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The aims of this study were to examine the nature and extent of cognitive impairment in first-episode early-onset psychosis (FE-EOP) soon after their stabilisation and to search for potential differences according to specific diagnostic sub-groups of patients. As part of a Spanish multicentre longitudinal study, 107 FE-EOP patients and 98 healthy c...
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... cognitive assessment was performed using a neuro- psychological battery designed to assess four cognitive domains-attention, working memory, executive func- tioning, and verbal learning and memory-by combining selected individual measures from different tests ( Table 1). Selection of these four domains was based on the MAT- RICS battery [11] and on a previous review of the literature [1,12]. ...
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Citations
... The deficit observed in the whole PRS-NP (and specifically in the PRS-NR group) is similar to that seen in patients with a low risk for psychosis [72,73], and in an early stage of psychosis [74,75]. Moreover, analysis of clinical symptoms (Suppl. ...
Cognitive impairments are proposed as predictors in the differentiation between subjects with psychosis risk syndrome (PRS) who will develop a psychotic disorder (PRS-P) and those who will not (PRS-NP). More in-depth study of the PRS-NP group could contribute to defining the role of cognitive alterations in psychosis. This study aims to analyze cognition of children and adolescents with PRS in terms of their clinical outcome at 18-month follow-up (psychosis, remission, and non-remission) and of determinate predictors of transition to psychosis and remission of PRS. The method is two-site, naturalistic, longitudinal study design, with 98 help-seeking adolescents with PRS and 64 healthy controls (HC). PRS-P (n = 24) and PRS-NP (n = 74) participants were clinically and cognitively assessed at baseline, and when full-blown psychotic disorder had developed or at 18-month follow-up. PRS-P subjects showed lower scores at baseline in processing speed, visuospatial memory, attention, and executive function (cognitive flexibility/processing speed) compared to HC. PRS-NP subjects showed lower baseline scores in verbal working memory and verbal fluency compared to HC. This deficit is also observed in the PRS group of participants still presenting attenuated psychotic symptoms at 18-month follow-up, while PRS subjects in remission showed a similar cognitive profile to HC subjects. Baseline score on processing speed, measured with a coding task, appeared to be a predictive variable for the development of a psychotic disorder. Performance in verbal working memory was predictive of remission in the PRS-NP. Post hoc comparisons indicate the need for careful interpretation of cognitive markers as predictors of psychosis. Cognitive impairments are present in both PRS-P and PRS-NP. Those individuals who recover from PRS show baseline cognitive performance comparable to the HC group. Together with sociodemographic variables, this observation could help in the differentiation of a variety of PRS trajectories in children and adolescents.
... Subsequent studies indicated that this domain was exclusively affected in FEP male patients (Montalvo et al., 2018), although contrary to expectation, male patients performed better, specifically in the Hit-RT attention task. Although we found an association between high prolactin levels and higher antipsychotic dosage, it is worth mentioning that antipsychotic treatment should not influence cognitive profiles (Zabala et al., 2010), suggesting that prolactin may affect cognitive performance independently of such medication, at least in FEP patients at baseline. However, it is described that D 2 receptor blockage by chronic antipsychotic treatment induces a downregulation of D 1 receptors in the prefrontal cortex that may produce cognitive impairments (Castner et al., 2000). ...
Background
Around 3% of the population suffers a first episode of psychosis (FEP) and a high percentage of these patients subsequently relapse. As the clinical course following a FEP is hard to predict, it is of interest to identify cognitive and biological markers that will help improve the diagnosis, treatment and outcome of such events, and to define new therapeutic targets. Here we analyzed the plasma oxytocin and prolactin levels during a FEP, assessing their correlation with clinical and cognitive features.
Methods
The oxytocin and prolactin in plasma was measured in 120 FEP patients and 106 healthy controls, all of whom were subjected to a clinical and neuropsychological assessment. Most patients were under antipsychotics. Statistical analyses aimed to identify factors associated with the FEP and to search for associations between the variables.
Results
FEP patients had less oxytocin, more prolactin, a poor premorbid-IQ and they performed worse in sustained attention. Male patients with higher prolactin levels experienced more severe psychotic symptoms and required higher doses of antipsychotics. Low oxytocin was associated with poor sustained attention in women, whereas low oxytocin and high prolactin in men correlated with better performance in sustained attention.
Conclusion
Low oxytocin, high prolactin, and poor premorbid-IQ and sustained attention are factors associated with a FEP, representing potential therapeutic targets in these patients. These biological factors and cognitive domains might play an important role during a FEP, which could help us to develop new strategies that improve the outcomes of this disorder and that should perhaps be gender specific.
