Schizophrenic Disorders Research Articles

What is the neurobiology of schizophrenia?

Schizophrenia spectrum disorders are brain diseases that are developmental dementias (dementia praecox). Their pathology begins in utero with psychosis most commonly becoming evident in adolescence and early adulthood. It is estimated they afflict the U.S. population at a prevalence rate of approximately 0.8%. Genetic studies indicate that these brain diseases are about 80% determined by genes and about 20% determined by environmental risk factors. Inheritance is polygenic with some 270 gene loci having been identified as contributing to the risk for schizophrenia. Interestingly, many of the identified gene loci and gene polymorphisms are involved in brain formation and maturation. The identified genetic and epigenetic risks give rise to a brain in which neuroblasts migrate abnormally, assume abnormal locations and orientations, and are vulnerable to excessive neuronal and synaptic loss, resulting in overt psychotic illness. The illness trajectory of schizophrenia then is one of loss of brain mass related to the number of active psychotic exacerbations and the duration of untreated illness. In this context, molecules such as dopamine, glutamate, and serotonin play critical roles with respect to positive, negative, and cognitive domains of illness. Acutely, antipsychotics ameliorate active psychotic illness, especially positive signs and symptoms. The long-term effects of antipsychotic medications have been debated; however, the bulk of imaging data suggest that antipsychotics slow but do not reverse the illness trajectory of schizophrenia. Long-acting injectable antipsychotics (LAI) appear superior in this regard. Clozapine remains the "gold standard" in managing treatment-resistant schizophrenia.

Impact of cannabinoids on synapse markers in an SH-SY5Y cell culture model

Patients suffering from schizophrenic psychosis show reduced synaptic connectivity compared to healthy individuals, and often, the use of cannabis precedes the onset of schizophrenic psychosis. Therefore, we investigated if different types of cannabinoids impact methylation patterns and expression of schizophrenia candidate genes concerned with the development and preservation of synapses and synaptic function in a SH-SY5Y cell culture model. For this purpose, SH-SY5Y cells were differentiated into a neuron-like cell type as previously described. Effects of the cannabinoids delta-9-THC, HU-210, and Anandamide were investigated by analysis of cell morphology and measurement of neurite/dendrite lengths as well as determination of methylation pattern, expression (real time-qPCR, western blot) and localization (immunocytochemistry) of different target molecules concerned with the formation of synapses. Regarding the global impression of morphology, cells, and neurites appeared to be a bit more blunted/roundish and to have more structures that could be described a bit boldly as resembling transport vesicles under the application of the three cannabinoids in comparison to a sole application of retinoic acid (RA). However, there were no obvious differences between the three cannabinoids. Concerning dendrites or branch lengths, there was a significant difference with longer dendrites and branches in RA-treated cells than in undifferentiated control cells (as shown previously), but there were no differences between cannabinoid treatment and exclusive RA application. Methylation rates in the promoter regions of synapse candidate genes in cannabinoid-treated cells were in between those of differentiated cells and untreated controls, even though findings were significant only in some of the investigated genes. In other targets, the methylation rates of cannabinoid-treated cells did not only approach those of undifferentiated cells but were also valued even beyond. mRNA levels also showed the same tendency of values approaching those of undifferentiated controls under the application of the three cannabinoids for most investigated targets except for the structural molecules (NEFH, MAPT). Likewise, the quantification of expression via western blot analysis revealed a higher expression of targets in RA-treated cells compared to undifferentiated controls and, again, lower expression under the additional application of THC in trend. In line with our earlier findings, the application of RA led to higher fluorescence intensity and/or a differential signal distribution in the cell in most of the investigated targets in ICC. Under treatment with THC, fluorescence intensity decreased, or the signal distribution became similar to the dispersion in the undifferentiated control condition. Our findings point to a decline of neuronal differentiation markers in our in vitro cell-culture system under the application of cannabinoids.

Written Narrative in Patients with Different Mental Disorders

Language disorders are criteria of psychopathology diagnostics listed both in the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistic Manual of Mental Disorders (DSM). However, structure and grammar remain understudied in this aspect, which makes structural analysis a relevant research topic. A structural analysis of written narrative may objectivize particular language disorders, thus facilitating psychodiagnostics of different mental disorders. The research objective was to describe the structural features of written narratives obtained from 127 patients with schizophrenic, bipolar, and personality disorders. The narratives were subjected to structural and statistical analyses. Schizophrenic narratives demonstrated a poor vocabulary, a low volume, and a high degree of formality with a passive narrator. Bipolar texts tended to be long, detailed, egocentric, and active, with multiple participles. Patients with personality disorders emotionally relived their memories, producing reflective written narratives with a lot of actors. The final list of written speech indicators to be used to distinguish between schizophrenic, bipolar, and personality disorders included such variables as text volume, verb tense, non-finite verb forms, first-person singular pronoun, number of actors, passive / active narrator, and laconic / detailed narration.

