Published online by Cambridge University Press: 09 September 2020
Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome.
A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning.
At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR.
Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
Silvia Amoretti and Adriane R Rosa both are joint first authors.
The notes appear after the main text.
G Anmella1,14, S Madero1,14, P Rubio2,12, J Merchán-Naranjo2,12, A Alonso-Solís2,13, M Rabella2,13, I González-Ortega2,11, I Zorrilla2,11, MF Barcones10,17, C De-la-Cámara2,10, J Sanjuan2,18,19, MD Moltó2,18, A Mané2,16, D Bergé2,16, N Verdolini2,3,14, J Sanchez-Moreno2,3,14, J Castro-Fornieles2,3,15, O Puig2,3,15, F Contreras2,20, C Saiz-Masvidal20, L García-Álvarez2,21, P García-Portilla2,21, M Gutiérrez2,22, A Zabala2,23, M Dompablo2, 24,25, R Rodriguez-Jimenez2,25,26, J Usall27, A Butjosa2,27,28, S Sarró2,29, R Landín-Romero30, A Ibáñez2,31, L Moreno-Izco7,8, V Balanzá-Martinez2,32
PEPs Group additional affiliations:
1Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, Spain; 2Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; 3August Pi I Sunyer Biomedical Research Institute (IDIBAPS); 4Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; 5Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; 6Department of Pharmacology and Postgraduate Program: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; 7Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; 8IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; 9Instituto de Investigación Sanitaria Gregorio Marañón. School of Psychology, Complutense University, Madrid, Spain; 10Department of Medicine and Psychiatry. Zaragoza University. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; 11Department of Psychiatry, Hospital Universitario de Álava (Sede Santiago), University of the Basque Country (UPV-EHU), Bioaraba Research Institute, Spain; 12Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Institute of Psychiatry and Mental Health, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain; 13Psychiatry 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; 14Bipolar and Depressive Disorders Unit, Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain; 15Child and Adolescent Psychiatry and Psychology Department, 2017SGR881, Institute of Neurosciences, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, Barcelona, Spain; 16Hospital del Mar, Department of Psychiatry, Barcelona, Spain; 17Department of Family Medicine, Hospital Universitario Miguel Servet, Zaragoza Spain; 18INCLIVA, Universidad de Valencia, Hospital Clínico Universitario de Valencia, Spain; 19Hospital Clínico Universitario de Valencia, Spain; 20Psychiatry Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Spain; 21Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); 22Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; 23University of the Basque Country (UPV/EHU), Department of Neurosciences. BioCruces Health Research Institute, Spain; 24Cardenal Cisneros, Centro de Enseñanza Superior adscrito a la Universidad Complutense de Madrid, Spain; 25Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; 26CogPsy Group, Universidad Complutense de Madrid (UCM), Madrid, Spain; 27Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; 28Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; 29FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; 30Neuroscience Research Australia, Sydney, NSW, Australia School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia; 31Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain; 32Teaching Unit of Psychiatry, Department of Medicine, University of Valencia, Valencia, Spain