First-episode Schizophrenia: I. Early Course Parameters

Concepts and definitions pertaining to the early course of schizophrenia are reviewed, along with recent illustrative studies of first-episode schizophrenia. Early course parameters of a Norwegian first-episode sample are presented. This sample (n = 43) demonstrated strong gender differences, with male patients having significantly higher frequency of single marital status, lower educational status, schizophrenia, early age at onset, and lower Global Assessment of Functioning scores the last year before hospitalization. The duration of untreated psychosis (DUP) was long (mean = 114 weeks), as in other studies. Longer DUP was associated with poorer work, social, and global functioning in the year before admission, with more insidious onset of psychosis, and with more negative symptoms at first clinical presentation. Longer DUP was not associated with the age at onset of psychosis. These findings were mostly gender independent. The data help to frame questions about why patients can be psychotic for so long before getting help. Finally, suggestions are offered for the definition and measurement of early course parameters for schizophrenia.