Drake RJ, Haley CJ, Akhtar S, Lewis SW: Causes and consequences of duration of untreated psychosis in schizophrenia. As previously described (18), duration of untreated initial psychosis was defined as the time period from the onset of the full positive syndrome to the initiation of antipsychotic treatment. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies. 19, No. 2019 Jul;28(7):957-971. doi: 10.1007/s00787-018-1262-5. 15, No. No differences in surface anatomy indices were observed between the groups with short and long duration of untreated initial psychosis except for sulcal cortical depth (F=3.91, df=1, 89, p=0.05). 4, Social Psychiatry and Psychiatric Epidemiology, Vol. The mean duration of untreated initial psychosis for the study group was 74.3 weeks (SD=145.1, median=13.0, 25th and 75th interquartile range=52). The current study explored the effect of an early intervention (EI) service for psychosis in Hong Kong (EASY) on the reduction of the duration of untreated psychosis (DUP) at 10 years, in adolescent and adult patients. Am J Psychiatry 2000; 157:1829-1834Link, Google Scholar, 21. de Haan L, van Der Gaag M, Wolthaus J: Duration of untreated psychosis and the long-term course of schizophrenia. Sheitman and Lieberman4 elaborated, claiming that the inability to regulate a presynaptic dopamine release in the limbic striatum and the prolonged sensitization and overstimulation resulted in people being refractory of treatment because of structural neuronal changes. Previous structural MRI studies have explored the effect of antipsychotics, the treatment most commonly used in psychosis, on the brain. The neurotoxicity hypothesis by Wyatt in 1991 proposed that periods of untreated psychosis are ‘biologically toxic’ to the brain 3. Traumatic Brain Injury. untreated psychosis may cause damage to brain structures. 187, No. 1-3, Nordic Journal of Psychiatry, Vol. Woods BT, Yurgelun-Todd D, Benes FM, Frankenburg FR, Pope HG Jr, McSparren J: Progressive ventricular enlargement in schizophrenia: comparison to bipolar affective disorder and correlation with clinical course. Rapp C, Studerus E, Bugra H, Aston J, Tamagni C, Walter A, Pflueger M, Borgwardt S, Riecher-Rössler A. Schizophr Res. The relationship between mycotoxins and psychosis has been documented throughout human history. Andreasen NC, Flaum M, Arndt S: The Comprehensive Assessment of Symptoms and History (CASH): an instrument for assessing diagnosis and psychopathology. 1-3, Acta Psychiatrica Scandinavica, Vol. The mean age of illness onset was 22.7 years (SD=6.7), and the mean age at first hospitalization was 25.8 years (SD=8.4). 12, American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, Vol. Our findings are consistent with two previous studies that examined the relation between duration of untreated initial psychosis and structural brain morphology. This automated stereotaxic-based method has been reported to be efficient and accurate for cerebral lobe measures (33). Spearman’s rank order correlation coefficients were used to examine the relationships between duration of untreated initial psychosis and the nine neurocognitive domains. Am J Psychiatry 2000; 157:1727-1730Link, Google Scholar, 4. As a predictor of outcome after one year, the duration of untreated psychosis had a small effect on variance in quality of life (4%, p<0.001) and a moderate effect on positive symptoms (11%, p<0.001). Duration of Untreated Psychosis Correlates With Brain Connectivity and Morphology in Medication-Naïve Patients With First-Episode Psychosis. DUP is generally determined as the time from the onset of psychotic symptoms to the initiation of treatment or first clinical presentation, when a diagnosis of first-episode psychosis may be given. Br J Psychiatry 2000; 177:207-211Crossref, Medline, Google Scholar, 23. Scores were reversed where necessary so that a larger negative score would indicate poor performance below the mean. Biol Psychiatry Cogn Neurosci Neuroimaging. 7. Epub 2018 Dec 1.  |  The majority of the subjects had DSM-IV schizophrenia (N=114); the remaining subjects had either schizophreniform disorder (N=36) or schizoaffective disorder (N=6). Ho B-C, Andreasen NC, Flaum M, Nopoulos P, Miller D: Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. 5, 1 June 2003 | Psychiatric Services, Vol. 19, No. Images were obtained on a 1.5-T GE (Milwaukee) Signa MRI scanner. Thirteen subjects did not have scans at intake. Height was used to account for differences in brain measurements across gender. Alternatively, we did not correct for multiple testing and kept the p value at the 0.05 level. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Aust NZ J Psychiatry 2000; 34(suppl):S145-S149Google Scholar, 3. In general, there was paucity of statistically significant differences between groups with short or long duration of untreated initial psychosis with regard to cognitive deficits and brain measures (Table 1 and Table 2). Wyatt RJ: Early intervention for schizophrenia: can the course of the illness be altered? 131, No. To provide a consistent and uniform basis for establishing the norms, these healthy comparison subjects were recruited from the same geographical area from which the schizophrenia subjects were ascertained. However, Dr. Nasrallah explained, science already has demonstrated how the neurotoxic effects of psychosis in the brain of a person with schizophrenia lead to brain tissue degradation with every psychotic episode. 4, General Hospital Psychiatry, Vol. 115, No. The known risks of untreated psychosis can include: Difficulties with work or school performance In this current study, which has the largest group of first-episode subjects collected to date to our knowledge, we examined whether untreated psychosis has toxic effects on brain tissue and function using the tools of anatomic magnetic resonance imaging (MRI) and tests of cognition. 35, No. 39, No. Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project. Barnes TR, Hutton SB, Chapman MJ, Mutsatsa S, Puri BK, Joyce EM: West London first-episode study of schizophrenia: clinical correlates of duration of untreated psychosis. Untreated psychosis has long been associated with worse clinical outcomes in patients with schizophrenia. "When psychosis is present, the life-threating effects of untreated illness outweigh any adverse effects on brain structure," said Dr. Voineskos. Haas GL, Garratt LS, Sweeney JA: Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. 154, No. These programs have proven that the innovative triad of networking with community providers, carefully targeted educational activities, and dedicated early detection teams can lead to timely referral and earlier treatment of patients with psychotic disorders. The only cognitive domain that differed significantly between the two groups was verbal memory (Table 1). 42, No. Only performance on one neurocognitive measure (an attentional set-shifting task) was somewhat worse in the group with a longer duration of untreated initial psychosis. 4, Progress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. Volumes of tissue were then obtained from each region in an automated fashion. 39, No. Duration of untreated psychosis is associated with orbital-frontal grey matter volume reductions in first episode psychosis. Talairach J, Tournoux P: Co-Planar Stereotaxic Atlas of the Human Brain: Three-Dimensional Proportional System. 1, Social Psychiatry and Psychiatric Epidemiology, Vol. Am J Psychiatry 2001; 158:1917-1919Link, Google Scholar, 48. (20) also found no relation between duration of untreated initial psychosis and measures of the whole brain, cortical gray matter, lateral ventricles, third ventricle, temporal lobe, and temporal lobe gray matter. Each cognitive domain had good internal consistency (Cronbach’s alpha: median=0.785). Am J Psychiatry 2000; 157:1824-1828Link, Google Scholar, 20. First-episode psychosis (FEP) can result in a loss of up to 1% of total brain volume and up to 3% of cortical gray matter. 30, No. Rund BR: A review of longitudinal studies of cognitive functions in schizophrenia patients. Thus, the goal of the present work was to examine if DUP and DUI are associated with abnormalities in HV, PV and GMV. 1-2, Acta Psychiatrica Scandinavica, Vol. Larsen TK, Moe LC, Vibe-Hansen L, Johannessen JO: Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. With these z scores, each domain score is the summed average of its component neuropsychological test variables (Appendix 1). 128, No. Consistent with previous first-episode study groups, we observed long delays between the onset of psychotic symptoms and initiation of treatment in a substantial proportion of our study group. Three different MRI sequences were used for each subject. Schizophrenia is often diagnosed after someone has a psychotic episode. Biol Psychiatry 2001; 49:487-499Crossref, Medline, Google Scholar, 44. Br J Psychiatry 2001; 179:340-345Crossref, Medline, Google Scholar, 37. 54, No. Programs like the Early Psychosis Prevention and Intervention Centre, TIPS, RAP (48), PRIME (49), and the Prevention and Early Intervention Program for Psychosis (36) also offer hope that future sufferers of schizophrenia will benefit from early interventive measures. 