Nationwide burden of sudden cardiac death among patients with a psychiatric disorder

BackgroundPatients with psychiatric disorders have increased all-cause mortality compared with the general population. Previous research has shown that there is a fourfold increased risk of sudden cardiac death (SCD) among...

Associations Between Dry Eye Disease and Mental Health Conditions in the All of Us Research Program

To determine the association between dry eye disease (DED) and mental health conditions in a sociodemographically diverse nationwide population of Americans. Cross-sectional study. We used the National Institute of Health's All of Us Research Program database to identify 18257 participants with DED who were propensity score matched in a 1:3 ratio to participants without DED. Univariate and multivariable logistic regression models were used to assess associations between DED and mental health conditions (i.e., depressive disorders, anxiety, bipolar disorder, and schizophrenic spectrum disorder). Participants with DED had a significantly higher prevalence of depressive disorders (31.6% vs. 10.7%; P < .001), anxiety disorders (34.8% vs. 14.7%; P < .001), bipolar disorder (5.5% vs. 2.3%; P < .001), and schizophrenia spectrum disorders (2.3% vs. 0.9%; P < .001) than controls. Adjusted for medical comorbidities (i.e., hypothyroidism, Sjögren's syndrome, systemic lupus erythematosus), participants with DED had higher odds than controls in having a depressive disorder (odds ratio [OR]: 3.47; 95% CI: 3.32-3.62), anxiety (OR: 2.74; 95% CI: 2.63-2.85), bipolar disorder (OR: 2.23; 95% CI: 2.04-2.44), and schizophrenia spectrum disorder (OR: 2.48; 95% CI: 2.17-2.84). The association between DED and mental health conditions was stronger in Black participants than White participants (OR: 3.68 vs. 3.09, P < .001). Participants with DED were significantly more likely to have mental health conditions than matched participants without DED; this association was stronger in Black participants than White participants. Greater efforts should be undertaken to screen DED patients for mental health conditions, particularly in historically medically underserved populations.

Genetic determinants of antidepressant and antipsychotic drug response.

Today, more than 90% of inpatients hospitalized with Major Depression or Schizophrenia are treated with psychotropic drugs. Since none of the treatment options is causal, response rates are modest and the course of recovery is very heterogeneous. Genetic studies on the etiology and pathogenesis of major psychiatric disorders over the past decades have been largely unsuccessful. Likewise, genetic studies to predict response to psychopharmacological treatment have also not been particularly successful. In this project we have recruited 902 inpatients with ICD-10 diagnoses of schizophrenic ("F2 patients") or depressive disorders ("F3 patients"). The study assessed today's acute inpatient treatment regimens with up to 8 repeated measurements regarding the time course of recovery and adverse side effects. The genotyping included 100 candidate genes with genotypic patterns computed from 549 Single Nucleotide Polymorphisms (SNPs). To predict response to psychopharmacological treatment, we relied on a multidimensional approach to analyzing genetic diversity in combination with multilayer Neural Nets (NNs). Central to this new method were the "gene vectors" that (1) assessed the multidimensional genotypic patterns observed with genes; and (2) evaluated the correlations between genes. By means of these methods, we searched for combinations of multidimensional genotypic patterns that were characteristic of treatment responders while being rare among non-responders. The chosen method of approach provided a powerful technique to detail the complex structures of SNP data that are not detectable by conventional association methods. Molecular-genetic NNs enabled correct classification of 100% "non-responders", along with 94.7% correctly classified "responders" among the F2 patients, and 82.6% correctly classified "responders" among the F3 patients. The F2 and F3 classifiers were not disjoint but showed an overlap of 29.6% and 35.7% between the diagnostic groups, thus indicating that clinical diagnoses may not constitute etiologic entities. Our results suggested that patients may have an unspecific physical-genetic disposition that enables, facilitates, impedes or prevents recovery from major psychiatric disorders by setting various thresholds for exogenous triggers that initiate improvement ("recovery disposition"). Even though this disposition is not causally linked to recovery, it can nonetheless be clinically used in the sense of a "surrogate". Indeed, clinicians are also interested in reliable tools that can "do the job", despite the fact that etiology and pathogenesis of the treated disorders remain unknown.

