آسیب شناسی روانی در اسکیزوفرنی هرگز درمان نشده

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.

One of the greatest challenges for clinicians and researchers with schizophrenia is the heterogeneity of the clinical manifestation of the disorder. There is considerable variation in symptoms in patients given this diagnosis [1]. Factor analytical studies demonstrated that symptoms occurred together as several syndromes [2], [3] and [4]. Pathophysiologic mechanisms have been proposed for the symptoms and their relationship to one another and to demographic and clinical characteristics [4], [5], [6] and [7]. Most of these studies were of patients who received drugs. One cannot be sure how far artifacts of drug treatment influenced these descriptions. A study of schizophrenia unmodified by drug treatment would describe the natural in situ manifestation of the illness. This would not merely be of clinical interest but of importance in understanding the neuropathology of the illness. The detailed descriptions of the illness in late 19th and early 20th centuries of the preneuroleptic era were of high clinical standards but could not directly be compared with current literature because of differences in mode of data collection and analysis. Recent studies of untreated patients usually examined either first-episode patients ill for a short time or previously treated patients in a new untreated episode [3], [8] and [9]. The phenomenology of schizophrenia present for many years without treatment was little studied in recent times. In developing countries, there are significant numbers of patients untreated for many years [10]. We described in this article clinical symptoms of schizophrenia that had lasted untreated for many years and explored their relationship to one another as well as to sex, age, age at onset, and duration of illness. The observations were compared with the reports in the literature on treated patients.

The observations on psychopathology in the never-treated schizophrenic patients showed some similarities to and differences from those described in literature on treated patients. Medication could influence the relationship of symptoms of the illness with one another and to sex, age, duration of illness, and age at onset. The delineation of a distinct motor symptom cluster in the never-treated state is of interest in the context of reducing frequency of catatonic syndromes since the introduction of antipsychotic drugs.