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The impact of psychosis on the course of cognition: a prospective, nested case-control study in individuals at clinical high-risk for psychosis

Published online by Cambridge University Press:  14 July 2015

R. E. Carrión ,
D. McLaughlin ,
A. M. Auther ,
R. Olsen ,
C. U. Correll  and
B. A. Cornblatt
R. E. Carrión*
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
D. McLaughlin
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA
A. M. Auther
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
R. Olsen
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA
C. U. Correll
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
B. A. Cornblatt
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
*
*Address for correspondence: R. E. Carrión, Ph.D., Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, New York 11004, USA. (Email: RCarrion@NSHS.edu)
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Abstract

Background

Although cognitive deficits in patients with schizophrenia are rooted early in development, the impact of psychosis on the course of cognitive functioning remains unclear. In this study a nested case-control design was used to examine the relationship between emerging psychosis and the course of cognition in individuals ascertained as clinical high-risk (CHR) who developed psychosis during the study (CHR + T).

Method

Fifteen CHR + T subjects were administered a neurocognitive battery at baseline and post-psychosis onset (8.04 months, s.d. = 10.26). CHR + T subjects were matched on a case-by-case basis on age, gender, and time to retest with a group of healthy comparison subjects (CNTL, n = 15) and two groups of CHR subjects that did not transition: (1) subjects matched on medication treatment (i.e. antipsychotics and antidepressants) at both baseline and retesting (Meds-matched CHR + NT, n = 15); (2) subjects unmedicated at both assessments (Meds-free CHR + NT, n = 15).

Results

At baseline, CHR + T subjects showed large global neurocognitive and intellectual impairments, along with specific impairments in processing speed, verbal memory, sustained attention, and executive function. These impairments persisted after psychosis onset and did not further deteriorate. In contrast, CHR + NT subjects demonstrated stable mild to no impairments in neurocognitive and intellectual performance, independent of medication treatment.

Conclusions

Cognition appears to be impaired prior to the emergence of psychotic symptoms, with no further deterioration associated with the onset of psychosis. Cognitive deficits represent trait risk markers, as opposed to state markers of disease status and may therefore serve as possible predictors of schizophrenia prior to the onset of the full illness.

Keywords

Clinical high risklinear mixed-effects modelsnested case-control studyneurocognitionprodromalpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 15 , November 2015 , pp. 3341 - 3354
Copyright
Copyright © Cambridge University Press 2015 

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