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Ding Y, Hou W, Wang C, Sha S, Dong F, Li X, Wang N, Lam ST, Zhou F, Wang C. Longitudinal changes in cognitive function in early psychosis: a meta-analysis with the MATRICS consensus cognitive battery (MCCB). Schizophr Res 2024; 270:349-357. [PMID: 38968806 DOI: 10.1016/j.schres.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/14/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION A previous meta-analysis indicated stable progress in cognitive functions in early psychosis, assessed through various tools. To avoid assessment-related heterogeneity, this study aims to examine the longitudinal cognitive function changes in early psychosis utilizing the MATRICS Consensus Cognitive Battery (MCCB). METHODS Embase, PubMed, and Scopus were systematically searched from their inception to September 26th 2023. The inclusion criteria were longitudinal studies that presented follow-up MCCB data for individuals experiencing first-episode psychosis (FEP) and those with ultra-high risk for psychosis (UHR). RESULTS Twelve studies with 791 participants (566 FEP patients and 225 healthy controls) were subjected to analysis. Suitable UHR studies were absent. Over time, both FEP patients and healthy controls showed significant improvements in MCCB total scores. Furthermore, FEP patients demonstrated improvements across all MCCB domains, while healthy controls only showed augmentations in specific domains such as speed of processing, attention, working memory, and reasoning and problem-solving. Visuospatial learning improvements were significantly greater in FEP patients compared to healthy controls. Subgroup analyses suggested that neither diagnostic type nor follow-up duration influenced the magnitude of cognitive improvement in FEP patients. CONCLUSION The magnitude of cognitive improvement for MCCB domains was not significantly different between FEP and healthy controls other than visuospatial learning. This underscores visuospatial learning as a potentially sensitive cognitive marker for early pathologic state changes in psychotic disorders.
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Affiliation(s)
- Yushen Ding
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Wenpeng Hou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Chenxi Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Fang Dong
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Xianbin Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Nan Wang
- Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747, Singapore.
| | - Sze Tung Lam
- Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore.
| | - Fuchun Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Chuanyue Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Chan SKW, Pang TSW, Tsui HKH, Suen YN, Yan WC, Tsui CF, Poon LT, Chan CWH, Lo A, Cheung KM, Hui CLM, Chang WC, Lee EHM, Chen EYH, Honer WG. Modeling the effects of treatment resistance and anticholinergic burden on cognitive function domains in patients with schizophrenia. Psychiatry Res 2024; 337:115985. [PMID: 38820652 DOI: 10.1016/j.psychres.2024.115985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
The contribution of anticholinergic burden to cognitive function in patients with treatment resistant schizophrenia (TRS) is uncertain. This case-control study aims to comprehensively examine the association between treatment resistance and cognitive functions and the contribution of anticholinergic burden in patients with schizophrenia. Anticholinergic burden of all patients was calculated using the Anticholinergic Cognitive Burden scale. Exploratory Factor Analysis of 11 cognitive assessments identified four cognitive domains: verbal memory, attention and general cognitive functions, visual memory and processing speed, and executive function. Two structural equation models (SEM) examined the relationship of TRS and these cognitive functions with, and without considering anticholinergic burden. A total of 288 participants were included (TRS N=111, non-TRS N=177). Patients with TRS performed poorer than the non-TRS group only in the executive function domain. Anticholinergic burden contributed significantly to the attention and general cognitive functions, visual memory and processing speed, and executive function. The impact of TRS on executive function was no longer significant after adding anticholinergic burden to the SEM. Results suggested that anticholinergic burden contributes to a wide range of cognitive function impairment in patients with schizophrenia and is likely to be part of the apparent differences of cognitive function between TRS and non-TRS.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR.
| | - Tiffanie Sze Wing Pang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Harry Kam Hung Tsui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yi Nam Suen
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Wai Ching Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR
| | - Chi Fong Tsui
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR
| | - Lap-Tak Poon
- Department of Psychiatry, United Christian Hospital. Hong Kong SAR
| | | | - Alison Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR
| | | | - Christy Lai Ming Hui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
| | - Edwin Ho Ming Lee
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
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Mueser KT, Sussman RF, DeTore NR, Eberlin ES, McGurk SR. The impact of early intervention for first episode psychosis on cognitive functioning. Schizophr Res 2023; 260:132-139. [PMID: 37657279 PMCID: PMC10592046 DOI: 10.1016/j.schres.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/17/2023] [Accepted: 07/23/2023] [Indexed: 09/03/2023]
Abstract
IMPORTANCE Impaired cognitive functioning is a core characteristic of schizophrenia, present from the onset of the illness and relatively stable thereafter. Despite evidence supporting the impact of early intervention services (EIS) on improving symptoms and functioning in first episode psychosis (FEP), controlled research has not examined its impact on cognitive functioning. OBJECTIVE To evaluate the longitudinal course of cognitive functioning in FEP patients participating in a large, controlled study comparing EIS with usual services. METHODS A total of 404 persons ages 15-40 years old with non-affective FEP participated in the Recovery After Initial Schizophrenia-Early Treatment Program. A cluster randomized controlled trial was conducted with 34 community mental health treatment centers across the U.S. randomized to provide either an EIS program (NAVIGATE) or usual Community Care (CC) to FEP patients for 2 years. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline and 1- and 2-years later. RESULTS Older participants (≥20 years old) in both treatment groups improved on all BACS tests. Younger participants (15-19) in NAVIGATE improved significantly more on Digit Sequencing (working memory) than those in CC, whereas both groups improved on most of the other BACS tests. Improvements in cognitive functioning occurred mostly over the first year and were correlated with reductions in symptom severity. DISCUSSION EIS do not improve cognitive functioning more than usual care for older FEP patients but may improve working memory in younger FEP patients. Interventions targeting cognition may be required to enhance cognitive functioning in most FEP patients.
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Affiliation(s)
- Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA; Department of Occupational Therapy, Boston University, Boston, MA, USA.
| | - Rachel F Sussman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Nicole R DeTore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA; Department of Occupational Therapy, Boston University, Boston, MA, USA
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Torgalsbøen AK, Mohn C, Larøi F, Fu S, Czajkowski N. A ten-year longitudinal repeated assessment study of cognitive improvement in patients with first-episode schizophrenia and healthy controls: The Oslo Schizophrenia Recovery (OSR) study. Schizophr Res 2023; 260:92-98. [PMID: 37634387 DOI: 10.1016/j.schres.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/19/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
The mapping of cognitive trajectories after a first episode of schizophrenia has been the aim in several studies, but the longitudinal course of cognitive impairments remains an important question. Due to methodological limitations, it has been challenging to pinpoint specific periods of improvement or stability in cognitive functioning over time. The objective of this study is to further clarify the longitudinal course of cognitive change after a first episode of schizophrenia through frequent repeated measurement. A total of 56 persons participated in the study (28 first episode patients and 28 healthy pairwise matched controls) with 79 % of patients retained at the 10-year follow-up. The Oslo Schizophrenia Recovery study has a repeated measurement design and includes data from nine cognitive assessments over 10 years. Cognition was assessed with the MATRICS Consensus Cognitive Battery, which is well suited for repeated measurements. Data were analyzed with linear multilevel models. The results challenge some of the views about the course of cognitive impairment in first-episode schizophrenia patients. Using quadratic time effects in our analyses and balancing the patient group with regards to the most relevant confounding demographic variables such as age, gender, and education, we showed that cognitive deficits change and improve more than in healthy individuals until year 6, when both groups stabilize. The patient group improved on some of the most important cognitive domains associated with functional outcome with 63.5 % full recovery at 10-year follow-up.
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Affiliation(s)
| | - Christine Mohn
- CoE NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Frank Larøi
- Department of Psychology University of Oslo, PO Box 1094, 0373 Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Susie Fu
- Vestre Viken Hospital Trust, PO Box, 800, 3004 Drammen, Norway
| | - Nikolai Czajkowski
- Department of Psychology University of Oslo, PO Box 1094, 0373 Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, 0403 Oslo, Norway
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Gurvich C, Thomas N, Hudaib AR, Van Rheenen TE, Thomas EHX, Tan EJ, Neill E, Carruthers SP, Sumner PJ, Romano-Silva M, Bozaoglu K, Kulkarni J, Rossell SL. The relationship between cognitive clusters and telomere length in bipolar-schizophrenia spectrum disorders. Psychol Med 2023; 53:5119-5126. [PMID: 35920237 DOI: 10.1017/s0033291722002148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Schizophrenia and bipolar disorder are complex mental illnesses that are associated with cognitive deficits. There is considerable cognitive heterogeneity that exists within both disorders. Studies that cluster schizophrenia and bipolar patients into subgroups based on their cognitive profile increasingly demonstrate that, relative to healthy controls, there is a severely compromised subgroup and a relatively intact subgroup. There is emerging evidence that telomere shortening, a marker of cellular senescence, may be associated with cognitive impairments. The aim of this study was to explore the relationship between cognitive subgroups in bipolar-schizophrenia spectrum disorders and telomere length against a healthy control sample. METHODS Participants included a transdiagnostic group diagnosed with bipolar, schizophrenia or schizoaffective disorder (n = 73) and healthy controls (n = 113). Cognitive clusters within the transdiagnostic patient group, were determined using K-means cluster analysis based on current cognitive functioning (MATRICS Consensus Cognitive Battery scores). Telomere length was determined using quantitative PCRs genomic DNA extracted from whole blood. Emergent clusters were then compared to the healthy control group on telomere length. RESULTS Two clusters emerged within the patient group that were deemed to reflect a relatively intact cognitive group and a cognitively impaired subgroup. Telomere length was significantly shorter in the severely impaired cognitive subgroup compared to the healthy control group. CONCLUSIONS This study replicates previous findings of transdiagnostic cognitive subgroups and associates shorter telomere length with the severely impaired cognitive subgroup. These findings support emerging literature associating cognitive impairments in psychiatric disorders to accelerated cellular aging as indexed by telomere length.
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Affiliation(s)
- Caroline Gurvich
- Department of Psychiatry, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
| | - Natalie Thomas
- Department of Biochemistry & Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne VIC, Australia
| | - Abdul-Rahman Hudaib
- Department of Psychiatry, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, VIC, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Elizabeth H X Thomas
- Department of Psychiatry, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
| | - Eric J Tan
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Erica Neill
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sean P Carruthers
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Philip J Sumner
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Marco Romano-Silva
- Department Saude Mental, Faculdade de Medicina, UFMG, Belo Horizonte, Brazil
| | - Kiymet Bozaoglu
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jayashri Kulkarni
- Department of Psychiatry, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
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Suen YN, Pang SWT, Cheung C, Wong TY, Hui LMC, Lee HME, Chang WC, Chen YHE, Chan SKW. Impact of early negative symptom patterns on the long-term outcomes of patients with first-episode schizophrenia-spectrum disorders: A 12-year follow up study. Psychiatry Res 2023; 323:115180. [PMID: 36989910 DOI: 10.1016/j.psychres.2023.115180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
Given the strong prognostic value of early negative symptoms (NS), understanding their associations with long-term outcomes of schizophrenia is essential. The study examined early NS patterns in trajectory, severity and variability and their association with 12-year outcomes. NS in the first 36 months after onset and the symptomatology, cognitive function, and functioning at 12 years were examined in 330 patients with first-episode schizophrenia spectrum disorders. The relationships and pathways between the outcomes at 12 years and the trajectory, severity, and variability of early NS were examined. We found that the prediction of trajectory of early NS to long-term outcomes was limited, whereas variability was negatively associated with the patient's long-term executive function, and severity was positively associated with long-term symptomatology and negatively associated with long-term functioning. Path modelling revealed that the severity and variability of early NS influenced patients' long-term functioning via cognitive function and/or clinical symptom pathways. Our findings support the notion that severity of early NS influences the prognosis of schizophrenia and the closer examination revealed that the severity and variability of early NS are differentially associated with long-term clinical symptoms, executive function, and functional outcomes via distinct pathways.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | | | - Charlton Cheung
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Ting Yat Wong
- Department of Psychiatry, University of Pennsylvania, United States of America
| | | | - Ho Ming Edwin Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Yu Hai Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China.
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Tschentscher N, Woll CFJ, Tafelmaier JC, Kriesche D, Bucher JC, Engel RR, Karch S. Neurocognitive Deficits in First-Episode and Chronic Psychotic Disorders: A Systematic Review from 2009 to 2022. Brain Sci 2023; 13:brainsci13020299. [PMID: 36831842 PMCID: PMC9954070 DOI: 10.3390/brainsci13020299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.
