Untreated schizophrenia may spare brain

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.