Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-19T05:14:50.668Z Has data issue: false hasContentIssue false
  • English
  • Français

Pretreatment predictors of cognitive deficits in early psychosis

Published online by Cambridge University Press:  09 October 2007

C. González-Blanch ,
B. Crespo-Facorro ,
M. Álvarez-Jiménez ,
J. M. Rodríguez-Sánchez ,
J. M. Pelayo-Terán ,
R. Pérez-Iglesias  and
J. L. Vázquez-Barquero
C. González-Blanch*
Affiliation:
University Hospital ‘Marqués de Valdecilla’, Psychiatry Research Unit of Cantabria, Department of Psychiatry, School of Medicine, Santander, Spain
B. Crespo-Facorro
Affiliation:
University Hospital ‘Marqués de Valdecilla’, Psychiatry Research Unit of Cantabria, Department of Psychiatry, School of Medicine, Santander, Spain
M. Álvarez-Jiménez
Affiliation:
University Hospital ‘Marqués de Valdecilla’, Psychiatry Research Unit of Cantabria, Department of Psychiatry, School of Medicine, Santander, Spain ORYGEN Research Centre, Melbourne, Australia
J. M. Rodríguez-Sánchez
Affiliation:
University Hospital ‘Marqués de Valdecilla’, Psychiatry Research Unit of Cantabria, Department of Psychiatry, School of Medicine, Santander, Spain
J. M. Pelayo-Terán
Affiliation:
University Hospital ‘Marqués de Valdecilla’, Psychiatry Research Unit of Cantabria, Department of Psychiatry, School of Medicine, Santander, Spain
R. Pérez-Iglesias
Affiliation:
University Hospital ‘Marqués de Valdecilla’, Psychiatry Research Unit of Cantabria, Department of Psychiatry, School of Medicine, Santander, Spain
J. L. Vázquez-Barquero
Affiliation:
University Hospital ‘Marqués de Valdecilla’, Psychiatry Research Unit of Cantabria, Department of Psychiatry, School of Medicine, Santander, Spain
*
*Address for correspondence: Dr C. González-Blanch, Hospital Universitario ‘Marqués de Valdecilla’, Unidad de Investigación en Psiquiatría de Cantabria, Planta 2a, Edificio 2 de Noviembre, Avda Valdecilla s/n, 39008 Santander, Spain. (Email: cgblanch@terra.es)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Predicting cognitive deficits in early psychosis may well be crucial to identify those individuals most in need of receiving intensive intervention. As yet, however, the identification of potential pretreatment predictors for cognitive performance has been hampered by inconsistent findings across studies. We aimed to examine the associations of functional and clinical pretreatment variables with cognitive functioning after a first psychotic episode.

Method

One hundred and thirty-one patients experiencing first-episode psychosis were assessed for psychopathology, pre-morbid functioning, duration of illness, age of onset, and family history of psychosis and neurocognitive functioning. Multiple regression analyses were conducted for six basic cognitive dimensions known to be affected in this population: verbal learning, verbal memory, verbal comprehensive abilities, executive functioning, motor dexterity and sustained attention.

Results

Pre-morbid functioning was the main predictor for five out of the six basic cognitive domains. Pre-morbid social adjustment difficulties were associated with worse performance in executive functioning, motor dexterity and sustained attention. Academic functioning was associated with verbal comprehension, and verbal learning and memory. Gender, age of onset, duration of untreated psychosis, and family history of psychosis had no or limited value as predictors of neurocognitive outcome.

Conclusions

Poor pre-morbid functioning was related to a worse performance in the six basic cognitive dimensions evaluated; however, this accounted for only a small amount of the explained variance. Cognitive impairment is a prominent feature in patients with early psychosis regardless of favorable prognostic features such as short duration of illness, female gender, later age of onset, and non-family history of psychosis.