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Affiliation(s)
- Nadja Tschentscher
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
- Correspondence:
| | - Christian F. J. Woll
- Section of Clinical Psychology of Children and Adolescents, Department of Psychology and Educational Sciences, Ludwig Maximilian University of Munich, Leopoldstr. 13, 80802 Munich, Germany
| | - Julia C. Tafelmaier
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Dominik Kriesche
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Julia C. Bucher
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Rolf R. Engel
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Susanne Karch
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
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Chan SKW, Liao Y, Hui CLM, Wong TY, Suen Y, Chang WC, Lee EHM, Chen EYH. Longitudinal changes of cognitive function and its relationship with subdomains of negative symptoms in patients with adult-onset first-episode schizophrenia: A 4-year follow up study. Schizophr Res 2023; 252:181-188. [PMID: 36657362 DOI: 10.1016/j.schres.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUNDS This study explores the longitudinal changes and trajectories of cognitive functions in patients with adult-onset first-episode schizophrenia (FES) over four years and their relationships with the baseline subdomains of negative symptoms. METHODS A total of 177 patients of age 25-55 with FES were recruited. Baseline demographics, clinical, social and cognitive functions were assessed. Diminished expression and diminished motivation of negative symptoms were assessed with Scale for the Assessment of Negative Symptoms (SANS). Patients had yearly follow-up of cognitive function assessments over four years. Latent class growth analysis (LCGA) and mixed linear regression model were used to explore the longitudinal changes of cognitive functions and the effect of baseline negative symptoms on the longitudinal cognitive function changes. Relationships of baseline negative symptoms subdomains and cognitive functions were also explored. RESULTS Two trajectories of cognitive functions were identified. Longitudinal improvements were found in most cognitive functions apart from the logical memory. One trajectory of patients had significant deterioration of logical memory while the other group had significant improvement. Baseline diminished expression was associated with baseline and longitudinal changes of processing speed and verbal fluency while diminished motivation was associated with baseline and longitudinal changes of processing speed. CONCLUSIONS Adult-onset FES patients had a homogeneous longitudinal improvement in most cognitive functions but not for logical memory suggesting the unique nature of verbal memory. The distinct relationship between baseline subdomains of negative symptoms with baseline and longitudinal cognitive functions suggesting the presence of differential overlapping etiology between negative symptom subdomains and cognitive functions.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Yingqi Liao
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Ting Yat Wong
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yinam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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9
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Martins DS, Hasse-Sousa M, Reckziegel RDFX, Lapa CDO, Petry-Perin C, Britto MJ, Remus IB, Gama CS, Czepielewski LS. A five-year follow-up of the verbal memory performance of individuals with bipolar disorder and schizophrenia: evidence of unchanging deficits under treatment. Cogn Neuropsychiatry 2023; 28:19-35. [PMID: 36254742 DOI: 10.1080/13546805.2022.2133694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) and schizophrenia (SZ) are chronic and heterogeneous mental disorders that present cognitive and functional impairments. Verbal memory is considered an important predictor of functioning and a domain vulnerable to the aging process. However, only few studies investigate the progression of memory longitudinally in BD and SZ, especially in lower- and middle-income countries. Therefore, we aim to evaluate the course of verbal memory in individuals with BD and SZ. METHODS We assessed 31 individuals with BD and 27 individuals with SZ under treatment at outpatient clinics at baseline and after five years. They were assessed through a sociodemographic questionnaire, memory and estimated IQ (eIQ) instruments, and clinical scales. RESULTS Individuals with SZ showed worse verbal memory performance in comparison to BD, however, we did not observe changes over time within patient groups. Individuals with BD with higher eIQ showed a better verbal memory performance, while no effect of eIQ was found for subjects with SZ. CONCLUSION Patients with SZ and BD showed different levels of verbal memory impairment, although they had similar unchanging trajectories after 5 years under psychiatric treatment. This finding indicates a relative stable cognitive course for both disorders.
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Affiliation(s)
- Dayane Santos Martins
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mathias Hasse-Sousa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Psicologia, Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ramiro de Freitas Xavier Reckziegel
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clara de Olivera Lapa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Petry-Perin
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Julia Britto
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Isadora Bosini Remus
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Clarissa Severino Gama
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leticia Sanguinetti Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Psicologia, Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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10
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Sousa AE, Ryan JD, Lepage M. Exploring the sociodemographic, clinical and neuropsychological factors associated with relational memory in schizophrenia. Cogn Neuropsychiatry 2023; 28:67-84. [PMID: 36464633 DOI: 10.1080/13546805.2022.2153657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Transverse Patterning (TP) task has been used to measure episodic relational memory (RM) deficits in clinical populations. Individuals with schizophrenia often fail to learn TP with standard, and sometimes extensive training. Identifying the differences between TP learners and non-learners can improve our understanding of successful TP performance and its underlying mechanisms, which may help improve interventions aimed at ameliorating RM performance. We investigated sociodemographic, clinical and neuropsychological factors associated with TP performance in schizophrenia. METHODS Sixty-six participants with schizophrenia completed a semantically rich and a relational-binding dependent version of the TP task and reported on their task awareness and strategy use. RESULTS Twenty-six participants failed to learn the task rules after extensive training. Learners had superior verbal, visual and working memory, executive functions and overall cognitive functioning compared to non-learners. Learners also had superior awareness of task rules and pairs relationships and used elaborated cognitive strategies more often. CONCLUSIONS Our results support previous findings that some individuals with schizophrenia show RM impairment even with extensive TP training. We shed light on neuropsychological and metacognitive factors associated with TP performance. This knowledge could enhance interventions targeted to improve relational memory in schizophrenia when extensive training fails.
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Affiliation(s)
- Ana Elisa Sousa
- Douglas Mental Health University Institute, Montreal, Canada.,Integrated Program in Neuroscience, McGill University, Montréal, Canada
| | - Jennifer D Ryan
- Rotman Research Institute, Baycrest, Department of Psychology, University of Toronto, Toronto, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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11
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Cuesta MJ, Sánchez-Torres AM, Moreno-Izco L, García de Jalón E, Gil-Berrozpe GJ, Zarzuela A, Peralta V, Ballesteros A, Fañanás L, Hernández R, Janda L, Lorente R, Papiol S, Peralta D, Ribeiro M, Rosero A, Zandio M. Neurocognitive correlates of the varied domains of outcomes at 20 year follow-up of first-episode psychosis. Psychiatry Res 2022; 318:114933. [PMID: 36334328 DOI: 10.1016/j.psychres.2022.114933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Little is known about long-term outcomes of the first episode of psychosis (FEP) other than in the symptomatic domain. We hypothesised that cognitive impairment is associated with poorer multi-domain outcomes at a long-term follow-up of FEP patients. We followed-up 172 FEP patients for a mean of 20.3 years. Ten outcome dimensions were assessed (symptomatic, functional and personal recovery, social disadvantage, physical health, suicide attempts, number of episodes, current drug use, chlorpromazine equivalent doses (CPZ), and schizophrenia/schizoaffective disorder final diagnosis). Cognition was assessed at follow-up. Processing speed and verbal memory deficits showed significant associations with poor outcomes on symptomatic, social functioning, social disadvantage, higher number of episodes, and higher CPZ. Significant associations were found between visual memory impairments were significantly associated with low symptomatic and functional recovery, between attentional deficits and a final diagnosis of schizophrenia/schizoaffective disorder, and between social cognition deficits and poor personal recovery.Lower cognitive global scores were significantly associated with all outcome dimensions except for drug abuse and physical status. Using multiple outcome dimensions allowed for the inclusion of the patients' perspective and other commonly neglected outcome measures. Taken together, cognitive impairment in FEP patients is strongly related to poor performance on several outcome dimensions beyond symptomatic remission.
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Affiliation(s)
- M J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - A M Sánchez-Torres
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - L Moreno-Izco
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - E García de Jalón
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - G J Gil-Berrozpe
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Zarzuela
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - V Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - A Ballesteros
- Red de Salud Mental de Álava, Vitoria-Gasteiz, Spain
| | - L Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - R Hernández
- CSMIJ Ciutat Vella. Consorci Parc de Salut Mar, Barcelona, Spain
| | - L Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - R Lorente
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Papiol
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain; Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany; Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - D Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - M Ribeiro
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Rosero
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - M Zandio
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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12
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Watson AJ, Harrison L, Preti A, Wykes T, Cella M. Cognitive trajectories following onset of psychosis: a meta-analysis. Br J Psychiatry 2022; 221:714-721. [PMID: 36149012 DOI: 10.1192/bjp.2022.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cognitive impairment is a core feature of schizophrenia, associated with poor functional outcomes. The course of cognitive function in the years following illness onset has remained a subject of debate, with a previous analysis finding no worsening, providing support for the neurodevelopmental model of schizophrenia. Since then, many more studies have reported on longitudinal cognitive performance in early psychosis, with some indicating deterioration, which does not align with this view. AIMS This study aims to quantitatively review the literature on the longitudinal trajectory of cognitive deficits in the years following psychosis onset, in comparison with healthy controls. It is the first to also synthesise longitudinal data on social cognition. METHOD Electronic databases ('PubMed', 'PsycInfo' and 'Scopus') were searched (to end September 2021). Meta-analyses of 25 longitudinal studies of cognition in early psychosis were conducted (1480 patients, 789 health controls). Unlike previous analyses, randomised controlled trials and those with multiple cognitive testing periods within the first year were excluded to minimise bias (PROSPERO, ID: CRD42021241525). RESULTS Small improvements were observed for global cognition (g = 0.25, 95% CI 0.17-0.33) and individual cognitive domains, but these were comparable with healthy controls and likely an artefact of practice effects. CONCLUSIONS There is no evidence of continued cognitive decline or improvement in the early years following psychosis onset, with a need for more studies over longer follow-up periods. Practice effects highlight the importance of including control samples in longitudinal and intervention studies. Further data are needed to evaluate the course of social cognition subdomains.
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Affiliation(s)
- Andrew J Watson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Lauren Harrison
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Antonio Preti
- Dipartimento di Neuroscienze, Università degli studi di Torino, Italy
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
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13
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Flaaten CB, Melle I, Bjella T, Engen MJ, Åsbø G, Wold KF, Widing L, Gardsjord E, Sæther LS, Øie MG, Lyngstad SH, Haatveit B, Simonsen C, Ueland T. Domain-specific cognitive course in schizophrenia: Group- and individual-level changes over 10 years. Schizophr Res Cogn 2022; 30:100263. [PMID: 35783460 PMCID: PMC9240854 DOI: 10.1016/j.scog.2022.100263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Cognitive impairments in schizophrenia are well-documented, present across several cognitive domains and found to be relatively stable over time. However, there is a high degree of heterogeneity and indications of domain-specific developmental courses. The present study investigated the 10-year cognitive course in participants with first-episode schizophrenia (FES) and healthy controls on eight cognitive domains and a composite score, looking at group- and individual-level changes. A total of 75 FES participants and 91 healthy controls underwent cognitive assessment at baseline and follow-up. Linear mixed models were used for group-level analyses and reliable change index (RCI) analyses were used to investigate individual change. The prevalence of clinically significant impairment was explored at both time points, using a cut-off of < −1.5 SD, with significant cognitive impairment defined as impairment on ≥2 domains. Group-level analyses found main effects of group and time, and time by group interactions. Memory, psychomotor processing speed and verbal fluency improved, while learning, mental processing speed and working memory were stable in both groups. FES participants showed deteriorations in attention and cognitive control. Individual-level analyses mainly indicated stability in both FES and controls, except for a higher prevalence of decline in cognitive control in FES. At baseline, 68.8 % of FES participants had clinically significant impairment, compared to 62.3 % at follow-up. We mainly found long-term stability and modest increases in cognition over time in FES, as well as a high degree of within-group heterogeneity. We also found indications of deterioration in participants with worse cognitive performance at baseline.
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Affiliation(s)
- Camilla Bärthel Flaaten
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
- Corresponding author at: NORMENT, Oslo University Hospital, Division of Mental Health and Addiction, P.O. Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Thomas Bjella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Magnus Johan Engen
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Gina Åsbø
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Kristin Fjelnseth Wold
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Line Widing
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Erlend Gardsjord
- Division of Mental Health and Addiction, Unit for Early Intervention in Psychosis, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Linn-Sofie Sæther
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| | - Siv Hege Lyngstad
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Beathe Haatveit
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Carmen Simonsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, P. O. box 4956 Nydalen, 0424 Oslo, Norway
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
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14
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Szyszko vel Chorazy K, Efkemann SA, Schneider U, Juckel G. Multi-dimensional recording of long-term treatment of patients with schizophrenic disorders compared to patients with major depression measured with the ASSESS battery. Heliyon 2022; 8:e11924. [DOI: 10.1016/j.heliyon.2022.e11924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/28/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022] Open
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15
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Global functioning, cognitive function, psychopathological symptoms in untreated patients with first-episode schizophrenia: A cross-sectional study. Psychiatry Res 2022; 313:114616. [PMID: 35576626 DOI: 10.1016/j.psychres.2022.114616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/02/2022] [Accepted: 04/16/2022] [Indexed: 02/07/2023]
Abstract
Although many studies have been conducted on the relationship between cognitive functioning, psychopathological symptoms, and global functioning in patients with schizophrenia, these studies frequently suffer from a lack of control for confounding variables, high attrition rates, and a lack of cognitive domains completed at each assessment point. The purpose of this study is to select patients with untreated first-episode schizophrenia to investigate the relationship between psychopathological symptoms, cognitive functioning, and global functioning. A total of 117 untreated first-episode schizophrenia patients were evaluated using the global assessment functions (GAF), the Positive And Negative Syndrome Scale (PANSS), the MATRICS Consensus Cognitive Battery (MCCB), and some social and role functional parameters. The GAF, PANSS, and MCCB scores of 117 patients were significantly lower than normal. Multiple stepwise linear regression analysis revealed that the negative symptom factor, positive symptom factor, excitation-hostility factor, and attention/vigilance were all independent factors influencing global functioning. Our findings show that the negative symptom factor, the positive symptom factor, the excitement hostility factor, and attention/vigilante are all independent risk factors for GAF in first-episode schizophrenia. The negative symptom factor had the most noticeable effect among these influencing factors, followed by the positive symptom factor, the excitement hostility factor, and attention/vigilance in that order.
