Throughout the world, persons diagnosed with schizophrenia may go for a long time before being properly diagnosed and receiving treatment. Sadly, this delay allows the disease to inflict additional suffering on them and their families. But even more frightening: Might the treatment delay allow the disease process to damage their brains permanently?

The answer appears to be no, according to two new studies reported in the November American Journal of Psychiatry.

These results, combined with some other recent ones along these lines, are reassuring. So assert Jeffrey Lieberman, M.D., a professor of psychiatry at the University of North Carolina at Chapel Hill, and Wayne Fenton, M.D., with the National Institute of Mental Health in Bethesda, Md., in an accompanying editorial. However, they concede that the studies do have limitations in that they were conducted retrospectively rather than prospectively.

In the first study, Lynn DeLisi, M.D., a professor of psychiatry at the State University of New York at Stony Brook, and her team interviewed 50 patients who had just experienced a first episode of schizophrenia, as well as their family members, to learn how long it had been between the time they had started experiencing the symptoms of schizophrenia and the time they sought treatment. The average duration of delusions, hallucinations, or formal thought disorder before the patients had sought treatment had been about a year, the researchers found, and the average duration of changes in social relationships, school or work performance, or personal habits had been some three and a half years.

The researchers used MRI scans to measure the left and right hemispheres, the left and right temporal lobes, and the lateral ventricles in the patients’ brains and gave the patients neuropsychological tests. The investigators then attempted to determine whether those patients whose schizophrenia had been untreated for more than a year had markedly different brain-measurement results and neuropsychological test results from those patients whose schizophrenia had gone untreated for less than a year. The answer was no, they found.

"The present study thus provides no support for the hypothesis that a period of untreated illness is toxic to brain structure or function," the researchers conclude.

In a second study, Dominic Fannon, M.D., a psychiatrist with the Institute of Psychiatry in London, and his team examined 37 patients with a first episode of psychosis and 25 matched healthy controls. Some of the patients had received no neuroleptic medication prior to the first episode of psychosis, whereas the others had. Compared with controls, the patients were found to have certain brain-anatomy abnormalities—for example, smaller total brains, smaller cortical gray matter, larger lateral ventricles, and larger third ventricles (see chart). These results were not surprising since other researchers have reported similar findings. More interestingly, however, the investigators could not find any link between the size of patients’ brain structures and whether they had received neuroleptic medication before their first psychotic episode.