Table 3 Correlations between positive and negative symptoms (Spearman correlation) P1 delusions P2 conceptual disorganization P3 hallucinatory behavior P4 excitement P5 grandiosity P6 suspiciousness/persecutions P7 hostility a p < 0.05 N1 blunted affect N2 emotional withdrawal N3 poor rapport –0.05 0.13 –0.01 –0.34a –0.25a –0.02 –0.17 –0.11 0.21a 0.08 –0.24a –0.08 0.17 0.12 –0.06 0.46a 0.10 –0.01 –0.09 0.18 0.28a Discussion This study is unique in its detailed evaluation of individual symptoms in patients experiencing first-episode schizophrenia. Observed psychopathology on positive subscale of PANSS at the initial assessment demonstrated the highest occurrence of suspiciousness/feelings of persecutions (82.3%), delusions (77%), conceptual disorganization (64.7%), and hallucinatory behavior (59.3%). Excitement, grandiosity and hostility were less frequent. All negative symptoms were present in about half the patients. The negative symptoms present in first hospitalized, drug-naive patients could be considered as primary negative symptoms (Peralta et al 2000). In a methodologically sound study, Peralta came to the conclusion, that negative symptoms rated during a first psychotic episode before and after starting antipsychotic treatment are mainly primary in character, and should be considered as a direct manifestation of the basic dysfunctions of schizophrenia. The high scores of negative symptoms, although it exceeds numerically the positive symptom score, is comparable with previously published studies that assessed symptoms by means of the PANSS and gave initial values (Sanger et al 1999; Oosthuizen et al 2004). In our sample, the most frequent general symptoms were lack of judgment and insight (87.6%), poor attention (70%), disturbance of volition (65.4%), active social avoidance (64%), preoccupation (60%), and unusual thought content (53%). Overall, the most frequently observed symptoms after admission were lack of judgment and insight and suspiciousness/feelings of persecutions. At discharge, lack of judgment and insight was present in 55.7% of patients. As for negative symptoms, blunted affect was present in 22.1% of patients, emotional withdrawal in 21.2%, and passive/apathetic social withdrawal in 19.5% of patients. As for positive symptoms, Neuropsychiatric Disease and Treatment 2005:1(2) First-episode schizophrenia N6 N4 N5 lack of passive/apathetic difficulty spontaneity N7 social in abstract and flow of stereotyped withdrawal thinking conversation thinking –0.07 0.23a 0.05 –0.24a –0.16 0.17 0.15 0.14 0.62a 0.00 0.41a 0.23a 0.24a 0.34a –0.07 0.29a 0.09 –0.16 –0.21a 0.11 0.18 0.04 0.56a 0.02 0.21a 0.07 0.30a 0.24a suspiciousness/feelings of persecutions persisted in 20.6% and grandiosity in 20.6% of patients. The high percentage of patients with lack of judgment and insight could contribute to the well known fact that patients with first- episode schizophrenia are highly noncompliant. Coping with first-episode schizophrenia may be similar to that seen in patients with serious somatic diseases, where denial is one of the first phases. Despite a favorable acute response profile, first-episode patients have been shown to experience a high rate of psychotic relapse, particularly if they have discontinued antipsychotic medication (Gitlin et al 2001). As for the treatment response, our results are consistent with those of prior studies of patients with first-episode schizophrenia that have found favorable rates of therapeutic response to antipsychotic drugs. In our sample a statistically significant improvement of both positive and negative symptoms was observed, but the reduction was less marked for negative symptoms. Most studies of first-episode schizophrenia report that the reduction of positive symptoms is faster and more complete, and negative symptoms usually persist in a mild form (Remington et al 1998; Bradford et al 2003; Oosthuizen et al 2004). The influence on negative symptoms in studies with the same acute treatment duration (6 weeks) was minor compared with the influence on positive symptoms and it was comparable with our results. The mean dose used in our patients is in agreement with observations suggested that first-episode patients may be more sensitive to the pharmacologic effects of antipsychotic drugs and may thus require lower drug doses (McEvoy et al 1991; Remington et al 1998). In a categorical analysis of the response rate, in a 6-week, randomized, controlled trial comparing the effects of risperidone with those of haloperidol, the response rates were 63% for risperidone and 56% for haloperidol (Emsley 1999). In another double-blind, 6-week acute treatment 183