8, Social Psychiatry and Psychiatric Epidemiology, Vol. Am J Psychiatry 2001; 158:1161-1163Link, Google Scholar, 46. Although the hypothesis is speculative, glutamate excitotoxicity or glucocorticoid-mediated neuronal damage may result in atrophy in cortical sulcal thickness in patients with long duration of untreated initial psychosis. Biol Psychiatry Cogn Neurosci Neuroimaging. Later brain development processes (e.g., apoptosis and synaptic pruning) and/or other neuropathological events (e.g., stress, illicit drug use, head trauma) interact with the already aberrant neuropathology to result in symptoms and signs of schizophrenia. None of the correlation coefficients achieved statistical significance. Written informed consent, approved by the University of Iowa’s institutional review board, was obtained from each subject. Anthony’s Fire.” Early North American settlers who ate mold-contaminated grain were also known to suffer psychotic episodes. In brief, a three-dimensional data set was created, and the images were then realigned, resampled, and transformed into Talairach and Tournoux atlas space (32). The period from the onset of frank psychotic symptoms to the start ofadequate treatment, the duration of untreated psychosis (DUP), varies considerablyin patients with first-episode psychosis. Br J Psychiatry Suppl 1998; 172:26-32Crossref, Medline, Google Scholar, 49. J Psychiatry Neurosci. It has also been noted that shorter duration of untreated psychosis has been associated with greater response to antipsychotic treatment, and may therefore underlie a subgroup with better prognosis . Association Between the Duration of Untreated Psychosis and Selective Cognitive Performance in Community-Dwelling Individuals With Chronic Untreated Schizophrenia in Rural China. Conn Med 2000; 64:339-341Medline, Google Scholar, Progress in Neuro-Psychopharmacology and Biological Psychiatry, Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Vol. McEwen BS: Effects of adverse experiences for brain structure and function. McGlashan TH: Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? 2, No. Thirty subjects had scans that were obtained by using noncomparable imaging parameters: 21 on an older scanning protocol and nine on a newer protocol. Clipboard, Search History, and several other advanced features are temporarily unavailable. However, there are other possible interpretations for these two significant associations (4, 44). Black K, Peters L, Rui Q, Milliken H, Whitehorn D, Kopala LC: Duration of untreated psychosis predicts treatment outcome in an early psychosis program. From the Mental Health Clinical Research Center, Department of Psychiatry, University of Iowa College of Medicine and the University of Iowa College of Public Health; and the MIND Institute, Department of Psychiatry, University of New Mexico, Albuquerque. 44, No. 18, No. Ho B-C, Andreasen NC, Arndt S: The effects of untreated psychosis on symptom severity, cognition, and brain volumes at the time of first hospitalization (abstract). In a previous study, our group found that a longer duration of untreated initial psychosis did not significantly impair quality of life, symptom severity, or remission of positive symptoms 6 months after a first psychiatric hospitalization (18). Pioneering early identification programs in Australia and Norway have demonstrated that treatment delays can be shortened (13, 47). The more time passes between the first psychosis symptoms and adequate treatment, the poorer the prognosis. 3, Revista Brasileira de Psiquiatria, Vol. Hoff et al. However, when adjusted for covariates, we found no significant correlation between DUP or DUI and HV, PV or GMV anymore. 22, No. Andreasen NC, Cohen G, Harris G, Cizadlo T, Parkkinen J, Rezai K, Swayze VW II: Image processing for the study of brain structure and function: problems and programs. However, studies that have specifically examined the relationship between duration of untreated initial psychosis and outcome have had more mixed findings (4) and call into question the plausibility of toxicity from untreated psychosis. (19) also examined the correlations between duration of untreated initial psychosis and seven summary scores from a neurocognitive battery. But researchers are still pursuing a better understanding of the neurological impact of psychotic episodes. Cohen G, Andreasen NC, Alliger R, Arndt S, Kuan J, Yuh WTC, Ehrhardt J: Segmentation techniques for the classification of brain tissue using magnetic resonance imaging. Ho B-C, Andreasen NC: Duration of initial untreated psychosis—methods and meanings, in Second International Conference on Early Psychosis. 