Schizophrenia spectrum disorders: does the non-psychotic schizophrenia exist?

Current understanding of schizophrenia comes from Kraepelin’s dementia praecox doctrine, a disease that combined Kalbaum’s catatonia, Hecker’s hebephrenia and chronic delusional psychoses and later renamed to schizophrenia thanks to Bleuler. Since the beginning of the XX century, the systematics of schizophrenia has undergone a serious evolution and narrowing of diagnostic boundaries, which is reflected in various revisions of the ICD and editions of the DSM. Currently, the existence of non-psychotic forms of schizophrenia, mainly manifested by negative symptoms, is being questioned. In addition, the need for diagnostic differentiation of schizophrenia from autism spectrum disorder, which have only external similarities, but require fundamentally different therapeutic interventions, is emphasized.

Типы нарушений речемыслительной деятельности у пациентов с расстройствами шизофренического спектра

&lt;p&gt;In the study of schizophrenia, special attention is paid to speech disorders. However, the descriptions of linguistic component are usually phenomenological. An objective structure analysis of language is needed, which could be useful to identify additional markers in assessing mental state and clarify criteria for differential psychodiagnostic. The possibility of adapting existing English-language studies is ambiguous, and a method based on the Russian-language sample is required. The study is aimed to identify types of speech characteristics in patients with schizophrenic spectrum disorders related to patopsychological thinking characteristics. The sample consisted of 70 people: 45 schizophrenia patients, 25 conditionally healthy participants. Methods used: expert assessment, experimental methods (tests of thinking, analysis of speech production), content-analysis, statistical analysis. Schizophrenia patients&amp;rsquo; oral and written speech consist of less words, descriptions of feelings and thoughts than healthy participants. Schizophrenia patients&amp;rsquo; speech is grammatically simpler, more formal, more inclusive, low communicative than healthy participants speech. Three types of written speech were found in patients with schizophrenia: Peculiar description of internal experiences, Narrative poverty, Reference to &amp;ldquo;I&amp;rdquo;. Two types of oral speech were also found: Narrative poverty, "Philosophizing". All types of written speech and Philosophizing in oral speech were significantly related to thinking disorders. The 5 speech characteristics that form in connection with thinking disorders characteristic of schizophrenia result in 3 types of speech-thinking disorders.&lt;/p&gt;

Understanding, schizophrenia, and the limits of phenomenology

Karl Jaspers’ assertion of the un-understandability of schizophrenic psychosis, which rests on a division between what is psychologically understandable and what must be explained via natural causation, has faced numerous challenges from within phenomenological psychopathology. But despite significant developments in the phenomenology of schizophrenia, I suggest that this dichotomy, between psychological understandability and naturalistic explanation, is still present in some phenomenological research on schizophrenia today, even in work that explicitly critiques the limitations of empathic understanding and the purported incomprehensibility of schizophrenic delusions. Other theories of subjectivity, particularly those in the Lacanian tradition, offer one way to recognize the impossibility of understanding without turning to naturalistic explanation. These theories may encourage us to better integrate other key insights in phenomenology, most clearly articulated in the work of Merleau-Ponty, that look beyond “conscious” awareness—those that allow for a renewed appreciation of the un-understandable in schizophrenia, and indeed in all human experience.

The influence of family history of schizophrenic spectrum disorders on the clinical presentation of schizophrenia

Objective: to identify the characteristics of the clinical debut of schizophrenia, as well as clinical aspects related to hereditary aggravation within schizophrenic spectrum disorders.Materials and methods: patients with a confirmed diagnosis of F20.0 “Paranoid schizophrenia” selected according to inclusion/non-inclusion criteria participated in the study. Material was collected through clinical interviewing, analysis of medical records and documentation, and self-questionnaires.Results: a total of 264 individuals participated in the study. Hereditary aggravation with schizophrenic spectrum disorders within two generations was detected in 127 of them (48.1%). Our results showed that having a family history of schizophrenic spectrum disorders correlated with earlier age of schizophrenia debut (p=0.018) and higher scores on the Calgary Depression Scale (p=0.013).Conclusions: the findings may serve as an effective tool for developing more accurate diagnostic strategies in individuals at high risk of developing schizophrenia due to hereditary aggravation, as well as for the subsequent treatment of these individuals.

