Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis

Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Archives of general psychiatry (Impact Factor: 13.75). 06/2010; 67(6):578-88. DOI: 10.1001/archgenpsychiatry.2010.66
Source: PubMed

ABSTRACT Early detection and prospective evaluation of clinical high-risk (CHR) individuals who may develop schizophrenia or other psychotic disorders is critical for predicting psychosis onset and for testing preventive interventions.
To elucidate the neuropsychology of the CHR syndrome, to determine the association of neuropsychological function with conversion to psychosis and family history of psychosis, and to examine whether baseline neuropsychological functioning predicts subsequent psychosis.
Longitudinal study with 2(1/2) years of follow-up.
Eight centers participating in the North American Prodrome Longitudinal Study.
Three hundred four prospectively identified CHR individuals meeting Structured Interview for Prodromal Syndromes criteria, 52 non-CHR persons with a family history of psychosis in first- or second-degree relatives (family high-risk group), and 193 normal controls with neither a family history of psychosis nor a CHR syndrome, all of whom underwent baseline neuropsychological evaluations.
A neurocognitive composite score, 8 individual neuropsychological measures, an IQ estimate, and high-risk status.
Global ("composite") neuropsychological functioning was comparably impaired in the CHR and family high-risk groups compared with controls, but profiles differed significantly between groups. Neuropsychological functioning in the CHR group was significantly lower in persons who progressed to psychosis than in those who did not and was worst in the subgroup with a family history of psychosis. Tests of processing speed and verbal learning and memory were most sensitive in discriminating CHR individuals from controls, although reductions were less severe than in established schizophrenia. Neuropsychological functioning did not contribute uniquely to the prediction of psychosis beyond clinical criteria, but worse verbal memory predicted more rapid conversion.
These findings document that CHR individuals have significant neuropsychological difficulties, particularly those who later develop psychosis. This dysfunction is generally of moderate severity but less than in first-episode schizophrenia, suggesting that further decline may occur after baseline CHR assessment.

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Available from: Eric Meyer, Jan 08, 2014
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    • "This could be an important time for early intervention before the onset of full blown psychosis and further cognitive and functional deterioration. Since these CHR individuals already evidence cognitive deficits, which increase around the time of conversion (Seidman et al., 2010; Fusar-Poli et al., 2012a), cognition is an excellent treatment target. Furthermore, treatments targeting cognition may consequently Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: Individuals at clinical high risk (CHR) of psychosis evidence cognitive deficits. Given suggestions that deficits in cognition are related to poor functional outcome, cognition is a good treatment target. The aim of this study was to test the efficacy of cognitive remediation therapy (CRT) in improving cognition of CHR individuals. Participants were tested at baseline, immediately following CRT and 9 months post-baseline. The mixed effects modelling demonstrated no differences in cognition between the experimental group and the control group at any time point. For the experimental group, however, there was a trend towards improvement in speed of processing between baseline and 9-month follow-up (t(29)=-2.91, P=0.06) and at post-CRT compared to 9-month follow-up (t(29)=-2.99, P<0.05). In the control group, significant improvements in working memory were observed between post-CRT and 9-month follow-up (t(29)=-3.06, P<0.05). Despite significant improvements in social functioning in the intervention group between baseline and 9-month follow-up (t(28)=-3.26, P<0.05), these improvements were not correlated with cognition. There were trends towards improvement and no trends of decline in the two groups. While CRT may be valuable for individuals at CHR, the type of intervention employed needs to be carefully considered. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 11/2014; 225(1-2). DOI:10.1016/j.psychres.2014.10.021
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    • "Regression analysis revealed that, within the groups at risk for psychosis (HR and UHR), a poor result in the speed domain was the most reliable predictor of an affiliation to the late UHR state. Other researchers have also determined that psychomotor speed is more consistent (Seidman et al. 2010; Kelleher et al. 2013) than reported (non-speed-dependent) deficits in working memory and executive functioning (Hawkins et al. 2004; Gschwandtner et al. 2006; Keefe et al. 2006; Niendam et al. 2006; Pukrop et al. 2006). "
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    ABSTRACT: BACKGROUND: Neurocognitive deficits are important aspects of the schizophrenic disorders because they have a strong impact on social and vocational outcomes. We expanded on previous research by focusing on the neurocognitive profiles of persons at high risk (HR) or ultra-high risk (UHR) for schizophrenic and affective psychoses. Our main aim was to determine whether neurocognitive measures are sufficiently sensitive to predict a group affiliation based on deficits in functional domains. METHOD: This study included 207 help-seeking individuals identified as HR (n = 75), UHR (n = 102) or at high risk for bipolar disorder (HRBip; n = 30), who were compared with persons comprising a matched, healthy control group (CG; n = 50). Neuropsychological variables were sorted according to their load in a factor analysis and were compared among groups. In addition, the likelihood of group membership was estimated using logistic regression analyses. RESULTS: The performance of HR and HRBip participants was comparable, and intermediate between the controls and UHR. The domain of processing speed was most sensitive in discriminating HR and UHR [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.28-0.78, p = 0.004] whereas learning and memory deficits predicted a conversion to schizophrenic psychosis (OR 0.47, 95% CI 0.25-0.87, p = 0.01). CONCLUSIONS: Performances on neurocognitive tests differed among our three at-risk groups and may therefore be useful in predicting psychosis. Overall, cognition had a profound effect on the extent of general functioning and satisfaction with life for subjects at risk of psychosis. Thus, this factor should become a treatment target in itself.
    Psychological Medicine 06/2014; FirstView:1-13. DOI:10.1017/S0033291714001007
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    • "Groups are also working on identifying cognitive predictors of conversion from what looks like a schizophrenia prodrome to a psychotic state. The literature suggests that probably we are looking too late: individuals who are considered to be prodromal and already have cognitive deficits seem more likely to convert to psychosis; those without the deficits seem at lower risk (Seidman et al., 2010). "
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    ABSTRACT: Schizophrenia Research: Cognition will serve an important function – a place where interests converge and investigators can learn about the recent developments in this area. This new journal will provide rapid dissemination of information to people who will make good use of it. In this initial article, we comment globally on the study of cognition in schizophrenia: how we got here, where we are, and where we are going. The goal of this first article is to place the study of cognition in schizophrenia within a historical and scientific context. In a field as richly textured as ours it is impossible to hit all the important areas, and we hope the reader will forgive our omissions. Phrased in cognitive terms, our limited presentation of the past is a matter of selective memory, the present is a matter of selective attention, and the future is a matter of selective prospection. This broad introduction emphasizes that cognition in schizophrenia provides clues to pathophysiology, treatment, and outcome. In fact, the study of cognitive impairment in schizophrenia has become wholly intertwined with the study of schizophrenia itself.
    03/2014; 1(1):e1–e9. DOI:10.1016/j.scog.2014.02.001
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