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16
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Oliver LD, Hawco C, Viviano JD, Voineskos AN. From the Group to the Individual in Schizophrenia Spectrum Disorders: Biomarkers of Social Cognitive Impairments and Therapeutic Translation. Biol Psychiatry 2022; 91:699-708. [PMID: 34799097 DOI: 10.1016/j.biopsych.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/11/2021] [Accepted: 09/11/2021] [Indexed: 12/23/2022]
Abstract
People with schizophrenia spectrum disorders (SSDs) often experience persistent social cognitive impairments, associated with poor functional outcome. There are currently no approved treatment options for these debilitating symptoms, highlighting the need for novel therapeutic strategies. Work to date has elucidated differential social processes and underlying neural circuitry affected in SSDs, which may be amenable to modulation using neurostimulation. Further, advances in functional connectivity mapping and electric field modeling may be used to identify individualized treatment targets to maximize the impact of brain stimulation on social cognitive networks. Here, we review literature supporting a roadmap for translating functional connectivity biomarker discovery to individualized treatment development for social cognitive impairments in SSDs. First, we outline the relevance of social cognitive impairments in SSDs. We review machine learning approaches for dimensional brain-behavior biomarker discovery, emphasizing the importance of individual differences. We synthesize research showing that brain stimulation techniques, such as repetitive transcranial magnetic stimulation, can be used to target relevant networks. Further, functional connectivity-based individualized targeting may enhance treatment response. We then outline recent approaches to account for neuroanatomical variability and optimize coil positioning to individually maximize target engagement. Overall, the synthesized literature provides support for the utility and feasibility of this translational approach to precision treatment. The proposed roadmap to translate biomarkers of social cognitive impairments to individualized treatment is currently under evaluation in precision-guided trials. Such a translational approach may also be applicable across conditions and generalizable for the development of individualized neurostimulation targeting other behavioral deficits.
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Affiliation(s)
- Lindsay D Oliver
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Colin Hawco
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joseph D Viviano
- Mila-Quebec Artificial Intelligence Institute, Montreal, Quebec, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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17
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Rodríguez-Sánchez JM, Setién-Suero E, Suárez-Pinilla P, Mayoral Van Son J, Vázquez-Bourgon J, Gil López P, Crespo-Facorro B, Ayesa-Arriola R. Ten-year course of cognition in first-episode non-affective psychosis patients: PAFIP cohort. Psychol Med 2022; 52:770-779. [PMID: 32686636 DOI: 10.1017/s0033291720002408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A large body of research states that cognitive impairment in schizophrenia is static. Nevertheless, most previous studies lack a control group or have small study samples or short follow-up periods. METHOD We aimed to address these limitations by studying a large epidemiological cohort of patients with first-episode schizophrenia spectrum disorders and a comparable control sample for a 10-year period. RESULTS Our results support the generalized stability of cognitive functions in schizophrenia spectrum disorders considering the entire group. However, the existence of a subgroup of patients characterized by deteriorating cognition and worse long-term clinical outcomes must be noted. Nevertheless, it was not possible to identify concomitant factors or predictors of deterioration (all Ps > 0.05). CONCLUSIONS Cognitive functions in schizophrenia spectrum disorder are stable; however, a subgroup of subjects that deteriorate can be characterized.
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Affiliation(s)
- José Manuel Rodríguez-Sánchez
- Red de Salud Mental de Bizkaia. Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12 48903, Barakaldo, Bizkaia, España
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
| | - Esther Setién-Suero
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Paula Suárez-Pinilla
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | | | - Javier Vázquez-Bourgon
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Patxi Gil López
- Red de Salud Mental de Bizkaia. Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12 48903, Barakaldo, Bizkaia, España
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Hospital universitario Virgen del Roció, IBiS, Universidad de Sevilla, Spain
| | - Rosa Ayesa-Arriola
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
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18
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Kharawala S, Hastedt C, Podhorna J, Shukla H, Kappelhoff B, Harvey PD. The relationship between cognition and functioning in schizophrenia: A semi-systematic review. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 27:100217. [PMID: 34631435 PMCID: PMC8488595 DOI: 10.1016/j.scog.2021.100217] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022]
Abstract
In schizophrenia, impairments in neurocognition (NC) and social cognition (SC) are associated with reduced functional capacity (FC) and poor real-world functioning (RWF). In this semi-systematic review, we examined this association across a range of research questions. We conducted a systematic search in Embase and MEDLINE from 2005 to 2019, and conducted additional pragmatic searches. After screening of titles, abstracts and full-texts, we included 564 citations, of which 44 (26 primary studies, 15 systematic reviews and 3 narrative reviews) were prioritized for reporting. Both NC and SC were significantly associated with functioning, with slightly stronger association for SC. Effect sizes were generally larger for FC than for RWF. NC showed stronger associations with occupational functioning and independent living, and SC with social functioning. Baseline cognition predicted long-term RWF up to 20 years of follow-up, though long-term data were limited for SC. Cognitive remediation improved RWF functioning, especially when it was combined with psychosocial rehabilitation. SC mediated the relationship of NC with functioning. Negative symptoms appeared to mediate and moderate the association of cognition with functioning. Other factors involved included severity of cognitive dysfunction, metacognition, depression and choice of RWF instrument. We discuss potential implications for studies of pharmacological cognitive interventions in schizophrenia – the relevance of both NC and SC, the advantage of adjunctive psychosocial rehabilitation, the role of relevant moderating and mediating variables, and the challenges with RWF instrument selection. Successful cognitive interventions could allow patients with schizophrenia to improve their potential for community functioning.
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Affiliation(s)
- Saifuddin Kharawala
- Bridge Medical Consulting Ltd., 2 Marsault Court, 11 Kew Foot Road, Richmond TW9 2SS, United Kingdom
| | - Claudia Hastedt
- Boehringer Ingelheim International GmbH, Binger Strasse 173, 55216 Ingelheim, Germany
| | - Jana Podhorna
- Boehringer Ingelheim International GmbH, Binger Strasse 173, 55216 Ingelheim, Germany
| | - Hemlata Shukla
- Bridge Medical Consulting Ltd., 2 Marsault Court, 11 Kew Foot Road, Richmond TW9 2SS, United Kingdom
| | - Bregt Kappelhoff
- Boehringer Ingelheim bv, De Boelelaan 32, 1083 HJ Amsterdam, the Netherlands
| | - Philip D Harvey
- University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL, United States of America
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19
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Suárez-Pinilla P, Suárez-Pinilla M, Setién-Suero E, Ortiz-García de la Foz V, Mayoral-Van Son J, Vázquez-Bourgon J, Gómez-Revuelta M, Juncal-Ruíz M, Ayesa-Arriola R, Crespo-Facorro B. Stability of schizophrenia diagnosis in a 10-year longitudinal study on first episode of non-affective psychosis: Conclusions from the PAFIP cohort. Acta Psychiatr Scand 2021; 144:342-357. [PMID: 34228812 DOI: 10.1111/acps.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the 10-year stability of schizophrenia diagnosis in a cohort of first-episode psychosis (FEP) patients and the factors associated with it. METHODS Changes in diagnosis of 209 FEP patients were described during 10 years of follow-up. Related factors with maintenance or change of schizophrenia diagnosis were evaluated in prospective and retrospective approaches through binary logistic regressions, ROC and survival curves. RESULTS Out of the 209 patients, 126 were diagnosed of schizophrenia 6 months after their inclusion in the clinical program. Prospective analyses showed that eight of those 126 schizophrenia patients had changed to a different diagnosis after 10 years, and predictors of change were better childhood premorbid adjustment, less severity of clinical global impression at baseline, and diagnosis of comorbid personality disorder during follow-up. Retrospectively, out of the 154 patients with schizophrenia in the 10-year assessment, 36 had a different diagnosis at baseline, and those factors related to a different prior diagnosis than schizophrenia were better socioeconomic status and shorter duration of untreated psychosis (DUP). A survival analysis on the timing of schizophrenia diagnosis showed that male gender and longer DUP were predictors of earlier definite diagnosis. CONCLUSIONS Diagnostic stability of schizophrenia in our FEP sample is high, especially prospective stability, and the group of patients with diagnostic change corresponded to a milder psychopathological profile before and at the onset of disease. Moreover, we observed a cautious attitude in the diagnosis of schizophrenia in patients with shorter DUP who had schizophrenia diagnosis after 10 years.
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Affiliation(s)
- Paula Suárez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Suárez-Pinilla
- Department of Neurodegenerative Disease, Institute of Neurology, University College of London, London, UK
| | - Esther Setién-Suero
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Ortiz-García de la Foz
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Jacqueline Mayoral-Van Son
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - María Juncal-Ruíz
- Department of Psychiatry, IDIVAL, School of Medicine, Sierrallana Hospital, University of Cantabria, Torrelavega, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Benedicto Crespo-Facorro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla, Spain
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20
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Amoretti S, Mezquida G, Rosa AR, Bioque M, Cuesta MJ, Pina-Camacho L, Garcia-Rizo C, Barcones F, González-Pinto A, Merchán-Naranjo J, Corripio I, Vieta E, Baeza I, Cortizo R, Bonnín CM, Torrent C, Bernardo M. The functioning assessment short test (FAST) applied to first-episode psychosis: Psychometric properties and severity thresholds. Eur Neuropsychopharmacol 2021; 47:98-111. [PMID: 33658165 DOI: 10.1016/j.euroneuro.2021.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/11/2021] [Indexed: 02/07/2023]
Abstract
Functional impairment is a defining feature of psychotic disorders. The Functional Assessment Short Test (FAST) is one of the most widely used instruments to measure psychosocial functioning. However, cut-offs of impairment have been well-established for bipolar disorders, but not for other clinical populations. This study aims to analyse psychometric properties of the FAST and establish their corresponding cut-off values for the different severity gradations in a first-episode of non-affective psychosis (FEP) patients. Global Assessment Functioning (GAF) and FAST ratings from 212 non-affective FEP and 204 healthy controls were analyzed. The psychometric properties of FAST (internal consistency, concurrent validity, discriminant validity, factorial analyses and sensitivity to change) were analyzed. The severity gradations of the FAST were defined by the congruence between two grading methods: linear regression analysis (LRA) and percentiles. The FAST showed strong psychometric properties. LRA with the GAF scores yielded the following equation: GAFscore= 80.83 - 0.639*FASTscore. The FAST ranges in non-affective FEP patients derived from LRA and percentiles, were as follows: 0-9 (No impairment); 10-19 (Minimal impairment); 20-34 (Mild impairment); 35-45 (Moderate impairment); 46-72 (Severe impairment). Patients with no functional impairment had a higher socioeconomic status, fewer depressive and negative symptoms, lower severity of illness and higher cognitive reserve level than the others groups. In conclusion, the FAST shows optimal psychometric properties which corroborate its applicability in FEP populations. It is a well-demonstrated valid instrument and the present cut-off scores could be implemented in clinical and research practice to assess properly the psychosocial functional outcome of non-affective FEP populations.