Histoire de la description du « signe du miroir » dans les Annales Médico-Psychologiques (1927–1930). Aperçus sur sa postérité et sa valeur sémiologique

Described as an early sign of schizophrenia (or dementia praecox) between the years 1927 and 1930 by two French psychiatrists, Paul Abély and Achille Delmas, the “mirror sign” was subsequently the object of in-depth studies by eminent specialists outside of France who discussed its semiotic value and its early interpretations. In this regard, we will underscore the key role played by psychoanalytical ideas, specifically the concept of narcissism. We will also note the relative neglect of results of the mirror test for other categories of patients, particularly those with intellectual deficiencies due to aging (a now well-studied group).

Нейропсихологическая оценка и верификация когнитивных нарушений в практике судебно-психиатрической экспертизы

&lt;p style="text-align: justify;"&gt;In modern clinical psychiatry, there is a tendency to introduce the principle of quasi-dimensional assessment, which can be facilitated by the use of specialized diagnostic methods such as neuropsychological examination. The purpose of the study is to clarify the possibilities of neuropsychological examination during forensic psychiatric examination for persons held criminally responsible. As part of the forensic psychiatric examination of persons brought to criminal responsibility on the basis of the Serbsky State Scientific Center for Social and Forensic Psychiatry Ministry of Health of the Russian Federation, 113 men (age 42&amp;plusmn;13) were examined with established groups of diagnoses, including organic, personality disorders, as well as schizophrenic spectrum disorders, disorders associated with the use of psychoactive substances. Of these, 50 people were declared &amp;ldquo;insane&amp;rdquo; and 63 were &amp;ldquo;sane&amp;rdquo;. A neuropsychological examination was performed using qualitative syndrome and quantitative analysis. In individuals with organic mental disorders (OMD), there were more pronounced disorders of neurocognitive functioning compared to those surveyed with other mental disorders. In addition, persons with OMD who were recognized as &amp;ldquo;insane&amp;rdquo;, compared with persons recognized as &amp;ldquo;sane&amp;rdquo;, had more pronounced disorders in such parameters as: programming, regulation and control, neurodynamic characteristics, auditory&amp;mdash;speech memory, with primary interest - frontal (p=0.004), temporal (p=0.004), and subcortical structures (p=0.005). The results of a neuropsychological examination can be used to verify an expert decision at the level of both medical and psychological criteria, primarily in the examination of persons suffering from an organic mental disorder.&lt;/p&gt;

Criminal Responsibility For Perpetrators of Criminal Acts With Schizophrenic Mental Disorders

Criminal Responsibility For Perpetrators of Criminal Acts With Schizophrenic Mental Disorders

Quantitative-Qualitative Assessment of Dream Reports in Schizophrenia and Their Correlations with Illness Severity.

Positive symptoms of schizophrenia have been proposed to be an intrusion of dreaming in wakefulness; conversely, psychotic patients' abnormal cognitive and behavioral features could overflow into sleep, so that their dreams would differ from those of healthy people. Here we assess this hypothesis by comparing dream features of 46 patients affected by schizophrenic spectrum disorders to those of 28 healthy controls. In patients, we also investigated correlations of dream variables with symptom severity and verbal fluency. Overall, patients reported fewer and shorter dreams, with a general impoverishment of content (including characters, settings, interactions) and higher spatiotemporal bizarreness. The number of emotions, mainly negative ones, was lower in patients' reports and correlated inversely with symptom severity. Verbal fluency correlated positively with dream report length and negatively with perceptive bizarreness. In conclusion, our data show a significant impoverishment of dream reports in psychotic patients versus controls. Future research should investigate to what extent this profile of results depends on impaired verbal fluency or on impaired mechanisms of dream generation in this population. Moreover, in line with theories on the role of dreaming in emotion regulation, our data suggest that this function could be impaired in psychoses and related to symptom severity.

How to better improve the treatment and outcomes of HCV in psychiatric patients: review of a Belgian monocentric psychiatric center.