1-3, Journal of Psychiatric Research, Vol. 39, No. Anderson KK, Rodrigues M, Mann K, Voineskos A, Mulsant BH, George TP, McKenzie KJ. Although longer duration of untreated initial psychosis was related to poorer verbal memory (r=–0.14, N=156, p=0.08) and to poorer problem-solving skills (r=–0.15, N=156, p=0.07), these correlations did not achieve statistical significance. Epub 2016 Oct 4. What is the duration of untreated psychosis (DUP)? Patients with more severe illness, as evidenced by poorer verbal memory and thinner cortical sulcal depth, may be less able to seek treatment early. Schizophrenia is a leading cause of disability worldwide.1 Kraepelin originally characterized the illness as having a course that led almost inevitably to severe cognitive and behavioral decline,2 and many clinicians and neuroscientists still consider it to be a progressive brain disease that leads to chronicity and social incapacity.3,4 This view has been reinforced by recent neuroimaging studies that have shown supposedly “progressive” changes in brain structure.5,6A progressive neuropathological process would … In the West London first-episode study of schizophrenia, Barnes et al. 1, Psychiatry Research: Neuroimaging, Vol. Equivocal evidence exists of an association between DUP/DUI and structural brain abnormalities, such as reduced hippocampus volume (HV), pituitary volume … Equivocal evidence exists of an association between DUP/DUI and structural brain abnormalities, such as reduced hippocampus volume (HV), pituitary volume (PV) and grey matter volume (GMV). Studies examining the relation between DUI and brain structure are therefore more likely to be informative if conducted in previously untreated patients. 54, No. 3, International Clinical Psychopharmacology, Vol. In addition to brain volumetric measures, Hoff et al. The purported toxicity of untreated psychosis may be biologically or psychosocially mediated. 2,6,7 This explains why enlarged ventricles are a common radiologic finding in patients with schizophrenia. T1-weighted spoiled grass sequences were acquired with the following parameters: 124 1.5-mm coronal slices, TE=5 msec, TR=24 msec, flip angle=40°, number of excitations=2, field of view=26 cm, matrix=256×192, and echo train length=8.  |  27, No. Br J Psychiatry 2000; 177:511-515Crossref, Medline, Google Scholar, 16. 2011 Jan;125(1):13-20. doi: 10.1016/j.schres.2010.09.021. Effect of an early detection programme on duration of untreated psychosis - Volume 187 Issue S48 - Svein Friis, Per Vaglum, Ulrik Haahr, Jan Olav Johannessen, Tor K. Larsen, Ingrid Melle, Stein Opjordsmoen, Bj⊘rn Risovd Rund, Erik Simonsen, Thomas H. Mcglashan Height and age were used as covariates. It has been postulated that N-methyl-d-aspartic acid receptor hypofunction may induce psychosis and produce glutamate excitotoxic damage in neurons at the same time (23). 139, No. This reason alone justifies efforts to reduce treatment delays, irrespective of whether early intervention improves outcome or whether untreated psychosis is neurotoxic. The relation of the duration of untreated initial psychosis with the nine cognitive domains, the MRI-based brain volumetric measures, and the surface anatomy indices are summarized in Table 1 and Table 2. This study investigated the relationships between duration of untreated initial psychosis and neurocognitive functioning and high-resolution imaging brain measurements. Parkville, Victoria, Australia, Early Psychosis Prevention and Intervention Centre, 2000, p 31Google Scholar, 47. Wilcoxon’s rank sum test was used to compare differences in neurocognitive functioning between groups with short and long duration of untreated initial psychosis. The duration of untreated initial psychosis, as it is retrospectively assessed, is subject to recall bias. We hypothesized that if psychosis is biologically toxic, exposure to longer periods of untreated psychosis would lead to poorer cognitive functioning and greater abnormalities in brain structure. Detailed information about the reliability and validity of its tools for image analysis have been previously described (28–31). The duration of untreated psychosis is significantly associated with positive symptoms at one year, with a long duration associated with a lower quality of life. When the study group was divided on the basis of the median duration of untreated initial psychosis, there were again no significant differences between the groups with long and short duration of untreated initial psychosis except on two measures (verbal memory and cortical sulcal depth). Arch Gen Psychiatry 1995; 52:998-1007Crossref, Medline, Google Scholar, 24. 