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Affiliation(s)
- Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain.; Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain.; Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Adriane R Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.; Pharmacology Department and Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Miquel Bioque
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain.; Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain.; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Laura Pina-Camacho
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; Department of Child and Adolescent Psychiatry, Institute of Psychatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain.; Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Fe Barcones
- Department of Family Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.; Department of Medicine and Psychiatry. Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Department of Neurociences, University of the Basque Country, Vitoria, Spain
| | - Jessica Merchán-Naranjo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; Department of Child and Adolescent Psychiatry, Institute of Psychatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.; Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain..
| | - Inmaculada Baeza
- Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.; Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, University of Barcelona, Barcelona, Spain
| | - Romina Cortizo
- Instituto de Neuropsiquiatria y Adicciones (INAD), Barcelona, Spain
| | - C Mar Bonnín
- Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.; Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain
| | - Carla Torrent
- Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.; Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain.; Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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21
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Mucci A, Galderisi S, Gibertoni D, Rossi A, Rocca P, Bertolino A, Aguglia E, Amore M, Bellomo A, Biondi M, Blasi G, Brasso C, Bucci P, Carpiniello B, Cuomo A, Dell’Osso L, Giordano GM, Marchesi C, Monteleone P, Niolu C, Oldani L, Pettorruso M, Pompili M, Roncone R, Rossi R, Tenconi E, Vita A, Zeppegno P, Maj M. Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses. JAMA Psychiatry 2021; 78:550-559. [PMID: 33566071 PMCID: PMC7876615 DOI: 10.1001/jamapsychiatry.2020.4614] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs. OBJECTIVE To assess whether baseline illness-related variables, personal resources, and context-related factors are associated with work skills, interpersonal relationships, and everyday life skills at 4-year follow-up. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective cohort study was conducted across 24 Italian university psychiatric clinics or mental health departments in which 921 patients enrolled in a cross-sectional study were contacted after 4 years for reassessment. Recruitment of community-dwelling, clinically stable persons with schizophrenia was conducted from March 2016 to December 2017, and data were analyzed from January to May 2020. MAIN OUTCOMES AND MEASURES Psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors were assessed, with real-life functioning as the main outcome. Structural equation modeling, multiple regression analyses, and latent change score modeling were used to identify variables that were associated with real-life functioning domains at follow-up and with changes from baseline in these domains. RESULTS In total, 618 participants (427 male [69.1%]; mean [SD] age, 45.1 [10.5] years) were included. Five baseline variables were directly associated with real-life functioning at follow-up: neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, -0.126; 95% CI, -0.190 to -0.062; P < .001); positive symptoms with work skills (β, -0.059; 95% CI, -0.112 to -0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001). Multiple regression analyses indicated that these variables accounted for the variability of functioning at follow-up after controlling for baseline functioning. In the latent change score model, higher neurocognitive abilities were associated with improvement of everyday life (β, 0.370; 95% CI, 0.253-0.486; P < .001) and work (β, 0.102; 95% CI, 0.016-0.188; P = .02) skills, social cognition (β, 0.133; 95% CI, 0.015-0.250; P = .03), and functional capacity (β, 1.138; 95% CI, 0.807-1.469; P < .001); better baseline social cognition with improvement of work skills (β, 0.168; 95% CI, 0.075-0.261; P < .001) and interpersonal functioning (β, 0.140; 95% CI, 0.069-0.212; P < .001); and better baseline everyday life skills with improvement of work skills (β, 0.121; 95% CI, 0.077-0.166; P < .001). CONCLUSIONS AND RELEVANCE Findings of this large prospective study suggested that baseline variables associated with functional outcome at follow-up included domains not routinely assessed and targeted by intervention programs in community mental health services. The key roles of social and nonsocial cognition and of baseline everyday life skills support the adoption in routine mental health care of cognitive training programs combined with personalized psychosocial interventions aimed to promote independent living.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonello Bellomo
- Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Blasi
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Claudio Brasso
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Liliana Dell’Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana,” Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Lucio Oldani
- Department of Psychiatry, State University of Milan, Milan, Italy
| | - Mauro Pettorruso
- Department of Neuroscience and Imaging, G. D’Annunzio University, Chieti, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Elena Tenconi
- Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy,Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli,” Naples, Italy
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Topology predicts long-term functional outcome in early psychosis. Mol Psychiatry 2021; 26:5335-5346. [PMID: 32632207 PMCID: PMC8589664 DOI: 10.1038/s41380-020-0826-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 12/02/2022]
Abstract
Early intervention in psychosis is crucial to improving patient response to treatment and the functional deficits that critically affect their long-term quality of life. Stratification tools are needed to personalize functional deficit prevention strategies at an early stage. In the present study, we applied topological tools to analyze symptoms of early psychosis patients, and detected a clear stratification of the cohort into three groups. One of the groups had a significantly better psychosocial outcome than the others after a 3-year clinical follow-up. This group was characterized by a metabolic profile indicative of an activated antioxidant response, while that of the groups with poorer outcome was indicative of oxidative stress. We replicated in a second cohort the finding that the three distinct clinical profiles at baseline were associated with distinct outcomes at follow-up, thus validating the predictive value of this new stratification. This approach could assist in personalizing treatment strategies.
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23
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Mayston R, Kebede D, Fekadu A, Medhin G, Hanlon C, Alem A, Shibre T. The effect of gender on the long-term course and outcome of schizophrenia in rural Ethiopia: a population-based cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1581-1591. [PMID: 32239264 DOI: 10.1007/s00127-020-01865-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although some studies have suggested that women with schizophrenia are more likely to achieve positive outcomes, the evidence-base is fraught with inconsistencies. In this study we compare the long-term course and outcomes for men and women living with schizophrenia in rural Ethiopia. METHODS The Butajira course and outcome study for severe mental disorders is a population-based cohort study. Community ascertainment of cases was undertaken between 1998 and 2001, with diagnostic confirmation by clinicians using the Schedules for Clinical Assessment in Neuropsychiatry. Findings from annual outcome assessments were combined with clinical records, patient and caregiver report, and psychiatric assessments at 10-13 years using the Longitudinal Interval Follow-up Evaluation- LIFE chart. For the sub-group of people with schizophrenia (n = 358), we compared course of illness and treatment, co-morbidity, recovery, social outcomes and mortality between men and women. Multivariable analyses were conducted for modelling associations identified in bivariate analyses according to blocks shaped by our a priori conceptual framework of the biological and social pathways through which gender might influence the course and outcome of schizophrenia. RESULTS Looking into over 10-13 years of follow-up data, there was no difference in the functioning or recovery in women compared to men (AOR = 1.79, 95% CI = 0.91, 3.57). Women were less likely to report overall life satisfaction (AOR = 0.22, 95% CI = 0.09, 0.53) or good quality of spousal relationships (AOR = 0.09, 95% CI = 0.01-1.04). Men were more likely to have co-morbid substance use and there was a trend towards women being more likely to be prescribed an antidepressant (AOR = 2.38, 95% CI = 0.94, 5.88). There were no gender differences in the course of illness, number of psychotic episodes or adherence to medications. CONCLUSION In this rural African setting, we found little evidence to support the global evidence indicating better course and outcome of schizophrenia in women. Our findings are suggestive of a gendered experience of schizophrenia which varies across contexts. Further investigation is needed due to the important implications for the development of new mental health services in low and middle-income country settings.
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Affiliation(s)
- Rosie Mayston
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Derege Kebede
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Global Health & Infection, Brighton & Sussex Medical School, Brighton, UK
| | - Girmay Medhin
- Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Shibre
- Department of Psychiatry, Horizon Health Network, Fredericton, NB, Canada.
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24
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Puntis S, Minichino A, De Crescenzo F, Cipriani A, Lennox B, Harrison R. Specialised early intervention teams (extended time) for recent-onset psychosis. Cochrane Database Syst Rev 2020; 11:CD013287. [PMID: 33135812 PMCID: PMC8094422 DOI: 10.1002/14651858.cd013287.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychosis is an illness characterised by the presence of hallucinations and delusions that can cause distress or a marked change in an individual's behaviour (e.g. social withdrawal, flat or blunted effect). A first episode of psychosis (FEP) is the first time someone experiences these symptoms that can occur at any age, but the condition is most common in late adolescence and early adulthood. This review is concerned with FEP and the early stages of a psychosis, referred to throughout this review as 'recent-onset psychosis.' Specialised early intervention (SEI) teams are community mental health teams that specifically treat people who are experiencing, or have experienced, a recent-onset psychosis. SEI teams provide a range of treatments including medication, psychotherapy, psychoeducation, educational and employment support, augmented by assertive contact with the service user and small caseloads. Treatment is time limited, usually offered for two to three years, after which service users are either discharged to primary care or transferred to a standard adult community mental health team. Evidence suggests that once SEI treatment ends, improvements may not be sustained, bringing uncertainty about the optimal duration of SEI to ensure the best long-term outcomes. Extending SEI has been proposed as a way of providing continued intensive treatment and continuity of care, of usually up to five years, in order to a) sustain the positive initial outcomes of SEI; and b) improve the long-term trajectory of the illness. OBJECTIVES To compare extended SEI teams with treatment as usual (TAU) for people with recent-onset psychosis. To compare extended SEI teams with standard SEI teams followed by TAU (standard SEI + TAU) for people with recent-onset psychosis. SEARCH METHODS On 3 October 2018 and 22 October 2019, we searched Cochrane Schizophrenia's study-based register of trials, including registries of clinical trials. SELECTION CRITERIA We selected all randomised controlled trials (RCTs) comparing extended SEI with TAU for people with recent-onset psychosis and all RCTs comparing extended SEI with standard SEI + TAU for people with recent-onset psychosis. We entered trials meeting these criteria and reporting usable data as included studies. DATA COLLECTION AND ANALYSIS We independently inspected citations, selected studies, extracted data and appraised study quality. For binary outcomes we calculated the risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean difference (MD) and their 95% CIs, or if assessment measures differed for the same construct, we calculated the standardised mean difference (SMD) with 95% CIs. We assessed risk of bias for included studies and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS We included three RCTs, with a total 780 participants, aged 16 to 35 years. All participants met the criteria for schizophrenia spectrum disorders or affective psychoses. No trials compared extended SEI with TAU. All three trials randomly allocated people approximately two years into standard SEI to either extended SEI or standard SEI + TAU. The certainty of evidence for outcomes varied from low to very low. Our primary outcomes were recovery and disengagement from mental health services. No trials reported on recovery, and we used remission as a proxy. Three trials reported on remission, with the point estimate suggesting a 13% increase in remission in favour of extended SEI, but this included wide confidence intervals (CIs) and a very uncertain estimate of no benefit (RR 1.13, 95% CI 0.97 to 1.31; 3 trials, 780 participants; very low-certainty evidence). Two trials provided data on disengagement from services with evidence that extended SEI care may result in fewer disengagements from mental health treatment (15%) in comparison to standard SEI + TAU (34%) (RR 0.45, 95% CI 0.27 to 0.75; 2 trials, 380 participants; low-certainty evidence). There may be no evidence of a difference in rates of psychiatric hospital admission (RR 1.55, 95% CI 0.68 to 3.52; 1 trial, 160 participants; low-certainty evidence), or the number of days spent in a psychiatric hospital (MD -2.70, 95% CI -8.30 to 2.90; 1 trial, 400 participants; low-certainty evidence). One trial found uncertain evidence regarding lower global psychotic symptoms in extended SEI in comparison to standard SEI + TAU (MD -1.90, 95% CI -3.28 to -0.52; 1 trial, 156 participants; very low-certainty evidence). It was uncertain whether the use of extended SEI over standard SEI + TAU resulted in fewer deaths due to all-cause mortality, as so few deaths were recorded in trials (RR 0.38, 95% CI 0.09 to 1.64; 3 trials, 780 participants; low-certainty evidence). Very uncertain evidence suggests that using extended SEI instead of standard SEI + TAU may not improve global functioning (SMD 0.23, 95% CI -0.29 to 0.76; 2 trials, 560 participants; very low-certainty evidence). There was low risk of bias in all three trials for random sequence generation, allocation concealment and other biases. All three trials had high risk of bias for blinding of participants and personnel due to the nature of the intervention. For the risk of bias for blinding of outcome assessments and incomplete outcome data there was at least one trial with high or unclear risk of bias. AUTHORS' CONCLUSIONS There may be preliminary evidence of benefit from extending SEI team care for treating people experiencing psychosis, with fewer people disengaging from mental health services. Evidence regarding other outcomes was uncertain. The certainty of evidence for the measured outcomes was low or very low. Further, suitably powered studies that use a consistent approach to outcome selection are needed, but with only one further ongoing trial, there is unlikely to be any definitive conclusion for the effectiveness of extended SEI for at least the next few years.