Hepatitis C (HCV) is one of the major worldwide infections with 58 million infected persons in the world. HCV can lead to chronic liver disease, cirrhosis, and cancer. These past few years, clinical progress allowed a curative rate of 95% of the patients. There are still populations in which, treating the disease is more difficult, especially psychiatric patients, when substance abuse, psychiatric disorders are important risks factors for getting HCV. With the WHO organization establishing goals for clinical management and treatment of HCV, it is important to target where the difficulties lie in getting a better treatment program for those populations. Try to highlight the challenges of treating a certain group of patients compare to the general population. This is a cross sectional monocentric study. 79 patients from a mental facility were included between 2012 and 2022. Inclusion criteria were: >18 years old, an active viral HCV infection. 34.7% of patients with a positive PCR were treated with a significant difference between the closed psychiatric unit and the open one (66.5 vs 22.6%, p<.05). There was an 82.4% eradication rate (Sustained Viral Response at 3 months). There were significantly more schizophrenic disorders in the closed unit and significantly more alcohol abuse in the open one. Treatment of HCV in a psychiatric population is feasible with eradication rate equivalent at those in the general population. Patients with more severe mental illness are better treated in the configuration of a closed psychiatric unit.

Treatment adherence rates across different psychiatric disorders and settings: findings from a large patient cohort.

Approximately 50% of patients with psychiatric disorders do not fully adhere to the prescribed psychopharmacological therapy, significantly impacting the progression of the disorder and the patient's quality of life. The present study aimed to assess potential differences in terms of rates and clinical features of treatment adherence in a large cohort of psychiatric patients with different diagnoses attending various psychiatric services. The study included 307 psychiatric patients diagnosed with a primary major depressive disorder, bipolar disorder, anxiety disorder, schizophrenic spectrum disorder, or personality disorder. Patient's adherence to treatment was evaluated using the Clinician Rating Scale, with a cutoff of at least five defining adherence subgroups. One-third of the sample reported poor medication adherence. A lower rate of adherence emerged among patients with schizophrenic spectrum disorder and bipolar disorder. Subjects with poor adherence were more frequently inpatients and showed higher current substance use, a greater number of previous hospitalizations, and more severe scores at psychopathological assessment compared with patients with positive adherence. Poor adherence was associated with symptom severity and increased rates of relapses and rehospitalizations. In addition, substance use appears to be an unfavorable transdiagnostic factor for treatment adherence.

Nationwide burden of sudden cardiac death among patients with a psychiatric disorder

Abstract Background and aim Patients with psychiatric disorders have increased all-cause mortality compared to the general population. Previous research has shown that they have a 4-fold increased risk of sudden cardiac death (SCD) among the young. However, the risk across all age groups remains unknown. Purpose To investigate the incidence of SCD in patients with psychiatric disorders aged 18-90 years in the Danish population by systematically reviewing all deaths in one year. Methods We examined all deaths in Denmark among residents aged 18-90 years in 2010 by reviewing death certificates and autopsy reports. All deaths were categorized as non-SCD, or SCD, based on the available information. Psychiatric disorder was defined according to ICD-10 criteria, or by redemption of a prescription for psychotropic medication within one year prior to death. Results Out of 4.3 million residents in 2010 aged 18-90 years, we observed 45 703 deaths of which 6 002 were SCD. Overall, the incidence of SCD was 4.35 times (CI: 4.20-4.50, p-value &amp;lt;0.001) higher among patients with psychiatric disorders than in the general population and was age dependent (p-value &amp;lt;0.001). When adjusting for age, sex, and comorbidities, psychiatric disorders were independently associated with SCD, with a hazard ratio (HR) of 2.46 (2.33-2.60, p-value: &amp;lt;0.001), with highest SCD risk among patients suffering from schizophrenic disorders with a HR of 5.27 (4.23-6.56 p-value &amp;lt;0.001). Furthermore, patients with psychiatric disorders had an expected 10-year excess loss of life of which 13% was caused by SCD. Conclusion The rate of SCD in patients with psychiatric disorders was 4 times higher than in the general population. Having a psychiatric disorder is independently associated with SCD. Life-expectancy for an 18-year-old with a psychiatric disorder is projected to be 10-years shorter in comparison.Incidence rate of SCD by age groupExcess loss of life-years

