Scully P J, Coakley G, Kinsella A, Waddington J L
St. Davnet's Hospital, Monaghan, Ireland.
Psychol Med. 1997 Nov;27(6):1303-10. doi: 10.1017/s0033291797005722.
It has been suggested that the expression of psychosis may reflect an active morbid process that is associated with increasingly poor outcome unless ameliorated by antipsychotic drugs.
The subjects of this study were 48 in-patients with schizophrenia, many of whom had been admitted before the introduction of antipsychotic drugs to rural Irish psychiatric hospitals in the late 1950s. Each patient was assessed for positive and negative symptoms, and for general and executive (frontal) cognitive function.
After controlling for age and for duration and continuity of subsequent antipsychotic treatment, current severity both of negative symptoms and of general cognitive impairment was predicted strongly by increasing duration of initially untreated psychosis; duration of illness following initiation of antipsychotic medication failed to predict the severity thereof. Neither of these indices of illness duration predicted the severity of positive symptoms or of executive dyscontrol.
Increasing duration of initially untreated psychosis was associated specifically with heightened accrual of prominent negative symptoms and general cognitive impairment. Executive dyscontrol, though also prominent in these patients, may be 'locked-in' at an earlier phase of the illness.
有观点认为，精神病的表现可能反映了一种活跃的病态过程，若不通过抗精神病药物改善，该过程会导致预后越来越差。
本研究的对象为48名精神分裂症住院患者，其中许多人在20世纪50年代末抗精神病药物引入爱尔兰农村精神病院之前就已入院。对每位患者进行阳性和阴性症状评估，以及一般和执行（额叶）认知功能评估。
在控制年龄以及后续抗精神病治疗的持续时间和连续性后，最初未治疗的精神病持续时间增加强烈预示着当前阴性症状和一般认知障碍的严重程度；抗精神病药物治疗开始后的病程未能预测其严重程度。这两个病程指标均未预测阳性症状或执行功能障碍的严重程度。
最初未治疗的精神病持续时间增加尤其与明显的阴性症状累积和一般认知障碍加剧相关。执行功能障碍虽然在这些患者中也很突出，但可能在疾病的较早阶段就已“固定”。
