Magnetic Resonance Imaging Correlates of Duration of Untreated Psychosis in Schizophrenia




S. Bachmann*,

J. Schröder, J. Pantel, D. Weimer, S. Demisch, F. Resch, and Ch.

Mundt. Dept. of Psychiatry, Univ. of Heidelberg, D-69115,


Cerebral changes as assessed by

volumetric magnetic resonance imaging (MRI) are a well

established finding in schizophrenia. These changes primarily

strike the frontal and temporal lobe and the amygdala-hippocampus

complex. They are hypothesized to result from developmental

disorders during pregnancy and early childhood since the majority

of studies did not reveal a significant correlation between

duration of illness and the respective changes. However, most

studies did not focus on first episode patients nor did they use

a standardized interview to assess duration of illness. We

investigated the “duration of untreated psychosis”

(DUP) in 28 first admitted patients with DSM-IV schizophreniform

disorder, schizophrenia, or schizoaffective psychosis with

respect to cerebral changes as assessed by volumetric MRI. 15

healthy volunteers were included for comparison. Patients with a

long DUP (>6 months) showed significantly (p <0.05) smaller volumes of the right and left frontal lobe than those with a short DUP (< 6 months) and than the healthy controls. Similar differences – although non-significant – were found for the amygdala-hippocampus complex. The short DUP patients presented with the smallest right temporal lobe volumes (p < 0.05). Moreover, long DUP was significantly correlated with smaller left frontal lobe volume ( r = 0.44, p < 0.05). Our finding of an association of long DUP with reduced left frontal lobe volumes is consistent with recent longitudinal MRI studies demonstrating a progression of volumetric changes in the disease process. Our findings do not seem to correspond to a generalized or uniform effect of DUP on brain morphology since temporal changes were more pronounced in the short DUP patients. Further studies are necessary to explore the potential influence of environmental agents.