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Am J Psychiatry 1996; 153:519-525
Copyright © 1996 by American Psychiatric Association
Course of treatment response in first-episode and chronic schizophrenia
SR Szymanski, TD Cannon, F Gallacher, RJ Erwin and RE Gur
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
OBJECTIVE: The timing and clinical correlates of symptom change following
antipsychotic treatment were examined in first-episode and chronic
schizophrenia. METHOD: The subjects were 36 first-episode schizophrenic
patients who had received minimal or no neuroleptics and 34 patients with
chronic illness whose neuroleptics had been withdrawn. They were followed
for 2 years and assessed with the Scale for the Assessment of Positive
Symptoms and the Scale for the Assessment of Negative Symptoms. Treatment
decisions during follow-up were made clinically by the treating physicians.
RESULTS: At 6-month follow-up, both the neuroleptic-naive and previously
treated patients showed significant improvement in positive symptoms (52%
and 44% reductions from baseline, respectively). The previously treated but
not the neuroleptic-naive patients also showed a significant reduction in
negative symptoms (19% from baseline). A longer duration of illness before
baseline assessment and inconsistent treatment during follow-up were
independently associated with poorer treatment outcome in terms of positive
symptoms in both groups. There were no significant changes on the outcome
measures in either group after the 6-month follow-up. CONCLUSIONS: The
results suggest that maximum symptomatic improvement occurs within the
first 6 months of treatment and that disease progression may blunt
treatment efficacy in both first-episode and chronic schizophrenia.
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