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Affiliation(s)
- Stephen Puntis
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rachael Harrison
- Oxford University Medical School, Medical Sciences Divisional Office, Oxford, UK
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25
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Puntis S, Minichino A, De Crescenzo F, Cipriani A, Lennox B, Harrison R. Specialised early intervention teams for recent-onset psychosis. Cochrane Database Syst Rev 2020; 11:CD013288. [PMID: 33135811 PMCID: PMC8092671 DOI: 10.1002/14651858.cd013288.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Psychosis is an illness characterised by the presence of hallucinations and delusions that can cause distress or a marked change in an individual's behaviour (e.g. social withdrawal, flat or blunted effect). A first episode of psychosis (FEP) is the first time someone experiences these symptoms that can occur at any age, but the condition is most common in late adolescence and early adulthood. This review is concerned with first episode psychosis (FEP) and the early stages of a psychosis, referred to throughout this review as 'recent-onset psychosis.' Specialised early intervention (SEI) teams are community mental health teams that specifically treat people who are experiencing, or have experienced a recent-onset psychosis. The purpose of SEI teams is to intensively treat people with psychosis early in the course of the illness with the goal of increasing the likelihood of recovery and reducing the need for longer-term mental health treatment. SEI teams provide a range of treatments including medication, psychotherapy, psychoeducation, and occupational, educational and employment support, augmented by assertive contact with the service user and small caseloads. Treatment is time limited, usually offered for two to three years, after which service users are either discharged to primary care or transferred to a standard adult community mental health team. A previous Cochrane Review of SEI found preliminary evidence that SEI may be superior to standard community mental health care (described as 'treatment as usual (TAU)' in this review) but these recommendations were based on data from only one trial. This review updates the evidence for the use of SEI services. OBJECTIVES To compare specialised early intervention (SEI) teams to treatment as usual (TAU) for people with recent-onset psychosis. SEARCH METHODS On 3 October 2018 and 22 October 2019, we searched Cochrane Schizophrenia's study-based register of trials, including registries of clinical trials. SELECTION CRITERIA We selected all randomised controlled trials (RCTs) comparing SEI with TAU for people with recent-onset psychosis. We entered trials meeting these criteria and reporting useable data as included studies. DATA COLLECTION AND ANALYSIS We independently inspected citations, selected studies, extracted data and appraised study quality. For binary outcomes we calculated the risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean difference (MD) and their 95% CIs, or if assessment measures differed for the same construct, we calculated the standardised mean difference (SMD) with 95% CIs. We assessed risk of bias for included studies and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS We included three RCTs and one cluster-RCT with a total of 1145 participants. The mean age in the trials was between 23.1 years (RAISE) and 26.6 years (OPUS). The included participants were 405 females (35.4%) and 740 males (64.6%). All trials took place in community mental healthcare settings. Two trials reported on recovery from psychosis at the end of treatment, with evidence that SEI team care may result in more participants in recovery than TAU at the end of treatment (73% versus 52%; RR 1.41, 95% CI 1.01 to 1.97; 2 studies, 194 participants; low-certainty evidence). Three trials provided data on disengagement from services at the end of treatment, with fewer participants probably being disengaged from mental health services in SEI (8%) in comparison to TAU (15%) (RR 0.50, 95% CI 0.31 to 0.79; 3 studies, 630 participants; moderate-certainty evidence). There was low-certainty evidence that SEI may result in fewer admissions to psychiatric hospital than TAU at the end of treatment (52% versus 57%; RR 0.91, 95% CI 0.82 to 1.00; 4 studies, 1145 participants) and low-certainty evidence that SEI may result in fewer psychiatric hospital days (MD -27.00 days, 95% CI -53.68 to -0.32; 1 study, 547 participants). Two trials reported on general psychotic symptoms at the end of treatment, with no evidence of a difference between SEI and TAU, although this evidence is very uncertain (SMD -0.41, 95% CI -4.58 to 3.75; 2 studies, 304 participants; very low-certainty evidence). A different pattern was observed in assessment of general functioning with an end of trial difference that may favour SEI (SMD 0.37, 95% CI 0.07 to 0.66; 2 studies, 467 participants; low-certainty evidence). It was uncertain whether the use of SEI resulted in fewer deaths due to all-cause mortality at end of treatment (RR 0.21, 95% CI 0.04 to 1.20; 3 studies, 741 participants; low-certainty evidence). There was low risk of bias for random sequence generation and allocation concealment in three of the four included trials; the remaining trial had unclear risk of bias. Due to the nature of the intervention, we considered all trials at high risk of bias for blinding of participants and personnel. Two trials had low risk of bias and two trials had high risk of bias for blinding of outcomes assessments. Three trials had low risk of bias for incomplete outcome data, while one trial had high risk of bias. Two trials had low risk of bias, one trial had high risk of bias, and one had unclear risk of bias for selective reporting. AUTHORS' CONCLUSIONS There is evidence that SEI may provide benefits to service users during treatment compared to TAU. These benefits probably include fewer disengagements from mental health services (moderate-certainty evidence), and may include small reductions in psychiatric hospitalisation (low-certainty evidence), and a small increase in global functioning (low-certainty evidence) and increased service satisfaction (moderate-certainty evidence). The evidence regarding the effect of SEI over TAU after treatment has ended is uncertain. Further evidence investigating the longer-term outcomes of SEI is needed. Furthermore, all the eligible trials included in this review were conducted in high-income countries, and it is unclear whether these findings would translate to low- and middle-income countries, where both the intervention and the comparison conditions may be different.
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Affiliation(s)
- Stephen Puntis
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rachael Harrison
- Oxford University Medical School, Medical Sciences Divisional Office, Oxford, UK
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Neurocognitive functioning in patients with first-episode schizophrenia: results of a prospective 15-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2020; 270:689-698. [PMID: 31214763 DOI: 10.1007/s00406-019-01030-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 06/03/2019] [Indexed: 02/04/2023]
Abstract
To evaluate the course of neuropsychological impairment, patients with first-episode schizophrenia and healthy controls were assessed with a comprehensive test battery at the time of index treatment and after a 5- and 15-year follow-up period. Summary scores for verbal intelligence (VBI), spatial organization, verbal fluency, verbal learning, semantic memory, visual memory, delay/retention rate, short-term memory, visual-motor processing and attention (VSM) and abstraction/flexibility were constructed. Our results show that neurocognitive functioning is impaired already at the onset of schizophrenia and remains stable over the 15-year follow-up period with an improvement in VBI. With regard to the presence of a deficit syndrome, it became apparent that the group with a deficit syndrome showed a deterioration of neurocognitive functions during the follow-up period, most pronounced in VSM. On the other hand, the group without a deficit syndrome showed an improvement in neurocognitive functions at the 15-year follow-up, which exceeded the learning effects of healthy control subjects. Neurocognitive performance at index assessment strongly predicted the performance at the 15-year follow-up. Most likely due to the small sample size, there were only weak associations between treatment with different types of neuroleptics and neurocognitive performance.
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The effects of age and sex on cognitive impairment in schizophrenia: Findings from the Consortium on the Genetics of Schizophrenia (COGS) study. PLoS One 2020; 15:e0232855. [PMID: 32401791 PMCID: PMC7219730 DOI: 10.1371/journal.pone.0232855] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
Recently emerging evidence indicates accelerated age-related changes in the structure and function of the brain in schizophrenia, raising a question about its potential consequences on cognitive function. Using a large sample of schizophrenia patients and controls and a battery of tasks across multiple cognitive domains, we examined whether patients show accelerated age-related decline in cognition and whether an age-related effect differ between females and males. We utilized data of 1,415 schizophrenia patients and 1,062 healthy community collected by the second phase of the Consortium on the Genetics of Schizophrenia (COGS-2). A battery of cognitive tasks included the Letter-Number Span Task, two forms of the Continuous Performance Test, the California Verbal Learning Test, Second Edition, the Penn Emotion Identification Test and the Penn Facial Memory Test. The effect of age and gender on cognitive performance was examined with a general linear model. We observed age-related changes on most cognitive measures, which was similar between males and females. Compared to controls, patients showed greater deterioration in performance on attention/vigilance and greater slowness of processing social information with increasing age. However, controls showed greater age-related changes in working memory and verbal memory compared to patients. Age-related changes (η2p of 0.001 to .008) were much smaller than between-group differences (η2p of 0.005 to .037). This study found that patients showed continued decline of cognition on some domains but stable impairment or even less decline on other domains with increasing age. These findings indicate that age-related changes in cognition in schizophrenia are subtle and not uniform across multiple cognitive domains.
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Fett AKJ, Velthorst E, Reichenberg A, Ruggero CJ, Callahan JL, Fochtmann LJ, Carlson GA, Perlman G, Bromet EJ, Kotov R. Long-term Changes in Cognitive Functioning in Individuals With Psychotic Disorders: Findings From the Suffolk County Mental Health Project. JAMA Psychiatry 2020; 77:387-396. [PMID: 31825511 PMCID: PMC6990826 DOI: 10.1001/jamapsychiatry.2019.3993] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE It remains uncertain whether people with psychotic disorders experience progressive cognitive decline or normal cognitive aging after first hospitalization. This information is essential for prognostication in clinical settings, deployment of cognitive remediation, and public health policy. OBJECTIVE To examine long-term cognitive changes in individuals with psychotic disorders and to compare age-related differences in cognitive performance between people with psychotic disorders and matched control individuals (ie, individuals who had never had psychotic disorders). DESIGN, SETTING, AND PARTICIPANTS The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Cognitive functioning was assessed 2 and 20 years later. Patients were recruited from the 12 inpatient facilities of Suffolk County, New York. At year 20, the control group was recruited by random digit dialing and matched to the clinical cohort on zip code and demographics. Data were collected between September 1991 and July 2015. Analysis began January 2016. MAIN OUTCOMES AND MEASURES Change in cognitive functioning in 6 domains: verbal knowledge (Wechsler Adult Intelligence Scale-Revised vocabulary test), verbal declarative memory (Verbal Paired Associates test I and II), visual declarative memory (Visual Reproduction test I and II), attention and processing speed (Symbol Digit Modalities Test-written and oral; Trail Making Test [TMT]-A), abstraction-executive function (Trenerry Stroop Color Word Test; TMT-B), and verbal fluency (Controlled Oral Word Association Test). RESULTS A total of 705 participants were included in the analyses (mean [SD] age at year 20, 49.4 [10.1] years): 445 individuals (63.1%) had psychotic disorders (211 with schizophrenia spectrum [138 (65%) male]; 164 with affective psychoses [76 (46%) male]; 70 with other psychoses [43 (61%) male]); and 260 individuals (36.9%) in the control group (50.5 [9.0] years; 134 [51.5%] male). Cognition in individuals with a psychotic disorder declined on all but 2 tests (average decline: d = 0.31; range, 0.17-0.54; all P < .001). Cognitive declines were associated with worsening vocational functioning (Visual Reproduction test II: r = 0.20; Symbol Digit Modalities Test-written: r = 0.25; Stroop: r = 0.24; P < .009) and worsening negative symptoms (avolition: Symbol Digit Modalities Test-written: r = -0.24; TMT-A: r = -0.21; Stroop: r = -0.21; all P < .009; inexpressivity: Stroop: r = -0.22; P < .009). Compared with control individuals, people with psychotic disrders showed age-dependent deficits in verbal knowledge, fluency, and abstraction-executive function (vocabulary: β = -0.32; Controlled Oral Word Association Test: β = -0.32; TMT-B: β = 0.23; all P < .05), with the largest gap among participants 50 years or older. CONCLUSIONS AND RELEVANCE In individuals with psychotic disorders, most cognitive functions declined over 2 decades after first hospitalization. Observed declines were clinically significant. Some declines were larger than expected due to normal aging, suggesting that cognitive aging in some domains may be accelerated in this population. If confirmed, these findings would highlight cognition as an important target for research and treatment during later phases of psychotic illness.
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Affiliation(s)
- Anne-Kathrin J. Fett
- Department of Psychology, City, University of London, London, United Kingdom,Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Department of Clinical and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Abraham Reichenberg
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
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Teigset CM, Mohn C, Rund BR. Perinatal complications and executive dysfunction in early-onset schizophrenia. BMC Psychiatry 2020; 20:103. [PMID: 32131788 PMCID: PMC7057649 DOI: 10.1186/s12888-020-02517-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The present study examined the association between perinatal obstetric complications and executive dysfunction in early-onset schizophrenia (EOS), compared to healthy controls. Higher incidences of obstetric complications and more severe executive dysfunctions characterize EOS. Research shows extensive brain maturation in newborns, suggesting them to be particularly vulnerable for perinatal insults. Executive function is mainly mediated by the prefrontal cortex, an area that matures last during pregnancy. Thus, exposure to perinatal complications may influence executive dysfunction in EOS. METHODS The participants were 19 EOS patients and 54 healthy controls. Executive function was assessed with the D-KEFS Color Word Interference Test and the Wisconsin Card Sorting Test. Information on perinatal obstetric complications and Apgar 5-min scores were obtained from the Norwegian Medical Birth Registry. Associations between perinatal conditions and executive function were studied using stepwise regression analyses. RESULTS Perinatal complications, and especially shorter gestational lengths, were significantly associated with significant executive dysfunctions in EOS. Perinatal complications did not affect executive function among healthy controls. A significant relationship between lower Apgar 5-min scores and executive dysfunction was found among both EOS patients and healthy controls. CONCLUSIONS Exposure to perinatal complications, and particularly a shorter gestational length, was associated with increased executive dysfunction in EOS. Exposed healthy controls did not exhibit similar executive difficulties, suggesting that the EOS patients seemed especially vulnerable for executive deficits due to perinatal insults. The findings indicate that EOS youths learn more slowly and experience more difficulty with problem-solving, which carry important implications for clinical practice. Lower Apgar 5-min scores were associated with executive dysfunction in both groups. Low Apgar score at 5 min may therefore be an important early indicator of executive difficulties among adolescents, independent of diagnosis.
