Cognitive impairments in individuals at clinical high-risk for psychosis:relationships to clinical symptoms and functioning and prediction of functional outcome (original) (raw)
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Epidemiology and Psychiatric Sciences, 2012
Although it is well established that cognitive impairment is a common feature of schizophrenia, only recently has cognitive functioning been prospectively studied in individuals at clinical high risk (CHR) for developing psychosis. To date, both cross-sectional and longitudinal studies have been conducted in the CHR population and in the context of later conversion to psychosis. A comprehensive review of the literature suggests that CHR individuals have general and specific baseline cognitive deficits compared to healthy controls. As a group, their cognitive course, tends to remain stable over time and in this way does not differ from healthy controls. For those who go on to develop a full-blown psychotic illness compared to those who do not convert, there appeared to be minimal differences at baseline with respect to cognition, although over time the converters may show deterioration in certain cognitive abilities compared to the non-converters. However, for many cognitive domains results are mixed, and may result from methodological limitations.
Schizophrenia bulletin, 2018
It remains unclear whether the onset of psychosis is associated with deterioration in cognitive performance. The aim of this study was to examine the course of cognitive performance in an ultrahigh risk (UHR) cohort, and whether change in cognition is associated with transition to psychosis and change in functioning. Consecutive admissions to Personal Assessment and Crisis Evaluation (PACE) Clinic between May 1994 and July 2000 who had completed a comprehensive cognitive assessment at baseline and follow-up were eligible (N = 80). Follow-up ranged from 7.3 to 13.4 years (M = 10.4 years; SD = 1.5). In the whole sample, significant improvements were observed on the Similarities (P = .03), Information (P < .01), Digit Symbol Coding (P < .01), and Trail Making Test-B (P = .01) tasks, whereas performance on the Rey Auditory Verbal Learning Test (Trials 1-3) declined significantly (P < .01) over the follow-up period. Change in performance on cognitive measures was not significant...
Journal of Psychiatric Research, 2015
Background: The long-term functional status of subjects at ultra high risk for psychosis (HR) is relatively under investigated. This study explores baseline predictors of long-term functional outcome in HR subjects who did not convert to psychosis during a 6 years follow-up period. Methods: A total of 154 HR were followed up for an average of 6 years. The primary outcome variable was global assessment of functioning at the last follow-up visit as assessed with the Global Assessment of Functioning tool. A multinomial logistic regression was performed to identify potential predictors of functional outcome. Results: Baseline and follow-up data on functioning was available for 92 HR. Twenty-four (43%) individuals who did not convert to psychosis reported poor functioning at follow-up. Baseline scores in the GAF (Exp(b) ¼ 0.857; 95% CIs: 0.75/0.97), employment status (Exp(b) ¼ 0.029; 95% CIs: 0.00/0.268), and CAARMS total scores (Exp(b) ¼ 1.976; 95% CIs: 1.00/1.14) predicted functional outcome in HR subjects at 6 years. Conclusions: Despite the preventive treatments received, many individuals who did not convert to fullblown psychosis in the longer term do not functionally remit. These individuals are lower functioning, unemployed and have higher symptom loading at the time of their presentation to the prodromal clinic. Our study suggests the need for innovative treatments targeting long term functional status beyond the prevention of psychosis onset in the HR population.
Schizophrenia Bulletin Open
A substantial proportion of individuals at ultra-high risk (UHR) for psychosis show long-term functional impairments, which may have profound consequences for the individual and society. Finding predictors of these functional impairments is critical to inform on the individual’s functional prognosis and potentially develop targeted interventions. This study used data from 91 UHR individuals participating in a randomized, clinical trial, that were followed up at 12 months, to elucidate on clinical, neuro- and social-cognitive predictors of UHR individuals’ functional outcome in the domains of social- and role functioning, quality of life, and functional capacity. The proportion of UHR individuals showing a poor social- and role outcome at 12-month follow-up was 50% and 63%, respectively. Worse social outcome was predicted by higher levels of negative symptoms, reduced processing speed, and impaired baseline social functioning explaining 52% of the variance. Worse role outcome was pre...
Schizophrenia Research, 2011
Little is known about the relationship between neurocognitive performance and functional outcome before the onset of frank psychosis. This longitudinal study aimed to investigate neurocognitive predictors of poor functional outcome in a group identified as ultra-high risk (UHR) for psychosis between two and 13 years prior. Method: Individuals (N = 230) identified as UHR for psychosis at the PACE Clinic in Melbourne completed assessment of psychopathology, functioning and neurocognition at baseline and follow-up. The mean length of follow-up was 7.26 years (SD 3.05).
