Symptomatic Remission and Cognitive Impairment in First-Episode Schizophrenia: A Prospective 3-Year Follow-Up Study
ABSTRACT Cognitive impairment is a core feature of schizophrenia, but its relationship with symptomatic remission has been understudied. This study aimed to examine the concurrent and longitudinal relationships between cognitive functioning and symptomatic remission in first-episode schizophrenia.
The sample comprised 92 Chinese patients, aged 18 to 55 years, who presented with first-episode DSM-IV schizophrenia spectrum disorder and were recruited from both outpatient and inpatient psychiatric units covering a defined catchment area in Hong Kong. The study commenced in September 1997 and ended in March 2005. Psychopathological evaluation was conducted using the Positive and Negative Syndrome Scale (PANSS) and the High Royds Evaluation of Negativity (HEN) scale at intake, after clinical stabilization of the first psychotic episode, and at 12, 24, and 36 months. Cognitive functions were measured at clinical stabilization and at 12, 24, and 36 months. Sustained symptomatic remission was operationally defined as fulfillment of mild severity ratings or less at 24 and 36 months on selected PANSS items for positive symptoms and on the basis of Andreasen's criteria and HEN subscales for negative symptoms.
At the end of the 3-year follow-up, 44.6% of patients achieved sustained symptomatic remission. Remitted patients had significantly better concurrent verbal memory (F = 4.6, P < .01) and functional (t = -2.4, P < .05) and vocational (t = 4.8, P < .01) outcomes at 36 months than nonremitted counterparts. Sustained remission attainment was associated with better premorbid adjustment (t = -3.1, P < .01), better baseline occupational status (χ2 = 4.7, P < .05), better 1-year verbal memory (F = 6.4, P < .01), and fewer 1-year positive (t = -2.9, P < .01) and negative (t = -4.7, P < .01) symptoms. Logistic regression indicated that verbal memory impairment, premorbid functioning, and negative symptom severity independently predicted remission status (Nagelkerke R2 = 0.425, P < .0001).
Our findings provide supportive evidence that verbal memory impairment might be specifically related to attainment of sustained remission in the early stage of schizophrenia.
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ABSTRACT: Schizophrenia is associated with pronounced vocational impairment. Previous research has mostly focused on chronic patients and few studies were conducted to investigate predictors of work outcome in first-episode populations. The impact of cognitive dysfunction on employment outcome in early psychosis was under-studied. In this study, we prospectively followed up 93 patients aged 18-55 years presented with first-episode schizophrenia-spectrum disorder for 3 years with an aim to identify early clinical and cognitive predictors of vocational outcome. Pre-morbid adjustment, baseline symptomatology and cognitive functions, and employment outcome were assessed. Result indicated that approximately half of the patients (53.8%) were engaged in full-time work at intake and at 3 years. Pre-morbid adjustment, baseline occupational status and Wisconsin Card Sorting Test (WCST) performance were found to predict vocational outcome. Analysis on a subgroup of patients who were unemployed at intake showed that subjects who remained unemployed over 3 years had poorer WCST performance and more severe positive symptoms at baseline than those having job attainment during follow-up. Our results thus confirmed predictive value of pre-morbid functioning and baseline occupational status on vocational outcome. In addition, our findings suggested that executive function might be a critical cognitive determinant of employment outcome in the early course of schizophrenia.Psychiatry Research 09/2014; 220(3). DOI:10.1016/j.psychres.2014.09.012 · 2.47 Impact Factor
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ABSTRACT: Cognitive deficits are observed throughout all developmental phases of psychosis. However, prior studies have usually focused on a limited illness period and used a wide variety of cognitive instruments. Therefore, it has been difficult to characterize or highlight cognitive functioning in different stages of psychosis. We administered the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) tests to 4 participant subgroups, including healthy volunteers (controls, HC, n = 28), subjects at high risk for clinical psychosis (prodrome, CHR, n = 27), first-episode schizophrenia patients (FE-Sz, n = 26), and mid-term and long-term chronic schizophrenia patients (Ch-Sz, n =147). Comparison, correlation, and regression analyses of RBANS index scores were assessed among groups. We examined clinical outcomes over 2 years between the CHR and HC subjects, and RBANS domains were used as possible predictors for conversion to psychosis. Performance on all RBANS domains was significantly impaired during a post-onset stage of psychosis (FE-Sz and Ch-Sz), and RBANS scores declined along with disease progression. Regression analyses showed that for CHR and HC subjects, baseline impairment in delayed memory (DM) significantly predicted conversion to psychosis. Additionally, partial correlations showed that for FE-Sz and Ch-Sz subjects, DM was the only correlate with a later stage of psychosis. Cognitive deficits broadly emerged, and diminished functioning followed along with disease progression. Impairment in DM is perhaps one domain that helps us understand the development of psychosis. A critical need is to monitor and treat memory functioning for psychotic patients throughout all phases of the disease.PLoS ONE 05/2015; 10(5):e0125784. DOI:10.1371/journal.pone.0125784 · 3.23 Impact Factor