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Affiliation(s)
- Charlotte M. Teigset
- grid.459157.b0000 0004 0389 7802Vestre Viken Hospital Trust, Research Department, Wergelands gate 10, 3004 Drammen, Norway
| | - Christine Mohn
- grid.459157.b0000 0004 0389 7802Vestre Viken Hospital Trust, Research Department, Wergelands gate 10, 3004 Drammen, Norway ,grid.5510.10000 0004 1936 8921NORMENT Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Bjørn Rishovd Rund
- grid.459157.b0000 0004 0389 7802Vestre Viken Hospital Trust, Research Department, Wergelands gate 10, 3004 Drammen, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Postboks 1094 Blindern, 0317 Oslo, Norway
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Kida H, Niimura H, Nemoto T, Ryu Y, Sakuma K, Mimura M, Mizuno M. Community transition at younger ages contributes to good cognitive function outcomes in long-term hospitalized patients with schizophrenia spectrum disorder: A 15-year follow-up study with group-based trajectory modeling. Psychiatry Clin Neurosci 2020; 74:105-111. [PMID: 31599068 DOI: 10.1111/pcn.12941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/20/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
AIM Cognitive dysfunction is a core symptom of schizophrenia spectrum disorder, but the reported long-term cognitive outcomes are heterogeneous. This study aimed to elucidate the long-term trajectories of patients with schizophrenia spectrum disorder who transitioned to community dwelling with integrated care, and to identify predictors of successful community reintegration. METHODS After the closure of a psychiatric hospital, 78 patients with schizophrenia spectrum disorder (mean age: 54.6 years) were transferred to the community. We assessed patients' cognitive function over 15 years with the Mini-Mental State Examination (MMSE) and analyzed the scores every 3 years. Forty-four patients completed all assessments. RESULTS The mean MMSE score at discharge was 25.8, which changed to 26.8 after 3 years and 25.3 after 6 years. After 12 and 15 years, it had decreased significantly to 23.3 and 23.0, respectively. Group-based trajectory modeling identified two groups of patients: a 'poor-outcome' group (63.4%), showing a decline in scores after maintaining post-discharge levels for several years, and a 'good-outcome' group (36.6%), maintaining post-discharge scores after showing improved scores. CONCLUSION Considering the significant difference in age between the aforementioned groups (P = 0.040), we suggest that community transitions at younger ages contribute to better cognitive function and adaptation to community life. Even middle-aged and elderly patients with chronic schizophrenia spectrum disorder showed improved or maintained cognitive function at least 3 years after discharge, and the good-outcome group maintained cognitive function over 15 years. Improvements were dominated primarily by age at discharge, with cognitive function being maintained longer in patients in the good-outcome group.
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Affiliation(s)
- Hisashi Kida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hidehito Niimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Yonosuke Ryu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
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Roson Rodriguez P, Franco JVA, Garegnani L, Arancibia M, Escobar Liquitay CM, Mohammad HA. Transitional discharge interventions for people with serious mental illness. Hippokratia 2019. [DOI: 10.1002/14651858.cd009788.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pablo Roson Rodriguez
- Instituto Universitario Hospital Italiano; Research Department; Potosí 4234 Buenos Aires Argentina 1199
| | - Juan VA Franco
- Instituto Universitario Hospital Italiano; Argentine Cochrane Centre; Potosí 4234 Buenos Aires Buenos Aires Argentina C1199ACL
| | - Luis Garegnani
- Instituto Universitario Hospital Italiano; Research Department; Potosí 4234 Buenos Aires Argentina 1199
| | - Marcelo Arancibia
- Universidad de Valparaíso; Interdisciplinary Centre for Health Studies CIESAL; Viña del Mar Chile
| | | | - Husam Aldeen Mohammad
- Al-Mowasat Hospital, Damascus University; Department of Psychiatry; Damascus Syrian Arab Republic
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Zanelli J, Mollon J, Sandin S, Morgan C, Dazzan P, Pilecka I, Reis Marques T, David AS, Morgan K, Fearon P, Doody GA, Jones PB, Murray RM, Reichenberg A. Cognitive Change in Schizophrenia and Other Psychoses in the Decade Following the First Episode. Am J Psychiatry 2019; 176:811-819. [PMID: 31256609 DOI: 10.1176/appi.ajp.2019.18091088] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Schizophrenia is associated with a marked cognitive impairment that is widely believed to remain stable after illness onset. Yet, to date, 10-year prospective studies of cognitive functioning following the first episode with good methodology are rare. The authors examined whether schizophrenia patients experience cognitive decline after the first episode, whether this decline is generalized or confined to individual neuropsychological functions, and whether decline is specific to schizophrenia. METHODS Participants were from a population-based case-control study of patients with first-episode psychosis who were followed prospectively up to 10 years after first admission. A neuropsychological battery was administered at index presentation and at follow-up to patients with a diagnosis of schizophrenia (N=65) or other psychoses (N=41) as well as to healthy comparison subjects (N=103). RESULTS The schizophrenia group exhibited declines in IQ and in measures of verbal knowledge and of memory, but not processing speed or executive functions. Processing speed and executive function impairments were already present at the first episode and remained stable thereafter. The magnitude of declines ranged between 0.28 and 0.66 standard deviations. Decline in measures of memory was not specific to schizophrenia and was also apparent in the group of patients with other psychoses. Healthy individuals with low IQ showed no evidence of decline, suggesting that a decline is specific to psychosis. CONCLUSIONS Patients with schizophrenia and other psychoses experience cognitive decline after illness onset, but the magnitude of decline varies across cognitive functions. Distinct mechanisms consequent to the illness and/or psychosocial factors may underlie impairments across different cognitive functions.
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Affiliation(s)
- Jolanta Zanelli
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Josephine Mollon
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Sven Sandin
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Craig Morgan
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Paola Dazzan
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Izabela Pilecka
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Tiago Reis Marques
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Anthony S David
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Kevin Morgan
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Paul Fearon
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Gillian A Doody
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Peter B Jones
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Robin M Murray
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
| | - Abraham Reichenberg
- The Department of Psychosis Studies (Zanelli, Dazzan, Pilecka, Reis Marques, David, Murray, Reichenberg) and the Department of Psychology (Pilecka), Institute of Psychiatry, Psychology, and Neuroscience, King's College London; the Department of Psychiatry, Harvard Medical School, Boston (Mollon); the Department of Psychiatry (Sandin, Reichenberg), the Department of Environmental Medicine and Public Health, and the Friedman Brain Institute (Reichenberg), Icahn School of Medicine at Mount Sinai, New York; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Sandin); the Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (C. Morgan); the Department of Psychology, University of Westminster, London (K. Morgan); the Department of Psychiatry, Trinity College, Dublin (Fearon); the Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, U.K. (Doody); and the Department of Psychiatry, University of Cambridge, Cambridge, U.K., and the Institute of Mental Health, University College London (Jones)
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McCleery A, Nuechterlein KH. Cognitive impairment in psychotic illness: prevalence, profile of impairment, developmental course, and treatment considerations
. DIALOGUES IN CLINICAL NEUROSCIENCE 2019; 21:239-248. [PMID: 31749648 PMCID: PMC6829172 DOI: 10.31887/dcns.2019.21.3/amccleery] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Despite effective pharmacological treatments for psychotic symptoms (eg, hallucinations, delusions), functional outcomes for people with psychotic disorders are often disappointing. Although it is not included in the diagnostic criteria for psychotic disorders, cognitive impairment is one of the strongest determinants of community functioning in this clinical population, and thus it is an important target for intervention. In this review, we discuss the major areas of research regarding impaired cognition in psychotic illness. The specific topics covered include: (i) the prevalence of cognitive impairment in psychotic disorders; (ii) the profile and magnitude of cognitive impairment in psychotic disorders; (iii) the developmental course of cognitive impairment; (iv) the longitudinal stability of cognitive impairment; and (v) treatment approaches to improve cognitive performance in people with psychotic disorders.
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Affiliation(s)
- Amanda McCleery
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, US; VA Greater Los Angeles, VISN 22 MIRECC, Los Angeles, California, US
| | - Keith H Nuechterlein
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, US; UCLA Department of Psychology, Los Angeles, California, US
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34
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Chan SKW, Chan HYV, Devlin J, Bastiampillai T, Mohan T, Hui CLM, Chang WC, Lee EHM, Chen EYH. A systematic review of long-term outcomes of patients with psychosis who received early intervention services. Int Rev Psychiatry 2019; 31:425-440. [PMID: 31353981 DOI: 10.1080/09540261.2019.1643704] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite convincing evidence of short-term symptom control and functional recovery of patients with psychosis after receiving early intervention (EI) services, little is known about the long-term outcomes of EI for these patients. This review aims to evaluate the effectiveness of EI services in improving long-term outcomes of patients with psychosis. A systematic literature search was conducted on PubMed, PsycINFO, Scopus, Medline, CINAHL, BIOSIS, and EMBASE electronic databases to identify studies that evaluated long-term outcomes of patients with psychosis measured 5 years or beyond after entering the EI service. Of 13,005 articles returned from the search, 14 eligible articles reporting study cohorts from nine EI services in seven countries and regions were identified. Data on study design, patient characteristics, intervention components, and outcomes were extracted and reviewed. Only a few studies reported better longitudinal outcomes for negative symptoms, mortality, employment, and hospitalization in patients received EI services. However, results from cross-sectional measurements provided little evidence for long-term impacts of EI services on clinical and functional outcomes. A dilution effect of benefits over time was also demonstrated in several studies. This review highlights the gap in current EI service provision and suggests possible future directions for service improvement and further research.
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Affiliation(s)
- Sherry K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong
| | - Hei Y V Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Jillian Devlin
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Tarun Bastiampillai
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University , Adelaide , South Australia
| | - Titus Mohan
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University , Adelaide , South Australia
| | - Christy L M Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Wing C Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong
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35
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Uribe E, Fernández L, Pacheco D, Fernandez L, Nayadoleni N, Eblen-Zajjur A. Administration of memantine reverses behavioral, histological, and electrophysiological abnormalities in rats subjected to early maternal deprivation. J Neural Transm (Vienna) 2019; 126:759-770. [DOI: 10.1007/s00702-019-02007-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/23/2019] [Indexed: 01/29/2023]
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36
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Sauvé G, Kline RB, Shah JL, Joober R, Malla A, Brodeur MB, Lepage M. Cognitive capacity similarly predicts insight into symptoms in first- and multiple-episode psychosis. Schizophr Res 2019; 206:236-243. [PMID: 30514643 DOI: 10.1016/j.schres.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/03/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lack of insight is a frequent characteristic of psychotic disorders, both in patients who recently experienced a first episode of psychosis (FEP) and those who experience recurrent multiple episodes (MEP). Insight is a multifaceted construct: its clinical form notably includes the unawareness of being ill, of symptoms, and of the need for treatment. Cognitive capacity is among the key determinants of insight into symptoms, but less is known about whether stage of illness (FEP vs. MEP) moderates this association. METHODS Our aim is to evaluate the association between cognitive capacity and symptom unawareness using structural equation modeling and moderated multiple regression. A total of 193 FEP and MEP patients were assessed using the CogState battery and the Scale to Assess Unawareness of Mental Disorder. RESULTS Analyses suggest that cognitive capacity accounts for a relatively small proportion of the total variation in symptom unawareness (6.4%). There was no evidence to suggest a moderating effect of stage of illness on this association. CONCLUSIONS The effect of general cognitive capacity on symptom unawareness is relatively small, and this basic relation was unrelated to stage of illness. It is possible that stage of illness could moderate this association only for certain facets of insight not assessed in this study (e.g., unawareness of the need for treatment).