1, No. Intraclass correlations for the automated MRI-based segmented image analysis and brain region volumetric measurements ranged from 0.97 to 0.98. Brain toxicity is a result of untreated psychosis. The premise of specialized early intervention (SEI) services is that intervention in the early years of illness can affect long-term outcomes. Larsen TK, McGlashan TH, Johannessen JO, Friis S, Guldberg C, Haahr U, Horneland M, Melle I, Moe LC, Opjordsmoen S, Simonsen E, Vaglum P: Shortened duration of untreated first episode of psychosis: changes in patient characteristics at treatment. Waddington JL, Youssef HA, Kinsella A: Sequential cross-sectional and 10-year prospective study of severe negative symptoms in relation to duration of initially untreated psychosis in chronic schizophrenia. J Comp Assist Tomogr 1996; 20:98-106Crossref, Medline, Google Scholar, 34. (19) reported that Spearman’s rank order correlations between duration of untreated initial psychosis and measures of the lateral ventricles, cerebral hemisphere, and temporal lobe ranged from 0.03 to 0.15. The American Psychiatric Association (APA) has updated its Privacy Policy and Terms of Use, including with new information specifically addressed to individuals in the European Economic Area. In this group, female subjects had a longer duration of untreated initial psychosis (median=15.0 weeks, interquartile range=69) than male subjects (median=13.0 weeks, interquartile range=43) (Wilcoxon’s rank sum z=0.94, N=156, p=0.35). In the United States, the average duration of untreated psychosis (DUP) is 21 months, and it remains unknown how longer DUP may affect brain functioning in antipsychotic-naïve patients with first-episode psychosis. The time period during which patients manifest psychotic or unspecific symptoms prior to treatment (duration of untreated psychosis, DUP, and the duration of untreated illness, DUI) has been found to be moderately associated with poor clinical and social outcome. In this study, we examined the relationship between duration of untreated initial psychosis and neurocognitive functioning and brain morphology, as assessed when patients with schizophrenia first presented for treatment. Poletti M, Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Gebhardt E, Pupo S, Andrea R. Eur Child Adolesc Psychiatry. Such lengthy delays are undesirable, since deferring effective treatments leads to unnecessary and undue suffering for both patients and their families. Wyatt RJ: Neuroleptics and the natural course of schizophrenia. None of the correlations was significant, and all were within 95% confidence intervals. 17, No. (36) reported that duration of untreated initial psychosis was not related to performance on an extensive battery of cognitive measures. 1. Untreated psychosis symptoms can impact all areas of a person’s life, leading to significant impairment at work, at home, at school, in relationships, and with society at large. Within the stereotaxic space, boxes were assigned to specific brain regions. Thus, the structural brain abnormalities and cognitive deficits found in schizophrenia patients may be primarily neurodevelopmental in origin. Lieberman J, Chakos M, Wu H, Alvir J, Hoffman E, Robinson D, Bilder R: Longitudinal study of brain morphology in first-episode schizophrenia. 3, Psychiatry Research: Neuroimaging, Vol. However, none of the relationships between duration of untreated initial psychosis and brain volumetric and surface measurements reached statistical significance (all p≥0.12). Maximo JO, Nelson EA, Armstrong WP, Kraguljac NV, Lahti AC. The aim of this study was to test whether untreated psychosis may be biologically toxic. 2, The Canadian Journal of Psychiatry, Vol. Medications for psychosis make things better not worse. In general, our data do not provide compelling evidence that long periods of untreated psychosis are associated with greater deficits in neurocognitive functioning or in brain morphology. Among the nine cognitive domains and 21 structural brain measures examined in this study, only two measures were significantly different between the groups with long and short duration of untreated initial psychosis. J Neuropsychiatry Clin Neurosci 1992; 4:125-133Crossref, Medline, Google Scholar, 29. Biol Psychiatry 2000; 48:721-731Crossref, Medline, Google Scholar, 25. Murray RM, Lewis SW: Is schizophrenia a neurodevelopmental disorder? 2020 Nov;44(6):373-378. doi: 10.1503/jpn.200172. 5, 6 This hypothesis has given rise to a substantial body of research on the relation between DUP and measure of brain structure, function, and (or) neurocognitive functioning. Hence, defining the duration of untreated initial psychosis as the time interval between the onset of psychosis and treatment may not be valid in a proportion of patients. The neurotoxicity postulated to arise through these biological mechanisms would, in turn, lead to impaired functioning and worsen outcome in schizophrenia. Using a region of interest (ROI) based approach, we present data of 39 patients from the Basel FePsy (Früherkennung von Psychosen, early detection of psychosis) study for which information about DUP, DUI and HV, PV and GMV data could be obtained. Supported in part by NIMH grants MH-31593, MH-40856, and MH-43271. Edited by Krishnan KRR, Doraiswamy PM. Twenty-three of them were first episode psychosis (FEP) and 16 at-risk mental state (ARMS) patients who later made the transition to frank psychosis. 