... Not in line with our results, the previous literature suggested patients with EOS did not differ from individuals with early-onset schizoaffective disorder [52], or psychotic disorder not otherwise specified [7]. Besides, PSD and EOS yielded a similar neurocognitive performance during their first psychotic episode [53]. Nevertheless, these negative results in the previous literature should be interpreted with the heterogeneity of EOS. ...
Previous studies demonstrated neurocognitive impairments in early-onset schizophrenia (EOS) and other psychotic spectrum
disorders (PSD). This study aimed to compare remitted and symptomatic cases in terms of neurocognition and theory of
mind (ToM). 50 healthy controls (HC) and 106 patients diagnosed schizophrenia in remission (EOS-R, n=38), symptomatic
schizophrenia (EOS-S, n=34), and other PSD (n=34) were included in our study. The Positive and Negative Symptom
Scale, Columbia-Suicide Severity Rating Scale, Reactive and Proactive Aggression Questionnaire were used to evaluate
psychopathology. A cognitive battery was conducted to measure verbal learning/memory, visual learning/memory, executive
functions (EF), inhibition, processing speed (PS), verbal fuency skills. Reading Mind in Eyes Test (RMET) and Faux-Pas
tests were implemented to assess ToM. Principal Component Analysis was used to identify cognitive domain scores. Patient
groups had poorer performance in cognitive domains than the HC group. The cognitive impairment and psychopathology
levels of EOS-R and the PSD groups were comparable for all cognitive domains. The EOS-S group also had poorer scores
in Rey verbal learning score (d=0.87), RMET (d=0.72), verbal fuency (d=0.66), PS/EF (d=0.82) and visual learning/
memory (d=0.83) test scores than the PSD group. Only RMET (d=0.72) and executive function/processing speed domain
(d=0.63) were signifcantly impaired in the EOS-S group than the EOS-R group Cognitive impairments seen in remitted
psychotic disorders were on the same continuum. Impaired EF/PS and ToM skills could be a cognitive marker for symptomatic illness in youth.
... Regarding cognition, there is strong evidence that patients diagnosed with either an EOS [18,19] or an AOS [20,21] psychotic disorder have global cognitive difficulties. Moreover, these difficulties have been associated with worse functional outcomes [22,23], and for this reason, are considered potential treatment targets [24]. ...
Psychotic disorders typically manifest from late adolescence to early adulthood, and an earlier onset might be associated with greater symptom severity and a worse long-term prognosis. This study aimed to compare the cognitive characteristics of patients with first-episode psychosis (FEP) by their age at onset. We included 298 patients diagnosed with FEP and classified them as having an early onset (EOS), youth onset (YOS), or adult onset (AOS) based on age limits of ≤ 18 years (N = 61), 19–24 years (N = 121), and ≥ 25 years (N = 116), respectively. Socio-demographic and clinical variables included age at baseline, gender, socio-economic status, antipsychotic medication, DSM-IV diagnoses assessed by clinical semi-structured interview, psychotic symptom severity, and age at onset. Neuropsychological assessment included six cognitive domains: premorbid intelligence, working memory, processing speed, verbal memory, sustained attention, and executive functioning. The EOS group had lower scores than the YOS or AOS groups in global cognition, executive functioning, and sustained attention. Although the scores in the YOS group were intermediate to those in the EOS and AOS groups for most cognitive factors, no statistically significant differences were detected between the YOS and AOS groups. Age at onset results in specific patterns of cognitive interference. Of note, impairment appears to be greater with EOS samples than with either YOS or AOS samples. A longitudinal study with a larger sample size is needed to confirm our findings.
... However, little research has been done in this early onset psychosis (EOP) population. Our own previous studies in EOP have shown that cognitive impairment is present at the time of the first episode [23], and that cognitive development seems to be arrested at the 2 year follow-up, at least for some high-order functions, such as sustained attention or working memory [14]. Research has identified the development of high-order cognition to begin as early as 12 months of age [24,25], and exhibits a rapid development during childhood and adolescence [26]. ...
... Raw test scores were converted to z-scores (mean = 0, standard deviation, SD = ±1) based on the cognitive performance of the control group at baseline. The sample was divided into three age groups to minimize the effect of age and education on cognitive performance (aged 11-14, aged 15-16 and aged 17 in accordance with our previous research in the CAFEPS sample [14,23]. A summary score for each cognitive domain at both baseline and 2 year assessment times, and a measure of change at follow-up (2 year follow-up minus baseline) was calculated based on z-scores. ...
