A longitudinal study of neurocognitive function in individuals at-risk for psychosis |
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| Institution: | 1. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America;2. Research Service, Tennessee Valley HealthCare System, US Department of Veterans Affairs, United States of America;1. Department of Psychology and Counselling, La Trobe University, Bundoora, Australia;2. Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia;3. The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia;4. Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria;5. Department of Psychiatry, University Hospital Jena, Jena, Germany;6. Brain and Mind Centre, University of Sydney, Sydney, Australia;7. Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland;8. Department of Psychiatry, University of Hong Kong, Hong Kong;9. Department of Psychiatry, Amsterdam University Medical Centers, the Netherlands;10. Psychiatric Centre Bispebjerg, Copenhagen, Denmark;11. Psychiatric University Clinics Basel, Basel, Switzerland;12. Institute of Mental Health, Singapore, Singapore;13. Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England, United Kingdom of Great Britain and Northern Ireland;14. North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire National Health Service Partnership Trust, Coventry, England, United Kingdom of Great Britain and Northern Ireland;15. Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland;p. Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland;1. Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands;2. Department of Psychiatry, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands;3. Departments of Psychiatry and Preventive Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, USA;4. Department of Psychiatry, VU University Medical Center Amsterdam, the Netherlands;5. Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands;6. Department of Clinical Psychology, VU University, Amsterdam, the Netherlands;7. Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, the Netherlands;8. Arkin Institute for Mental Health, Amsterdam, the Netherlands |
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| Abstract: | IntroductionClinically defined prodromal diagnostic criteria identify at-risk individuals with a 35–40% likelihood of developing a psychotic disorder within a year. The time course and predictive value of cognitive deficits in the development of psychosis has not been established.MethodsA comprehensive neurocognitive battery and clinical assessments were administered to 37 subjects meeting Criteria of Prodromal States (COPS) criteria for being at risk for psychosis, and two comparison groups: 59 first episode and 47 healthy subjects. Subjects were also evaluated at 6-month and 1-year follow-up periods. Primary analyses used a neurocognitive composite score derived from individual neurocognitive measures, including measures of vigilance, verbal memory, working memory, and processing speed.ResultsAt-risk subjects performed more poorly than healthy subjects (t = 2.93, P = 0.01), but better than first episode subjects (t = 4.72, p < 0.0001). At-risk subjects were particularly impaired on measures of vigilance and processing speed. Cognitive composite scores were significantly lower in at-risk subjects who progressed to psychosis (N = 11; z = ? 1.2), while those at-risk subjects who did not progress to psychosis (N = 17) performed better (z = ? 0.5), and not significantly different from controls. Poor CPT performance combined with better WAIS-R digit symbol performance predicted progression to psychosis. Severity of neurocognitive deficits was not related to duration of prodrome or to time to development of psychosis and neurocognitive function improved in all subjects except those who progressed to psychosis.ConclusionNeurocognitive impairment emerges early in the course of psychotic illness. Performance on tests of neurocognition may prove to be an early risk predictor for subsequent development of psychotic disorders. |
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