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Affiliation(s)
- Geneviève Sauvé
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Rex B Kline
- Department of Psychology, Concordia University, 7141 Sherbrooke West, Montreal, Quebec H4B 1R6, Canada.
| | - Jai L Shah
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Ridha Joober
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Ashok Malla
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Mathieu B Brodeur
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Martin Lepage
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
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37
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Bliksted V, Frith C, Videbech P, Fagerlund B, Emborg C, Simonsen A, Roepstorff A, Campbell-Meiklejohn D. Hyper- and Hypomentalizing in Patients with First-Episode Schizophrenia: fMRI and Behavioral Studies. Schizophr Bull 2019; 45:377-385. [PMID: 29534245 PMCID: PMC6403062 DOI: 10.1093/schbul/sby027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Historically, research investigating neural correlates of mentalizing deficits in schizophrenia has focused on patients who have been ill for several years with lengthy exposure to medication. Little is known about the neural and behavioral presentations of theory-of-mind deficits in schizophrenia, shortly after the first episode of psychosis. METHODS We investigated social cognition in 17 recently diagnosed first-episode schizophrenia (FES) patients with little or no exposure to antipsychotic medication and 1:1 matched healthy controls. We recorded behavioral and neural responses to the Animated Triangles Task (ATT), which is a nonverbal validated mentalizing task that measures the ascription of intentionality to the movements of objects. RESULTS FES patients under-interpreted social cues and over-interpreted nonsocial cues. These effects were influenced by current intelligence (IQ). Control group and FES neural responses replicated earlier findings in healthy adults. However, a region of anterior medial prefrontal cortex (amPFC) of FES patients showed a different response pattern to that of controls. Unlike healthy controls, patients increased activity in this social cognition region while studying "random" movements of shapes, as compared to the study of movements normally interpreted as "intentional". CONCLUSIONS Mentalizing deficits in FES consists of hypo- and hypermentalizing. The neural pattern of FES patients is consistent with deficits in the ability to switch off mentalizing processes in potentially social contexts, instead increasing them when intentionality is not forthcoming. Overall, results demonstrate complexities of theory of mind deficits in schizophrenia that should be considered when offering social cognitive training programs.
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Affiliation(s)
- Vibeke Bliksted
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Risskov, Denmark
- Interacting Minds Centre, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Chris Frith
- Leopold Müller Functional Imaging Laboratory, Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | | | - Birgitte Fagerlund
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, Glostrup, Denmark
- Lundbeck Foundation Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, Glostrup, Denmark
| | - Charlotte Emborg
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Risskov, Denmark
| | - Arndis Simonsen
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Risskov, Denmark
- Interacting Minds Centre, Aarhus University, Aarhus, Denmark
| | - Andreas Roepstorff
- Interacting Minds Centre, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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38
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Coutinho LS, Honorato H, Higuchi CH, Cavalcante DA, Belangeiro S, Noto M, Bressan RA, Cordeiro Q, Noto C, Gadelha A. Cannabis acute use impacts symptoms and functionality in a cohort of antipsychotic naïve First Episode of Psychosis individuals. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 16:12-16. [PMID: 30581766 DOI: 10.1016/j.scog.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/27/2022]
Abstract
Introduction Cannabis use increases the risk of developing psychosis, and subjects with psychosis are more likely to use cannabis. However, studies on the influence of cannabis on psychotic dimensions, response to treatment, and functional outcomes showed conflicting results. Such heterogeneity may be due the inclusion of patients who were already under treatment, and lack of specificity in evaluations. We investigated whether cannabis use yields distinct symptom profiles and functionality in a cohort of antipsychotic-naïve patients at first episode of psychosis (FEP). Methods This research is part of a prospective cohort study performed in Sao Paulo, Brazil. The baseline assessment was completed by 175 individuals, and 99 of them were reassessed in a ten-week follow up. We investigated the relationship between cannabis exposure variables (acute use, lifetime use and age at first use) and outcomes: symptom dimensions and functioning. Results Individuals who reported acute use of cannabis had higher excitement symptoms at baseline, higher excitement and positive response rates, but no significant differences at follow-up. Additionally, more days of cannabis use in the last month predicted worse functionality and clinical impression at baseline but not at follow-up. Discussion The acute use of cannabis influenced the clinical presentation at our FEP baseline assessment, but did not to influence symptoms or functional outcomes at 10-week follow-up. Additionally, acute cannabis users had a better response for excitement and positive symptoms. Higher excitement symptoms at presentation of FEP should raise concerns of possible acute use of cannabis. Longer follow-up times may elucidate whether the effects on functionality would be more evident later in disease development.
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Affiliation(s)
- Luccas S Coutinho
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Hianna Honorato
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Cinthia H Higuchi
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Daniel A Cavalcante
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Sintia Belangeiro
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Mariane Noto
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Rodrigo A Bressan
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Quirino Cordeiro
- Department of Psychiatry, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | - Cristiano Noto
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Ary Gadelha
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil.,Schizophrenia Program (PROESQ), Universidade Federal de São Paulo (UNIFESP), Brazil
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39
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Le TP, Holden JL, Link PC, Granholm EL. Neurocognitive and theory of mind deficits and poor social competence in schizophrenia: The moderating role of social disinterest attitudes. Psychiatry Res 2018; 270:459-466. [PMID: 30551311 PMCID: PMC6347469 DOI: 10.1016/j.psychres.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
Neurocognitive and theory of mind deficits, dysfunctional attitudes, and negative symptoms have all been linked to poor functioning in schizophrenia, but interactions among these factors have not been extensively examined. We investigated whether dysfunctional attitudes (e.g., defeatist performance beliefs and social disinterest attitudes) moderated associations between neurocognition and theory of mind and poor everyday functioning and social competence in 146 participants with schizophrenia. We examined whether cognitive deficits are more likely to influence functioning in participants with more severe dysfunctional attitudes. Social disinterest, but not defeatist performance, attitudes were found to moderate associations between cognitive deficits and social competence but not everyday functioning, such that neurocognition and theory of mind deficits were only associated with poorer social competence in participants with more severe social disinterest attitudes. In contrast, no significant moderation effects were found for defeatist performance beliefs. Findings indicate that deficits in abilities were less likely to impact social competence in participants with greater interest in socializing. It may be that greater motivation for socializing engenders increased practice and engagement in social interactions, which then leads to greater social competence despite poor cognitive abilities. Treatments that target social disinterest attitudes may lead to greater social competence and engagement.
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Affiliation(s)
- Thanh P. Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA,Send correspondence to: Thanh P. Le, B.S., Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA, USA 70803,
| | - Jason L. Holden
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Peter C. Link
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Eric L. Granholm
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA USA
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40
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Niendam TA, Ray KL, Iosif AM, Lesh TA, Ashby SR, Patel PK, Smucny J, Ferrer E, Solomon M, Ragland JD, Carter CS. Association of Age at Onset and Longitudinal Course of Prefrontal Function in Youth With Schizophrenia. JAMA Psychiatry 2018; 75:1252-1260. [PMID: 30285056 PMCID: PMC6583034 DOI: 10.1001/jamapsychiatry.2018.2538] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/08/2018] [Indexed: 01/19/2023]
Abstract
Importance The extent of cognitive deterioration after schizophrenia (SZ) onset is poorly understood because prior longitudinal studies used small samples of older individuals with established illness. Objective To examine the association of age at onset and subsequent longitudinal course of prefrontal activity during the first 2 years of illness in youths with SZ and healthy control participants (HCs). Design, Setting, and Participants This naturalistic, longitudinal, functional magnetic resonance imaging (fMRI) study included patients with recent-onset SZ and HCs aged 12 to 25 years enrolled in an ongoing study of cognition in recent-onset psychosis in the Sacramento, California, area from October 13, 2004, through June 25, 2013. Participants completed clinical assessments and an established measure of cognitive control, the AX Continuous Performance Task (AX-CPT), during fMRI at baseline and at 6-, 12-, and 24-month follow-up. Whole-brain, voxelwise, and an a priori dorsolateral prefrontal cortex (DLPFC) region of interest analyses were performed. Group differences in developmental trajectories were examined by focusing on behavioral performance (d'-context) and cognitive control-associated brain activity. The association of antipsychotic medication and clinical factors were also examined. Data were analyzed from April 15, 2015, through August 29, 2017. Main Outcomes and Measures Primary outcomes included group differences (HC vs SZ) in behavioral performance (d'-context from AX-CPT) and brain activity for cue B-A trials of the AX-CPT in an a priori DLPFC region of interest at baseline and across the age span. Secondary analysis examined the influence of antipsychotics on behavioral performance and DLPFC activity. Results Among the sample of 180 participants (66.1% male; mean [SD] age at baseline, 19.2 [3.2] years), 87 patients with SZ (mean [SD] age, 19.6 [3.0] years) showed impaired performance compared with 93 HCs (mean [SD] age, 18.8 [3.4] years) across the age span (estimated difference [SE], -0.571 [0.12], d'-context; P < .001). Patients with SZ showed reduced activation in the DLPFC and parietal cortex (false discovery rate cluster corrected to P < .05) compared with HCs under conditions of high cognitive control at baseline. Region-of-interest analysis showed reduced activation in the DLPFC bilaterally for patients with SZ, with a trajectory that paralleled that of HCs across the age span (left DLPFC β [SE] estimates, 0.409 [0.165] for the HC group and -0.285 [0.130] for the SZ group [main effect of group, P = .03]; right DLPFC β [SE] estimates, 0.350 [0.103] for the HC group and -0.469 [0.157] for the SZ group [P = .003]). Antipsychotic medication, clinical symptoms, and global functioning were associated with SZ performance. Conclusions and Relevance During the initial 1 to 2 years after illness onset, young individuals with SZ showed deficits in DLPFC activation and cognitive control, with developmental trajectories comparable to those of HCs. Younger age at onset was not associated with reduced cognition or activation. For individuals contributing to longitudinal analysis, results suggest that young patients do not show deterioration or disruption of ongoing brain development in the initial years after illness onset.
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Affiliation(s)
- Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Kimberly L. Ray
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
- Department of Psychology, The University of Texas at Austin
| | - Ana-Maria Iosif
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Tyler A. Lesh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Stefania R. Ashby
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
- Department of Psychology, University of Oregon, Eugene
| | - Pooja K. Patel
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
- Department of Psychology, UCLA (University of California, Los Angeles), Westwood
| | - Jason Smucny
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Emilio Ferrer
- Department of Psychology, University of California, Davis, Sacramento
| | - Marjorie Solomon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
- MIND Institute, University of California, Davis, Sacramento
| | - J. Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Cameron S. Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
- Center for Neuroscience, University of California, Davis, Sacramento
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41
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Sauvé G, Malla A, Joober R, Brodeur MB, Lepage M. Comparing cognitive clusters across first- and multiple-episode of psychosis. Psychiatry Res 2018; 269:707-718. [PMID: 30273896 DOI: 10.1016/j.psychres.2018.08.119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/11/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022]
Abstract
Cognitive impairments in psychotic disorders (PD) present heterogeneously across patients. Between 2 and 5 clusters have been identified in previous studies with first-episode (FEP) and multiple-episodes of psychosis (MEP) patients suggesting different profiles of impairment. Past findings suggest there are differences between FEP and MEP patients regarding severity and number of affected cognitive domains. Heterogeneity of cognitive deficits in PD has perhaps hindered our understanding of their course. The present study compared non-affective FEP and MEP patients to assess whether illness chronicity could influence cognitive impairment profiles. We analyzed cognitive data, collected with the Cogstate Schizophrenia Battery, of FEP and MEP patients using cluster analysis. We compared clustering methods to obtain a more robust solution. For FEP patients, data were collected at their entry to a specialized clinic; the MEP group consisted of in- and outpatients. Results suggested cognitive heterogeneity was similar in FEP and MEP samples, although in different proportions. Three clusters were identified as the most stable solution and comprised groups of patients with either 1- no cognitive impairment (over-representation of FEP), 2- generalized deficits (over-representation of MEP), or 3- intermediate impairments. These findings encourage early interventions adapted to the profile of impairment.
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Affiliation(s)
- Geneviève Sauvé
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Mathieu B Brodeur
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
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42
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Gardner RL, Youssef R, Morphis B, DaCunha A, Pelland K, Cooper E. Use of Chronic Care Management Codes for Medicare Beneficiaries: a Missed Opportunity? J Gen Intern Med 2018; 33:1892-1898. [PMID: 30030734 PMCID: PMC6206335 DOI: 10.1007/s11606-018-4562-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/12/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Physicians spend significant time outside of regular office visits caring for complex patients, and this work is often uncompensated. In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a billing code for care coordination between office visits for beneficiaries with multiple chronic conditions. OBJECTIVE Characterize use of the Chronic Care Management (CCM) code in New England in 2015. DESIGN Retrospective observational analysis. PARTICIPANTS All Medicare fee-for-service beneficiaries in New England continuously enrolled in Parts A and B in 2015. INTERVENTION None. MAIN MEASURES The primary outcome was the number of beneficiaries with a CCM claim per 1000 eligible beneficiaries. Secondary outcomes included the total number of CCM claims, total reimbursement, mean number of claims per beneficiary, and beneficiary characteristics independently associated with receiving CCM services. KEY RESULTS Of the more than two million Medicare fee-for-service beneficiaries in New England, almost 1.7 million were potentially eligible for CCM services. Among eligible beneficiaries, 10,951 (0.65%) had a CCM claim in 2015. Massachusetts had the highest penetration of CCM use (9.40 claims per 1000 eligible beneficiaries); Vermont had the lowest (0.54 claims per 1000 eligible beneficiaries). Mean reimbursement per physician was $1745.98. Age, race/ethnicity, dual-eligible status, income, number of chronic conditions, and state of residence were associated with receiving CCM services in an adjusted model. CONCLUSIONS The CCM code is likely underutilized in New England; the program may therefore not be achieving its intended goal of encouraging consistent, team-based chronic care management for Medicare's most complex beneficiaries. Or practices may be foregoing reimbursement for care coordination that they are already providing. Recently implemented revisions may improve uptake of CCM services; it will be important to compare our results with future utilization.