... Individuals with EOP were not significantly different from controls, in terms of age, sex, parental socioeconomic status, years of education, developmental history, race or handedness (see Table 2). There were significant differences between groups for estimated IQ at baseline, consistent with previous reports on this sample [14,23] and for months of inter-scan interval in our sample (see Table 2). The mean duration of the illness, defined as the time between the appearance of their first positive symptoms and their baseline MRI scan, was 3.12 ± 2.75 months for the EOP sample included in the current analyses. ...
Cognitive maturation during adolescence is modulated by brain maturation. However, it is unknown how these processes intertwine in early onset psychosis (EOP). Studies examining longitudinal brain changes and cognitive performance in psychosis lend support for an altered development of high-order cognitive functions, which parallels progressive gray matter (GM) loss over time, particularly in fronto-parietal brain regions. We aimed to assess this relationship in a subsample of 33 adolescents with first-episode EOP and 47 matched controls over 2 years. Backwards stepwise regression analyses were conducted to determine the association and predictive value of longitudinal brain changes over cognitive performance within each group. Fronto-parietal GM volume loss was positively associated with decreased working memory in adolescents with psychosis (frontal left (B = 0.096, p = 0.008); right (B = 0.089, p = 0.015); parietal left (B = 0.119, p = 0.007), right (B = 0.125, p = 0.015)) as a function of age. A particular decrease in frontal left GM volume best predicted a significant amount (22.28%) of the variance of decreased working memory performance over time, accounting for variance in age (14.9%). No such association was found in controls. Our results suggest that during adolescence, EOP individuals seem to follow an abnormal neurodevelopmental trajectory, in which fronto-parietal GM volume reduction is associated with the differential age-related working memory dysfunction in this group.
... Reproduced with permission of the Licensor through PLSclear. (1 fup) PP: (Albus et al., 2019;Becker et al., 2010;Benoit et al., 2015;Egloff et al., 2019;Gjerde et al., 2019;Ittig et al., 2015;Moura et al., 2019;Zabala et al., 2010) CMP: ...
Background
Even in the early phases of psychotic spectrum illnesses such as schizophrenia, patients can experience cognitive decline or deficits prior to the onset of psychotic symptoms such as delusions and hallucinations. In this systematic review, we assessed which verbal memory assessments are most widely used in first-episode psychosis and may be applied via digital technologies (smartphone applications, etc.) for use in early detection.
Methods
In November 2019, we searched for studies measuring verbal memory in first episode psychosis or schizophrenia over the past 10 years on PubMed and PsycINFO. We screened abstracts of these studies and excluded review studies. Full-texts of included studies were used to identify the verbal memory measurement tests, follow-up frequencies, and sample sizes.
Results
We screened 233 reports and found that 120 original research studies measured verbal memory in first episode psychosis over the past 10 years. Four of these studies specified using a computer, 24 (20%) used a paper-pen format, 1(1%) used both, and 91 (76%) studies did not specify their administration tools or suggest there were offered in digital formats. Thirty-five (30%) studies had follow-up measurements of verbal memory, while 85 (70%) had only a single verbal memory measurement.
Discussion
While many scales are commonly used to measure verbal memory in first episode psychosis, they are not often administered via digital technology. There is an emerging opportunity to administer these and other tests via digital technologies for expanding access to early detection of cognitive decline in clinical high risk and first-episode psychosis.
... NP impairments are one of the core symptoms in psychotic disorders and they are found all along the psychosis continuum: in offspring of patients with schizophrenia [19], subjects with PRS [20][21][22], in first-episode psychosis [23,24] and in patients with schizophrenia [25,26]. In adult subjects with PRS, NP deficit is well documented too, indicating impairments in general intelligence, verbal and visual memory, verbal fluency, attention and working memory, and social cognition [27]. ...
Neuropsychological underperformance is well described in young adults at clinical high risk for psychosis, but the literature is scarce on the cognitive profile of at-risk children and adolescents. The aim of this study is to describe the neuropsychological profile of a child and adolescent sample of patients with psychosis risk syndrome (PRS) compared to healthy controls and to analyze associations between attenuated psychotic symptoms and cognitive impairment. Cross-sectional baseline data analysis from a longitudinal, naturalistic, case–control, two-site study is presented. Eighty-one help-seeking subjects with PRS and 39 healthy controls (HC) aged between 10 and 17 years of age were recruited. PRS was defined by: positive or negative attenuated symptoms, Brief Limited Intermittent Psychotic Symptoms (BLIPS), genetic risk (first- or second-degree relative), or schizotypal personality disorder plus impairment in functioning. A neuropsychological battery was administered to assess general intelligence, verbal and visual memory, visuospatial abilities, speed processing, attention, and executive functions. The PRS group showed lower general neuropsychological performance scores at a multivariate level and lower scores than controls in general intelligence and executive functions. Lower scores on executive function and poorer attention were associated with high scores of positive attenuated psychotic symptoms. No association with attenuated negative symptoms was found. This study provides evidence of cognitive impairment in PRS children and adolescents and shows a relationship between greater cognitive impairment in executive functions and attention tasks and severe attenuated positive symptoms. However, longitudinal studies are needed to clarify the nature of cognitive impairment as a possible vulnerability marker.
