Psychopathology in never-treated schizophrenia

The effect of drug treatment and its adverse effects confound studies on symptoms and associated factors in schizophrenia. Knowledge of psychopathology in the untreated state would identify the natural state of the illness and is relevant to understand pathology underlying the illness. We report here symptoms of schizophrenia as measured by Positive and Negative Syndrome Scale in 143 patients with schizophrenia living in the community never treated with antipsychotic drugs. Positive symptoms were more frequent than negative ones. Negative subscale scores correlated negatively with positive subscale scores and positively with general psychopathology subscale scores. Age correlated negatively with negative and general psychopathology subscale scores independent of duration of illness. Duration of illness and the proportion of life spent in psychosis did not correlate with any Positive and Negative Syndrome Scale scores. The factors (negative, positive, anxiety-depression, motor, and excitement) extracted by a forced 5-factor analysis explained 56% of variance. This factor structure resembled that of treated patients reported in most studies except for the identification of a motor symptom cluster. Psychopathology in the never-treated schizophrenia varied in some aspects from descriptions in the treated state. The differences can be said to demarcate the natural features of the illness from medication effects on the relationship of symptoms with one another and to sex, age, duration of illness, and age at onset.