The Dopamine Hypothesis as a Causal Explanation of Schizophrenia

Schizophrenia, a severe psychiatric disorder, profoundly impacts individuals, families, and society, characterized by symptoms such as delusions, hallucinations, disorganized thinking, speech, and motor behavior, as outlined in the DSM-5 criteria. Coined by Eugen Bleuler in 1911 to emphasize fragmented cognition, the term "schizophrenia" replaced Emile Kraepelin's "dementia praecox"(1908) reflecting its chronic nature, with an estimated prevalence of 1% in the general population and a significant heritability rate of around 79%. The dopamine hypothesis, central to schizophrenia research, suggests heightened dopaminergic transmission as a primary factor in its development, supported by the efficacy of antipsychotic drugs targeting dopamine receptors. However, recent studies have revealed complexities beyond dopamine dysfunction, including the glutamate hypothesis, which proposes deficits in glutamate activity as an alternative explanation. This essay critically evaluates the dopamine hypothesis within the broader biopsychosocial framework, emphasizing the interaction of biological, psychological, and social factors in schizophrenia etiology. Despite its foundational role, the dopamine hypothesis has limitations in fully clarifying the multifaceted nature of schizophrenia, highlighting the need for comprehensive approaches integrating diverse perspectives and methodologies to enhance understanding of this complex disorder. Keywords: Dopamine Hypothesis, Schizophrenia, Mental Illness, Psychotic Symptoms, GENE x ENVIROMENT Interaction

Towards the DSM-6: Results of a Survey of Experts on the Reintroduction of First-Rank Symptoms as Core Criteria of Schizophrenia and on Redefining Hallucinations.

Diagnostic criteria for mental disorders are subject to change. This is particularly true for schizophrenia, whose diagnostic criteria in the current DSM-5 bear little resemblance to what Kraepelin once named "dementia praecox" and Bleuler termed "the schizophrenias." The present study reports results from a survey of experts on two core topics of schizophrenia: (a) whether subsequent editions of the DSM should once again give the Schneiderian first-rank symptoms (FRS; eg, thought broadcasting) the prominent role they had in the DSM-IV and (b) whether the currently quite narrow definition of hallucinations in the DSM-5 requiring them to be vivid and clear and have the full force and impact of normal perceptions should be broadened to incorporate perceptual-like phenomena that the individual can differentiate from proper perceptions but still perceives as real and externally generated. The aim of the survey was to learn about experts' opinions with no clear hypotheses. International experts on schizophrenia were recruited via various sources and invited to participate in a short online survey. The final sample comprised 136 experts with a subgroup of 53 experts with verified identity and at least 6 years of clinical and/or research experience. Slightly more experts voted in favor (49.3%) of returning FRS to the prominent role they had in earlier versions of the DSM than against (34.6%). Approximately four out of five experts agreed that the definition of hallucinations in the DSM should be expanded. According to the results, alongside internal symptoms that are phenomenologically indistinguishable from true perceptions, sensory intrusions that the holder is convinced were inserted from another source (ie, not self-generated) should be included in the definition. While a large majority of experts recommend a change in the definition of hallucinations, the experts' opinions on FRS are more mixed. We hope that this article will stimulate future studies targeting the diagnostic relevance of these symptoms and encourage discussion about the definition of core psychotic symptoms and the diagnostic criteria for the upcoming edition of the DSM.

INFLUENCE OF DURATION OF UNTREATED PSYCHOSIS ON THE SHORT-TERM OUTCOME IN FIRST-EPISODE SCHIZOPHRENIA

Objectives: Schizophrenia is a devastating disease and many patients present late for treatment due to difficulty in identifying symptoms by family members. The objective of this study is to find if there is an association between a longer duration of untreated psychosis (DUP) and poor treatment outcome in first-episode Schizophrenics and to find if there is an association between premorbid social adjustment on DUP. Methods: Anti-psychotic-naïve patients with an international classification of diseases-10 schizophrenia were evaluated 12 weeks after their first in-patient hospitalization. Association between untreated initial psychosis duration (measured from the beginning of first symptom as well as from first hospital admission) was examined by conducting the clinical interview, symptom severity by positive and negative syndrome scale, and clinical global impression scale, pre-morbid social adjustment by premorbid social adjustment (PSA) scale; and symptoms improvement after treatment by CGI-I scale. Results: Of the 57 patients studied, 57.9% showed improvement after treatment, paranoid type was more common, patients responded better when treated with combined typical and atypical antipsychotics and improvement was better when DUP was &lt;2 years. There was a major negative correlation between positive syndrome scores and DUP. There was no association of DUP with negative syndrome score, psychopathology score and PSA score. Conclusion: DUP was an independent predictor of treatment outcome and early intervention is necessary for better prognosis.