... Deficits in these core processes have consistently been shown in early psychosis [5][6][7]. Our own previous studies in an independent group of adolescents with psychosis have shown that executive functioning performance is altered at the time of the first episode [8], and, although function in this cognitive domain improves at follow-up, the degree of the impairment relative to healthy controls remains stable over the first two years of the illness [9,10]. Specifically, studies on the first episode psychosis have supported the notion that executive functioning deficits are predictors of significant social, functional, and vocational disability leading to a poor quality of life in this population [11][12][13][14][15]. ...
An improvement in negative symptoms and a reduction in the number of visits to the emergency department have been reported in a problem solving based psychoeducational group intervention (PE) for adolescents with psychosis relative to a nonstructured group (NS). One of the factors that may play a role on the response to PE treatment is executive function (EF), a crucial cognitive domain for problem-solving performance. We aimed to examine the role of EF in response to PE treatment versus an NS group. We examined the associations between changes in cognition and in clinical/functional variables within each treatment group using Spearman-ranked and partial correlation analyses. A total of 22 individuals (mean age: 16.3) were randomized to PE (N = 10) and NS (N = 12). We found an association between improvements in EF performance and a reduction in positive symptoms (rs = –0.756, p = 0.030 for semantic fluency), reduction in negative symptoms (r = 0.758, p = 0.029 for semantic; rs = –0,733, p = 0.025 for verbal fluency), and reduction in the number of visits to the emergency department (r = –0,743, p = 0.035 for semantic fluency) in the PE group. No associations were found in the NS group. Our results suggest that EF may play a role in the specific improvements observed in the PE group. This may have implications in the development of new areas of clinical intervention focusing on the role of cognitive functioning in response to psychosocial treatments in psychosis.
... Neurocognition, cognitive reserve, and social cognition have all been related to functioning in first-episode psychosis (FEP). Specifically, numerous studies have found that cognitive deficits are present early in psychosis, manifesting in multiple cognitive domains including working memory, executive function, attention, processing speed, and/or learning and memory (Zabala et al., 2010;González-Ortega et al., 2013;Bora and Murray, 2014). These deficits have been related to poorer psychosocial functioning ( Leeson et al., 2011;González-Ortega et al., 2013;Green and Harvey, 2014;Torgalsbøen et al., 2015), but some studies have not found this association ( Kravariti et al., 2003;Stirling et al., 2003). ...
Background
Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.
Methods
The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.
Results
At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).
Conclusions
Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
... Deficits occur across the spectrum of cognitive domains early after the onset of bipolar disorder with psychotic features, including in samples of first-episode bipolar disorder with psychotic features (FEBP+) and recent onset psychosis diagnosed with bipolar disorder (Barrett et al. 2009;Dickerson et al. 2011;Reichenberg et al. 2009;Zabala et al. 2010). These cognitive impairments have generally been localized to attention, processing speed, verbal learning or memory, and executive functioning (Albus et al. 1996;Daglas et al. 2016;Demmo et al. 2016;Elshahawi et al. 2011;Hellvin et al. 2012;Trisha et al. 2017). ...
... Firstepisode schizophrenia is associated with greater impairments on most cognitive measures, including measures of verbal memory, executive functioning, and processing speed (Barrett et al. 2009;Demmo et al. 2016;Hill et al. 2009). Yet there is some evidence for similar severity in deficits between schizophrenia and FEBP+ (Albus et al. 1996;Ayres et al. 2007;McClellan et al. 2004;Zabala et al. 2010), especially in processing speed and attention (Albus et al. 1996;Dickerson et al. 2011). Taken together, the synthesis of this research indicates that any differences in cognitive impairments between schizophrenia and FEBP+ are quantitative rather than qualitative in nature (Hill et al. 2009;Mojtabai et al. 2000;Pena et al. 2011;Reichenberg et al. 2009;Zanelli et al. 2010). ...
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. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
