Duration of untreated psychosis (DUP) appears to be the best predictor of long-term outcome in schizophrenia, claims a team from the University of Milan, Italy. They stress the importance of recognition and prompt treatment of early symptoms.

The researchers, led by A Altamura, studied the clinical charts of 67 DSM-II-R schizophrenic patients, which detailed the first episode of psychosis and the follow-up period over at least four years.

Based on the number of psychotic relapses observed during the follow-up period, they divided the participants into two groups: mono- and multi-episode patients.

Comparisons of clinical variables revealed that multi-episode patients had an earlier onset of the illness and a longer duration of DUP, defined as the interval between the onset of the first psychotic symptoms and the first antipsychotic treatment. Moreover, compared with the mono-episode group, multi-episode patients had lower scores on the Brief Psychiatric Rating Scale (BPRS), and higher 'avolition/apathy' scores on the scale for the assessment of negative symptoms. Logistic regression analysis confirmed that the DUP and the pre-treatment BPRS scores were significant predictors of outcome.

'Thus, patients with an insidious onset and more severe negative symptoms appear to be more likely to present a multi-episode course of the illness,' the researchers write.

They suggest that because of the nature of the predominant symptoms occurring at the onset of the illness, 'these patients experience a delay in the first observation, in the diagnostic assessment and, as a consequence, in the first antipsychotic treatment'.

Writing in Schizophrenia Research, Altamura's team concludes that the latency between the onset of illness and the time of first antipsychotic treatment is the most relevant predictor of schizophrenia outcome.

'Thus, the timing, in recognizing patognomonic symptoms of schizophrenia in order to start the pharmacological treatment as soon as possible, is a core issue for the clinical management of schizophrenia.

'This becomes more critical if we consider that the patients with subtle onset and predominant avolition/apathy symptoms appear to have a worse outcome,' they add.

Schizophr Res 2001; 52: 29–36