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Affiliation(s)
- Rebekah L Gardner
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA. .,Healthcentric Advisors, Providence, RI, USA.
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43
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Sheffield JM, Karcher NR, Barch DM. Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective. Neuropsychol Rev 2018; 28:509-533. [PMID: 30343458 DOI: 10.1007/s11065-018-9388-2] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN, 37212, USA.
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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44
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Sánchez-Torres AM, Moreno-Izco L, Lorente-Omeñaca R, Cabrera B, Lobo A, González-Pinto AM, Merchán-Naranjo J, Corripio I, Vieta E, de la Serna E, Butjosa A, Contreras F, Sarró S, Mezquida G, Ribeiro M, Bernardo M, Cuesta MJ. Individual trajectories of cognitive performance in first episode psychosis: a 2-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2018; 268:699-711. [PMID: 29164332 DOI: 10.1007/s00406-017-0857-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/14/2017] [Indexed: 11/28/2022]
Abstract
Individual changes over time in cognition in patients with psychotic disorders have been studied very little, especially in the case of first episode psychosis (FEP). We aimed to establish whether change in individual trajectories in cognition over 2 years of a sample of 159 FEP patients was reliable and clinically significant, using the reliable change index (RCI) and clinically significant change (CSC) methods. We also studied a sample of 151 matched healthy controls. Patients and controls were assessed with a set of neuropsychological tests, as well as premorbid, clinical and functionality measures. We analysed the course of cognitive measures over time, using analysis of variance, and the individual trajectories in the cognitive measures with the regression-based RCI (RCISRB) and the CSC. The RCISRB showed that between 5.4 and 31.2% of the patients showed deterioration patterns, and between 0.6 and 8.8% showed improvement patterns in these tests over time. Patients showing better cognitive profiles according to RCISRB (worsening in zero to two cognitive measures) showed better premorbid, clinical and functional profiles than patients showing deterioration patterns in more than three tests. When combining RCISRB and CSC values, we found that less than 10% of patients showed improvement or deterioration patterns in executive function and attention measures. These results support the view that cognitive impairments are stable over the first 2 years of illness, but also that the analysis of individual trajectories could help to identify a subgroup of patients with particular phenotypes, who may require specific interventions.
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Affiliation(s)
- A M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 3, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - L Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 3, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - R Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 3, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - B Cabrera
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - A Lobo
- Department of Medicine and Psychiatry, Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Saragossa, Spain
| | - A M González-Pinto
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- BIOARABA Health Research Institute, OSI Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Vitoria, Spain
| | - J Merchán-Naranjo
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, IISGM, Universidad Complutense, Madrid, Spain
| | - I Corripio
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Vieta
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, Catalonia, Spain
- August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Catalonia, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, University of Barcelona, Catalonia, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - E de la Serna
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Butjosa
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Sant Boi de Llobregat, Barcelona, Spain
- Sant Joan de Déu Research Foundation. Esplugues de Llobregat, Barcelona, Spain
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - F Contreras
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - S Sarró
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - G Mezquida
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Ribeiro
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 3, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - M Bernardo
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - M J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 3, 31008, Pamplona, Spain.
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
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45
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Dorofeikova M, Neznanov N, Petrova N. Cognitive deficit in patients with paranoid schizophrenia: Its clinical and laboratory correlates. Psychiatry Res 2018; 262:542-548. [PMID: 28951142 DOI: 10.1016/j.psychres.2017.09.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 12/16/2022]
Abstract
The aim of this study was to search for correlates of cognitive impairment in patients with paranoid schizophrenia among clinical, demographic, anamnestic and biochemical markers (NSE, S100B protein, BDNF, hs-CRP). Patients with paranoid schizophrenia (n=125) were examined using the Brief Assessment of Cognitive Function in Schizophrenia, the Rey-Osterrieth Complex Figure task, and a number of clinical scales including the Positive and Negative Syndrome Scale. The majority of patients demonstrated cognitive impairment. The type of impairment was highly heterogeneous and individual. Relationships were found between the degree of executive functioning and family history of mental illness; working memory and age of onset of schizophrenia; and visual memory and psychopathological symptomatology. Negative and affective symptoms were not significantly associated with cognitive functioning. Treatment with first generation antipsychotics was associated with a more frequent impairment of motor skills, and concomitant anticholinergic drugs, with reduced accuracy. Use of second-generation antipsychotics only was associated with better accuracy, working memory and speech fluency. Among the patients, 21.4% had signs of a systemic inflammatory response, indicating a possible role of inflammatory response in the development of schizophrenia. CRP, S100B and NSE levels reflected features of the course of illness and therapeutic response. Patients with lower concentrations of BDNF were characterized by lower processing speeds.
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Affiliation(s)
- Mariia Dorofeikova
- State Federal Budgetary Institution, Saint-Petersburg Bekhterev Psychoneurological Research Institute, Saint-Petersburg, Russia.
| | - Nikolay Neznanov
- State Federal Budgetary Institution, Saint-Petersburg Bekhterev Psychoneurological Research Institute, Saint-Petersburg, Russia
| | - Nataliia Petrova
- State Federal Budgetary Institution for Higher Education, Saint-Petersburg State University,Saint-Petersburg, Russia
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46
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Czepielewski LS, Massuda R, Panizzutti B, Grun LK, Barbé-Tuana FM, Teixeira AL, Barch DM, Gama CS. Telomere Length and CCL11 Levels are Associated With Gray Matter Volume and Episodic Memory Performance in Schizophrenia: Evidence of Pathological Accelerated Aging. Schizophr Bull 2018; 44:158-167. [PMID: 28338779 PMCID: PMC5767949 DOI: 10.1093/schbul/sbx015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Schizophrenia (SZ) is associated with increased somatic morbidity and mortality, in addition to cognitive impairments similar to those seen in normal aging, which may suggest that pathological accelerated aging occurs in SZ. Therefore, we aim to evaluate the relationships of age, telomere length (TL), and CCL11 (aging and inflammatory biomarkers, respectively), gray matter (GM) volume and episodic memory performance in individuals with SZ compared to healthy controls (HC). One hundred twelve participants (48 SZ and 64 HC) underwent clinical and memory assessments, structural MRI, and had their peripheral blood drawn for biomarkers analysis. Comparisons of group means and correlations were performed. Participants with SZ had decreased TL and GM volume, increased CCL11, and worse memory performance compared to HC. In SZ, shorter TL was related to increased CCL11, and both biomarkers were related to reduced GM volume, all of which were related to worse memory performance. Older age was only associated with reduced GM, but longer duration of illness was related with all the aforementioned variables. Younger age of disease onset was associated with increased CCL11 levels and worse memory performance. In HC, there were no significant correlations except between memory and GM. Our results are consistent with the hypothesis of accelerated aging in SZ. These results may indicate that it is not age itself, but the impact of the disease associated with a pathological accelerated aging that leads to impaired outcomes in SZ.
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Affiliation(s)
- Leticia Sanguinetti Czepielewski
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Raffael Massuda
- Departamento de Psiquiatria, Universidade Federal do Paraná, Curitiba, Brazil
| | - Bruna Panizzutti
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Kich Grun
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Florencia María Barbé-Tuana
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Antonio Lucio Teixeira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, MO,Department of Psychiatry and Radiology, Washington University in St Louis, St Louis, MO
| | - Clarissa S Gama
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,To whom correspondence should be addressed; Hospital de Clínicas de Porto Alegre/CPE, Molecular Psychiatry Laboratory, Rua Ramiro Barcelos, 2350, Prédio Anexo, 90035-903 Porto Alegre, Brazil; tel: +55-51-33598845, fax: +55-51-33598846, e-mail:
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47
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Giersch A, Mishara AL. Is Schizophrenia a Disorder of Consciousness? Experimental and Phenomenological Support for Anomalous Unconscious Processing. Front Psychol 2017; 8:1659. [PMID: 29033868 PMCID: PMC5625017 DOI: 10.3389/fpsyg.2017.01659] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/08/2017] [Indexed: 12/27/2022] Open
Abstract
Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients' conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and conscious level. We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness.
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Affiliation(s)
- Anne Giersch
- INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire of Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Aaron L. Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Los Angeles, CA, United States
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48
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Conus P, Cotton S, Schimmelmann BG, McGorry PD, Lambert M. Rates and predictors of 18-months remission in an epidemiological cohort of 661 patients with first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1089-1099. [PMID: 28477070 DOI: 10.1007/s00127-017-1388-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/01/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Most first episode psychosis (FEP) outcome studies are based on patient samples enrolled through an informed consent procedure, which may induce important biases. Our aim was to study the 18-month outcome of FEP in an epidemiological sample of patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC). METHODS The files of 661 FEP patients treated for up to 18 months between 1998 and 2000 were assessed. Symptomatic remission was defined as receiving a score ≤3 on the Clinical Global Impressions (CGI) scales, and functional remission as concurrent fulfillment of occupation/employment and independent living. Predictors were analyzed using stepwise logistic regression models. RESULTS At endpoint, 63% of FEP patients had reached symptomatic remission and 44% functional remission. Duration of untreated psychosis, baseline symptom intensity, time in service and decrease or remission of substance use, predicted both symptomatic and functional outcome. A history of suicide attempt or non-adherence to medication was linked to lower likelihood to reach symptomatic remission while pre-morbid GAF and employment at baseline were linked to functional outcome. CONCLUSIONS The development of early intervention strategies should be pursued, in order both to provide treatment before symptoms reach a high intensity and to maintain social integration. Specific strategies need to promote engagement, facilitate adherence to medication and to create a framework where key issues such as substance abuse co-morbidity can be addressed.
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Affiliation(s)
- Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008, Prilly, Switzerland. .,Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.
| | - Sue Cotton
- Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.,Centre for Youth Mental Health University of Melbourne, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia
| | - Benno G Schimmelmann
- Department of Child- and Adolescent Psychiatry, University of Bern, Bern, Switzerland.,Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.,Centre for Youth Mental Health University of Melbourne, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Eskelinen S, Sailas E, Joutsenniemi K, Holi M, Koskela TH, Suvisaari J. Multiple physical healthcare needs among outpatients with schizophrenia: findings from a health examination study. Nord J Psychiatry 2017; 71:448-454. [PMID: 28497707 DOI: 10.1080/08039488.2017.1319497] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the abundant literature on physical comorbidity, the full range of the concurrent somatic healthcare needs among individuals with schizophrenia has rarely been studied. AIMS This observational study aimed to assess the distressing somatic symptoms and needs for physical health interventions in outpatients with schizophrenia, and factors predicting those needs. METHODS A structured, comprehensive health examination was carried out, including a visit to a nurse and a general practitioner on 275 outpatients with schizophrenia. The required interventions were classified by type of disease. Logistic regression was used to assess the influence of sociodemographic factors, lifestyle, functional limitations, factors related to psychiatric disorder, and healthcare use on the need for interventions. RESULTS In total, 44.9% of the patients (mean age 44.9 years) reported somatic symptoms affecting daily life; 87.6% needed specific interventions for a disease or condition, most commonly for cardiovascular, dermatological, dental, ophthalmological, and gastrointestinal conditions, and for altered glucose homeostasis. Smoking and obesity predicted significantly a need of any intervention, but the predictors varied in each disease category. Strikingly, use of general practitioner services during the previous year did not reduce the need for interventions. CONCLUSIONS Health examinations for outpatients with schizophrenia revealed numerous physical healthcare needs. The health examinations for patients with schizophrenia should contain a medical history taking and a physical examination, in addition to basic measurements and laboratory tests. Prevention and treatment of obesity and smoking should be given priority in order to diminish somatic comorbidities in schizophrenia.
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Affiliation(s)
- Saana Eskelinen
- a Kellokoski Hospital , Tuusula , Finland.,b Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
| | | | - Kaisla Joutsenniemi
- c Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Matti Holi
- c Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Tuomas H Koskela
- d Department of General Practice , University of Tampere , Tampere , Finland
| | - Jaana Suvisaari
- b Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
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Choi S, Cho HK, Lee MK. Demographic Characteristics, Medication Profile and Treatment Outcome of Patients with Very Early-Onset Schizophrenia in One Hospital. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- SungKu Choi
- Division of Medical Services, National Center for Mental Health, Seoul, Korea
| | - Hye-Kyung Cho
- Division of Medical Services, National Center for Mental Health, Seoul, Korea
| | - Min-Koo Lee
- Department of Information and Statistics, Chungnam National University, Daejeon, Korea
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