Keywords

Duration of illnessfirst-episodegenderpredictorspre-morbid functioningschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 5 , May 2008 , pp. 737 - 746
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J, Addington, D (1993). Premorbid functioning, cognitive functioning, symptoms and outcome in schizophrenia. Journal of Psychiatry and Neuroscience 18, 18–23.Google Scholar
Andreasen, NC (1981). Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City, IA.Google Scholar
Andreasen, NC (1983). Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City, IA.Google Scholar
Andreasen, NC, Rice, J, Endicott, J, Reich, T, Coryell, W (1986). The family history approach to diagnosis. How useful is it? Archives of General Psychiatry 43, 421–429.CrossRefGoogle Scholar
Barnett, JH, Salmond, CH, Jones, PB, Sahakian, BJ (2006). Cognitive reserve in neuropsychiatry. Psychological Medicine 36, 1053–1064.CrossRefGoogle ScholarPubMed
Bellino, S, Rocca, P, Patria, L, Marchiaro, L, Rasetti, R, Di Lorenzo, R, Paradiso, E, Bogetto, F (2004). Relationships of age at onset with clinical features and cognitive functions in a sample of schizophrenia patients. Journal of Clinical Psychiatry 65, 908–914.CrossRefGoogle Scholar
Bilder, RM, Goldman, RS, Robinson, D, Reiter, G, Bell, L, Bates, JA, Pappadopulos, E, Willson, DF, Alvir, JM, Woerner, MG, Geisler, S, Kane, JM, Lieberman, JA (2000). Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. American Journal of Psychiatry 157, 549–559.CrossRefGoogle ScholarPubMed
Bilder, RM, Lipschutz-Broch, L, Reiter, G, Geisler, SH, Mayerhoff, DI, Lieberman, JA (1992). Intellectual deficits in first-episode schizophrenia: evidence for progressive deterioration. Schizophrenia Bulletin 18, 437–448.Google Scholar
Cannon, M, Caspi, A, Moffitt, TE, Harrington, H, Taylor, A, Murray, RM, Poulton, R (2002). Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Archives of General Psychiatry 59, 449–456.CrossRefGoogle ScholarPubMed
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.Google Scholar
Cegalis, J, Bowlin, J (1991). Vigil: Software for the Assessment of Attention. Forthought: Nashua, NH.Google Scholar
Censits, DM, Ragland, JD, Gur, RC, Gur, RE (1997). Neuropsychological evidence supporting a neurodevelopmental model of schizophrenia: a longitudinal study. Schizophrenia Research 24, 289–298.Google Scholar
Crespo-Facorro, B, Perez-Iglesias, R, Ramirez-Bonilla, M, Martinez-Garcia, O, Llorca, J, Vazquez-Barquero, JL (2006). A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. Journal of Clinical Psychiatry 67, 1511–1521.Google Scholar
Daban, C, Amado, I, Bourdel, MC, Loo, H, Olie, JP, Poirier, MF, Krebs, MO (2005). Cognitive dysfunctions in medicated and unmedicated patients with recent-onset schizophrenia. Journal of Psychiatric Research 39, 391–398.Google Scholar
Davidson, L, McGlashan, TH (1997). The varied outcomes of schizophrenia. Canadian Journal of Psychiatry 42, 34–43.CrossRefGoogle ScholarPubMed
de Haan, L, Linszen, DH, Lenior, ME, de Win, ED, Gorsira, R (2003). Duration of untreated psychosis and outcome of schizophrenia: delay in intensive psychosocial treatment versus delay in treatment with antipsychotic medication. Schizophrenia Bulletin 29, 341–348.Google Scholar
DeQuardo, JR, Tandon, R, Goldman, R, Meador-Woodruff, JH, McGrath-Giroux, M, Brunberg, JA, Kim, L (1994). Ventricular enlargement, neuropsychological status, and premorbid function in schizophrenia. Biological Psychiatry 35, 517–524.CrossRefGoogle ScholarPubMed