Acta Psychiatrica Scandinavica, 2019
Objective: To investigate potential clinical differences in high risk profiles presenting with and without basic symptoms, and additionally investigate the association between basic symptoms and clinical symptoms, functioning, and cognition. Methods: High risk individuals (n=133) were stratified into individuals fulfilling ultra high risk (UHR) criteria (n=59) and individuals fulfilling UHR + basic symptoms criteria (BS) (n=74). Group differences were assessed on clinical symptoms, real-life functioning, and cognition. Regression analyses were conducted to elucidate on the relationship between BS and clinical symptoms, functioning, neuro-and social cognition. Results: The group fulfilling both UHR + BS criteria had significantly more symptoms and lower real-life functioning and quality of life but not more cognitive deficits. BS influenced on attenuated psychotic, depressive-, and general symptoms, but only modestly on negative symptoms. No relationship between BS and neuro-and social cognition was established except for an association with emotion recognition processing speed. BS influenced real-life functioning, and this finding was sustained when controlling for the effect of negative symptoms. Conclusions: Our findings indicate that BS contribute highly to the distress and symptom load of clinical high risk individuals. Longitudinal findings are needed to establish the predictive validity of BS on high-risk individuals' clinical and functional prognosis.
Efficacy of using cognitive status in predicting psychosis: a 7-year follow-up
2009
Background: Despite extensive early detection research in schizophrenic psychoses, methods for identifying at-risk individuals and predicting their transition to psychosis are still unreliable. Moreover, there are sparse data on long-term prediction. We therefore investigated long-term psychosis transition in individuals with an At Risk Mental State (ARMS) and examined the relative efficacy of clinical and neuropsychological status in optimizing the prediction of transition.
Cognitive Functioning in Recent Onset Psychosis
The Journal of Nervous and Mental Disease, 2011
The purpose of the study was to compare the cognitive functioning of persons with a recent onset of psychosis with schizophrenia-spectrum disorders and bipolar disorder and nonpsychiatric controls. A total of 56 persons with a schizophrenia-spectrum disorder and 60 with bipolar disorder, all with a recent onset psychosis, and 312 nonpsychiatric controls were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Wisconsin Card Sorting Test (WCST). Comparison of the three groups through analysis of covariance indicated a significant difference among the groups for all of the cognitive variables. Pairwise contrasts of the two recent onset groups showed a significant difference favoring the bipolar disorder group on RBANS Language (p = 0.020) and Total (p = 0.050) and a marginally significant difference on RBANS Immediate Memory (p = 0.053) but not on the other RBANS variables or on the WCST. Cognitive performance is broadly impaired in recent onset psychosis, with a cognitive advantage to bipolar disorder patients compared with schizophrenia-spectrum patients.
Background: Baseline functioning has been found to be a strong predictor of transition to psychosis in ultra high risk populations. However, the time course of functioning may enhance prediction. We investigated whether there were different patterns of functioning over time and whether particular temporal patterns were related to baseline characteristics and psychosis outcome. Method: Functional data was assessed at baseline and after 3 to 6 year follow-up in an ultra high risk sample (n = 158; 92 female, mean age = 19.28 (SD = 3.33), range = 14-29). Using the median score of the GAF and the QLS scale, a 'High' and 'Low' group (comprising of subjects functioning above or below median at both baseline and follow-up) and a 'Deterioration' group and 'Improving' group were created. Results: Chi-square analyses showed that the Low and Deteriorating functioning groups were the most likely to develop first-episode psychosis (FEP). Importantly, UHR individuals with deteriorating functioning were at higher risk of transition than those whose functioning was low at baseline but improved over time (GAF: X 2 = 5.10, df = 1, p = .02; QLS: X 2 = 9.13, df = 1, p = .003). Binary logistic regression analyses showed that a decline in functioning was more strongly associated with FEP (GAF: p = b.0001; QLS: p b .0001) than the level of baseline functioning (GAF: p = .005; QLS: p = .09). The deteriorating group could not be distinguished from the High group in terms of baseline symptomatology. Discussion: With the addition of the 'low functioning' criterion to the UHR criteria, we may miss out on some true positive cases. Limiting our attention to baseline poor functioning may therefore distort the picture in terms of risk for psychosis.