111, No. 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). 4, Social Psychiatry and Psychiatric Epidemiology, Vol. Untreated Psychosis Has Long-Term Impact on Memory. It has been postulated that untreated psychosis might be neurotoxic to the brain (Wyatt, 1991) and result in cognitive impairments and changes in brain morphology. Arch Gen Psychiatry 1992; 49:615-623Crossref, Medline, Google Scholar, 26. 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. 39, No. 10, Social Psychiatry and Psychiatric Epidemiology, Vol. s429, 1 October 2005 | American Journal of Psychiatry, Vol. The reasons for these conflicting findings may be related to differences in sampling, power, and statistical methods (4, 45) as well as in the reliability and validity of measuring the duration of untreated initial psychosis (46). 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. Epub 2019 Nov 9. METHOD: A total of 156 subjects with DSM-IV schizophrenia, schizophreniform disorder, or schizoaffective disorder were evaluated during their first episode of psychosis. These two associations lend support for the “toxic psychosis” hypothesis. The aim of this study was to test whether untreated psychosis may be biologically toxic. 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. If there is any effect, it might rather occur very early in the disease process, during which patients experience only unspecific symptoms. 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). Biol Psychiatry Cogn Neurosci Neuroimaging. McGorry PD: Evaluating the importance of reducing the duration of untreated psychosis. J Psychiatr Res 1998; 32:151-159Crossref, Medline, Google Scholar, 13. Am J Psychiatry 2000; 157:808-815; correction, 2001; 158:986Google Scholar, 19. 2, The Canadian Journal of Psychiatry, Vol. Am J Psychiatry 2000; 157:1824-1828Link, Google Scholar, 20. ), suggesting that additional pathogenic processes may contribute to further deteriorative progression in these deficits. Carbone S, Harrigan S, McGorry PD, Curry C, Elkins K: Duration of untreated psychosis and 12-month outcome in first-episode psychosis: the impact of treatment approach. 4, British Journal of Psychiatry, Vol. In order to provide comprehensive yet efficient measurements of the subjects’ cognitive functioning, 36 neuropsychological test variables were grouped into nine cognitive domains: verbal memory, nonverbal memory, working memory, language skills, visuospatial skills, initiation and speed, sustained and selective attention, problem solving, and motor skills (Appendix 1). 8, Journal of Psychiatric and Mental Health Nursing, Vol. Schizophr Bull 1998; 24:425-435Crossref, Medline, Google Scholar, 39. 2, European Neuropsychopharmacology, Vol. 123, No. In addition to volumetric brain measures, quantitative indices of surface anatomy were obtained through a method that generated a triangle-based isosurface: cortical thickness (cerebral cortical depth, sulcal cortical depth, gyral cortical depth), sulcal curvature index, gyral curvature index, cortical surface area, and surface complexity index (35). Published by Elsevier B.V. NLM Iowa City, University of Iowa, 1983Google Scholar, 27. Andreasen NC, Harris G, Cizadlo T, Arndt S, O’Leary D, Swayze V, Flaum M: Techniques for measuring sulcal/gyral patterns in the brain as visualized through magnetic resonance scanning: BRAINPLOT and BRAINMAP. One concern regarding treatment delays is the potential for untreated psychosis to be toxic to the brain (5, 6). This article was entitled “Brain Boom”, and it was written by Mathew Herper. Studies examining the relation between DUI and brain structure are therefore more likely to be informative if conducted in previously untreated patients. 2,6,7 This explains why enlarged ventricles are a common radiologic finding in patients with schizophrenia. Schizophr Res 2000; 45:1-9Crossref, Medline, Google Scholar, 15. Our study had the power to detect at least small to moderate correlations. 1, No. "When psychosis is present, the life-threating effects of untreated illness outweigh any adverse effects on brain structure," said Dr. Voineskos. 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. Weinberger DR: Implications of normal brain development for the pathogenesis of schizophrenia. 3, Psychiatry Research: Neuroimaging, Vol. Hoff AL, Sakuma M, Razi K, Heydebrand G, Csernansky JG, DeLisi LE: Lack of association between duration of untreated illness and severity of cognitive and structural brain deficits at the first episode of schizophrenia. 1-3, Schizophrenia Research, 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). In addition to interviews with the subjects, supplemental information was obtained from collateral sources, including family members and previous medical records, to complete the comprehensive intake evaluation. Volumes of tissue were then obtained from each region in an automated fashion. 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. Intracranial volume was divided into brain tissue and CSF. 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. 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