Faul, F, Erdfelder, E (1992). GPOWER: A Priori, Post-hoc, and Compromise Power Analyses for MS-DOS. Bonn University, Department of Psychology: Germany.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders. Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Fitzgerald, D, Lucas, S, Redoblado, MA, Winter, V, Brennan, J, Anderson, J, Harris, A (2004). Cognitive functioning in young people with first episode psychosis: relationship to diagnosis and clinical characteristics. Australian and New Zealand Journal of Psychiatry 38, 501–510.CrossRefGoogle ScholarPubMed
Gold, S, Arndt, S, Nopoulos, P, O'Leary, DS, Andreasen, NC (1999). Longitudinal study of cognitive function in first-episode and recent-onset schizophrenia. American Journal of Psychiatry 156, 1342–1348.Google Scholar
González-Blanch, C, Alvarez-Jimenez, M, Rodriguez-Sanchez, JM, Perez-Iglesias, R, Vazquez-Barquero, JL, Crespo-Facorro, B (2006). Cognitive functioning in the early course of first-episode schizophrenia spectrum disorders: timing and patterns. European Archives of Psychiatry and Clinical Neuroscience 256, 364–371.Google Scholar
González-Blanch, C, Crespo-Facorro, B, Álvarez-Jiménez, M, Rodríguez-Sánchez, JM, Pelayo-Terán, JM, Pérez-Iglesias, R, Vázquez-Barquero, JL (2007). Cognitive dimensions in first-episode schizophrenia spectrum disorders. Journal of Psychiatric Research 41, 968–977.Google Scholar
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119–136.Google Scholar
Green, MF, Kern, RS, Heaton, RK (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research 72, 41–51.Google Scholar
Grube, BS, Bilder, RM, Goldman, RS (1998). Meta-analysis of symptom factors in schizophrenia. Schizophrenia Research 31, 113–120.Google Scholar
Hafner, H, Hambrecht, M, Loffler, W, Munk-Jorgensen, P, Riecher-Rossler, A (1998). Is schizophrenia a disorder of all ages? A comparison of first episodes and early course across the life-cycle. Psychological Medicine 28, 351–365.Google Scholar
Heydebrand, G, Weiser, M, Rabinowitz, J, Hoff, AL, DeLisi, LE, Csernansky, JG (2004). Correlates of cognitive deficits in first episode schizophrenia. Schizophrenia Research 68, 1–9.Google Scholar
Hoff, AL, Wieneke, M, Faustman, WO, Horon, R, Sakuma, M, Blankfeld, H, Espinoza, S, DeLisi, LE (1998). Sex differences in neuropsychological functioning of first-episode and chronically ill schizophrenic patients. American Journal of Psychiatry 155, 1437–1439.CrossRefGoogle ScholarPubMed
Joyce, EM, Hutton, SB, Mutsatsa, SH, Barnes, TR (2005). Cognitive heterogeneity in first-episode schizophrenia. British Journal of Psychiatry 187, 516–522.Google Scholar
Leung, A, Chue, P (2000). Sex differences in schizophrenia, a review of the literature. Acta Psychiatrica Scandinavica Supplement 401, 3–38.Google Scholar
Lewis, SW, Reveley, AM, Reveley, MA, Chitkara, B, Murray, RM (1987). The familial/sporadic distinction as a strategy in schizophrenia research. British Journal of Psychiatry 151, 306–313.Google Scholar
Lezak, MD, Howieson, DB, Loring, W (2004). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Liddle, PF (1987). Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine 17, 49–57.CrossRefGoogle ScholarPubMed
Lucas, S, Fitzgerald, D, Redoblado-Hodge, MA, Anderson, J, Sanbrook, M, Harris, A, Brennan, J (2004). Neuropsychological correlates of symptom profiles in first episode schizophrenia. Schizophrenia Research 71, 323–330.CrossRefGoogle ScholarPubMed
Mohamed, S, Paulsen, JS, O'Leary, D, Arndt, S, Andreasen, N (1999). Generalized cognitive deficits in schizophrenia: a study of first-episode patients. Archives of General Psychiatry 56, 749–754.Google Scholar
Moritz, S, Krausz, M, Gottwalz, E, Lambert, M, Perro, C, Ganzer, S, Naber, D (2000). Cognitive dysfunction at baseline predicts symptomatic 1-year outcome in first-episode schizophrenics. Psychopathology 33, 48–51.Google Scholar
