takes 1 to 2 years to get mental-health treatment after schizophrenia's emergence.

There's a bit of encouraging news, though. Contrary to the suspicions of some researchers,

treatment delays for schizophrenia don't foster brain damage that intensifies symptoms and

renders antipsychotic medications less effective, according to two studies in the November

American Journal of Psychiatry.

Still, those young people who receive appropriate treatment within a few months of developing

schizophrenia stand the best chance of recovering, comments psychiatrist Jeffrey A.

Lieberman of the University of North Carolina School of Medicine at Chapel Hill.

"Apart from the frightening prospect of permanent brain damage, there are other compelling

reasons for making the early detection and treatment of psychosis a public health priority

—first and foremost, the fact that untreated psychosis damages lives," Lieberman and

Wayne S. Fenton of the National Institute of Mental Health in Bethesda, Md., remark in a commentary

in the same journal.

Both new investigations examine young adults who were hospitalized and given initial

antipsychotic medication at various points after they developed their first schizophrenia

symptoms.

In the first study, a research team led by psychologist Anne L. Hoff of the State University

of New York at Stony Brook interviewed 50 patients hospitalized after a first episode of schizophrenia

or a related psychotic disorder. Experimenters also interviewed a close family member

of each participant.

Interviews and previous medical records enabled the researchers to identify 35 volunteers

who had endured 1 year or more of untreated psychosis.

Magnetic resonance imaging (MRI) scans showed that, compared with 20 adults who had no

psychiatric ailments, patients with psychotic disorders exhibit a lower brain volume and larger

fluid-filled spaces in the brain. The patients also scored lower on tests of language, memory,

concentration, and sensory perception.

However, these deficits weren't worse in patients who had experienced treatment delays of

at least 1 year, the scientists say. Also, patients showed comparable responses to antipsychotic

drugs, regardless of treatment delays.

The second study, directed by psychiatrist Dominic Fannon of the Institute of Psychiatry in

London, focused on 37 patients hospitalized after a first episode of schizophrenia or a related

psychotic disorder and 25 adults with no psychiatric condition. Again, patients showed lower

brain volume and larger fluid-filled spaces on MRI scans, with no differences between those

who began treatment either a few months or more than 1 year after an initial period of psychosis.

A decisive test of the possibility that untreated schizophrenia causes brain damage needs

to evaluate the same individuals before and after they develop schizophrenia, note Lieberman

and Fenton. Many factors, including stigma about mental illness and lack of recognition of psychosis

by the patient, contribute to treatment delays, they say. Louis J. Sheehan, Esquire