O R I G I N A L R E S E A R C H Psychopatholog y and treatment responsiveness of patients with first-episode schizophrenia Eva C° ešková Radovan Pr°ikr yl Tomáš Kašpárek Marta Ondrušová Department of Psychiatry, Masaryk University and Faculty Hospital Brno, Czech Republic Correspondence: Eva C°ešková Department of Psychiatry, Masaryk University and Faculty Hospital Brno, Jihlavska 20, Brno-Bohunice, 625 00 Brno, Czech Republic Tel +42 5 3223 2053 Fax +42 5 3223 3706 Email eceskova@fnbrno.cz Abstract: One hundred and four male patients hospitalized for the first time with the diagnosis of first-episode schizophrenia were comprehensively assessed on admission and discharge. Psychopathology, treatment response, and remission rates were evaluated (based on the Positive and Negative Syndrome Scale (PANSS), severity of symptoms only). On admission, the most frequently observed symptoms were lack of judgment and insight (87.6%), suspiciousness/ feelings of persecution (82.3%), delusions (77%), poor attention (70%), disturbance of volition (65.4%), conceptual disorganization (64.7%), and active social avoidance (64%). Except for delusions and hallucinations, the positive items of the PANSS correlated significantly with negative symptoms, and conceptual disorganization correlated with the greatest number of negative symptoms. Individual negative symptoms were present in about half the patients. At discharge, the most frequent symptoms were again lack of judgment and insight (in 55.7%), and for negative symptoms they were blunted affect (22.1%), emotional withdrawal (21.2%), and passive/apathetic social withdrawal (19.5%). The positive symptoms of suspiciousness/ feelings of persecution and grandiosity persisted in 20.6% of patients. On average, all symptoms were significantly reduced 44 days after admission. The negative symptoms improved less, compared with the positive ones. At discharge there was a high rate of responders (response defined as minimal 30% reduction of total PANSS): 73% and 74% of patients fulfilled the criteria for remission. On admission, the responders (n = 76) had significantly higher scores of most symptoms, both positive and negative ones than nonresponders (n = 28). Keywords: first-episode schizophrenia, treatment response, psychopathology, remission Introduction Studying drug-naive, first-episode patients has several advantages, including the opportunity to assess symptoms and signs of illness before the confounding effects of treatment, which ultimately are difficult to disentangle from the effects of illness progression. The investigation of responses to medication offers similar advantages. The small number of clinical trials exploring first-episode schizophrenia leaves a gap between evidence-based and practice-based management. The available data indicate that in first-episode patients, positive symptoms, including hallucinations and delusions, will most often remit with antipsychotic treatment. According to Bradford et al (2003), estimates of the proportion of first-episode patients responding to acute antipsychotic treatment vary from 29% to 96%. The variance in response rates in these studies is related to a number of factors, but most importantly to the duration of the antipsychotic trial, the definition of response, and the drug administered. The treatment of patients with first-episode schizophrenia has specific features. Compared with later stages of the disease, the first episode is characterized by a more pronounced drug response. Furthermore, both positive and negative symptoms Neuropsychiatric Disease and Treatment 2005:1(2) 179 –185 © 2005 Dove Medical Press Limited. All rights reserved 179