Norman, RM, Lewis, SW, Marshall, M (2005 a). Duration of untreated psychosis and its relationship to clinical outcome. British Journal of Psychiatry 48, s19–23.CrossRefGoogle ScholarPubMed
Norman, RM, Malla, AK, Manchanda, R, Townsend, L (2005 b). Premorbid adjustment in first episode schizophrenia and schizoaffective disorders: a comparison of social and academic domains. Acta Psychiatrica Scandinavica 112, 30–39.Google Scholar
Norman, RM, Townsend, L, Malla, AK (2001). Duration of untreated psychosis and cognitive functioning in first-episode patients. British Journal of Psychiatry 179, 340–345.Google Scholar
Overall, JE, Gorham, DR (1962). The Brief Psychiatric Rating Scale. Psychological Reports 10, 799–812.Google Scholar
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 1785–1804.Google Scholar
Rey, A (1987). Test de Copia de la Figura Compleja [Rey Complex Figure Test]. TEA Ediciones: Madrid.Google Scholar
Rund, BR, Melle, I, Friis, S, Larsen, TK, Midboe, LJ, Opjordsmoen, S, Simonsen, E, Vaglum, P, McGlashan, T (2004). Neurocognitive dysfunction in first-episode psychosis: correlates with symptoms, premorbid adjustment, and duration of untreated psychosis. American Journal of Psychiatry 161, 466–472.Google Scholar
Sautter, FJ, McDermott, BE, Cornwell, J, Black, FW, Borges, A, Johnson, J, O'Neill, P (1994). Patterns of neuropsychological deficit in cases of schizophrenia spectrum disorder with and without a family history of psychosis. Psychiatry Research 54, 37–49.Google Scholar
Sautter, FJ, McDermott, BE, Cornwell, J, Johnson, J, Borges, A, Wilson, AF, Vasterling, JJ, Foundas, AL (1995). A preliminary study of the neuropsychological heterogeneity of familial schizophrenia. Schizophrenia Research 18, 1–7.Google Scholar
Schretlen, D, Bobholz, J, Brandt, J (1996). Development and psychometric properties of the Brief Test of Attention. Clinical Neuropsychologist 10, 80–89.CrossRefGoogle Scholar
Silverstein, ML, Mavrolefteros, G, Close, D (2002). Premorbid adjustment and neuropsychological performance in schizophrenia. Schizophrenia Bulletin 28, 157–165.Google Scholar
Silverstein, ML, Mavrolefteros, G, Turnbull, A (2003). Premorbid factors in relation to motor, memory, and executive functions deficits in adult schizophrenia. Schizophrenia Research 61, 271–280.Google Scholar
Spreen, O, Strauss, E (1998). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford University Press: New York.Google Scholar
Tuulio-Henriksson, A, Partonen, T, Suvisaari, J, Haukka, J, Lonnqvist, J (2004). Age at onset and cognitive functioning in schizophrenia. British Journal of Psychiatry 185, 215–219.Google Scholar
van Mastrigt, S, Addington, J (2002). Assessment of premorbid function in first-episode schizophrenia: modifications to the Premorbid Adjustment Scale. Journal of Psychiatry and Neuroscience 27, 92–101.Google Scholar
Verdoux, H, Liraud, F, Assens, F, Abalan, F, van Os, J (2002). Social and clinical consequences of cognitive deficits in early psychosis: a two-year follow-up study of first-admitted patients. Schizophrenia Research 56, 149–159.Google Scholar
Wechsler, D (1999). Wechsler Adult Intelligence Scale-III. TEA Ediciones: Madrid.Google Scholar
Wolitzky, R, Goudsmit, N, Goetz, RR, Printz, D, Gil, R, Harkavy-Friedman, J, Malaspina, D (2006). Etiological heterogeneity and intelligence test scores in patients with schizophrenia. Journal of Clinical and Experimental Neuropsychology 28, 167–177.Google Scholar
Wyatt, RJ (1991). Early intervention with neuroleptics may decrease the long-term morbidity of schizophrenia. Schizophrenia Research 5, 201–202.Google Scholar