2020 Apr;270(3):337-350. doi: 10.1007/s00406-019-01018-9. Reconsidering brain tissue changes as a mechanistic focus for early intervention in psychiatry. Weinberger DR: Implications of normal brain development for the pathogenesis of schizophrenia. However, several studies have shown that schizophrenia patients with poor outcome exhibit greater ventricular enlargement over time (41–43, unpublished study by Ho et al. I approach psychosis as a result of trauma and mental phenomena as opposed focusing on the brain, the empirical and the medical model of mental illness. Analysis of covariance (ANCOVA) methods were used to examine the effects of grouping by short versus long duration of untreated initial psychosis on MRI-based brain morphology measures. The duration of untreated psychosis (DUP) has been shown to have an effect on outcome after first-episode psychosis. 1, Schizophrenia Research, Vol. The severity of impairment was between 0.5 and 1.5 standard deviations below the mean (of zero). 5, Schizophrenia Research, Vol. Being in the midst of their first episode of psychosis, the subjects were moderately ill (negative symptom severity [sum of global ratings for alogia, anhedonia, avolition, and affective flattening]: mean=11.53, SD=3.56; psychotic symptom severity [sum of global ratings for delusions and hallucinations]: mean=6.45, SD=2.41; disorganized symptom severity [sum of global ratings for disorganized behavior, positive formal thought disorder, and inappropriate affect]: mean=5.49, SD=2.60). The explanation most often offered for any beneficial effects of reducing DUP is the postulate that untreated psychosis results in changes in the brain that are difficult to reverse and therefore treatment delay is somehow neurotoxic. 123, No. mechanism underlying untreated psychosis on brain structure. Andreasen NC: Scale for the Assessment of Positive Symptoms (SAPS). 1, Journal of Psychiatric Research, Vol. by itself i mean untreated psychosis, there have been no proof that psychosis itself , if untreated ,causes damage/ shrinkage /loss of the brain tissue but the use of Aps definitely caused the issue , i really dun know,… All scans were rated for overall quality and for movement artifacts by using a 0–4 scale (0=very poor, 4=excellent). 2018 Mar 16;669:59-67. doi: 10.1016/j.neulet.2016.10.003. Please enable it to take advantage of the complete set of features! These results suggest that large-scale initiatives designed to prevent neural injury through early intervention in the prepsychotic or early psychosis phase may be based on incorrect assumptions that neurotoxicity or cognitive deterioration may be avoided. Stone WS, Cai B, Liu X, Grivel MM, Yu G, Xu Y, Ouyang X, Chen H, Deng F, Xue F, Li H, Lieberman JA, Keshavan MS, Susser ES, Yang LH, Phillips MR. JAMA Psychiatry. Acta Psychiatr Scand 1999; 100:96-104Crossref, Medline, Google Scholar, 14. 69, No. Schizophr Bull 1998; 24:425-435Crossref, Medline, Google Scholar, 39. Patients with a short duration of untreated initial psychosis had significantly thicker sulcal cortical depth (mean=1.90 mm, SD=0.23, versus mean=1.77 mm, SD=0.17, respectively). 118, No. Published by Elsevier B.V. NLM Patients with a short duration of untreated initial psychosis had less impairment in verbal memory than those with a long duration of untreated initial psychosis (mean=–1.21, SD=0.97, versus mean=–1.51, SD=0.98, respectively) (Wilcoxon’s rank sum z=1.9, N=156, p=0.05). Longer duration of untreated psychosis was associated with accelerated hippocampal atrophy during initial antipsychotic treatment of first-episode schizophrenia, suggesting that psychosis … “Full psychotic syndrome” was defined as the presence of any one of five positive symptoms (i.e., delusions, hallucinations, bizarre [disorganized] behaviors, positive formal thought disorder, and catatonic motor behavior) rated at a severity level of moderate or worse. To our knowledge, this is by far the largest study to examine the neurocognitive and brain morphology correlates of duration of untreated initial psychosis. Proton density and T2-weighted images were acquired with the following parameters: 3-mm coronal slices, TE=36 msec (for proton density) or 96 msec (for T2), TR=3000 msec, number of excitations=1, field of view=26 cm, matrix=256×192, and echo train length=8.