The Course of Neurocognition and Social Functioning in Individuals at Ultra High Risk for Psychosis

Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 06/2007; 33(3):772-81. DOI: 10.1093/schbul/sbm020
Source: PubMed


This study evaluates longitudinal neuropsychological performance and its association with clinical symptomatology and psychosocial outcome in individuals identified as ultra high risk (UHR) for psychosis.
Thirty-five UHR individuals completed neurocognitive, clinical, and social/role functioning assessments at baseline and, on average, 8.3 months later.
UHR subjects showed significant cognitive deficits at baseline and 2 distinct profiles of cognitive change over time. On average, 50% demonstrated improvement in social and role functioning over the follow-up period, while the other half showed either stability or decline in functioning. Functional improvement was associated with improved processing speed and visual memory, as well as improvement in clinical symptoms over the follow-up period. In contrast, patients who did not improve functionally showed stable clinical symptoms and cognitive performance over time.
Although the degree of neurocognitive deficit at baseline in UHR patients does not predict psychosocial outcome, the course of neurocognitive change over the first 8 months of follow-up does differentiate patients with good and poor functional outcomes.

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Available from: Carrie E Bearden, Aug 08, 2014
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    • "IQ was unrelated to functional disability (Cornblatt et al., 2007; Corcoran et al., 2011; Lin et al., 2011; Carrión et al., 2013; Goghari et al., 2014). However, deficits in composite neurocognitive performance (Barbato et al., 2013) and discrete neurocognitive domains including processing speed (Carrión et al., 2011; Meyer et al., in press), verbal learning and memory (Niendam et al., 2006b; Lin et al., 2011; Meyer et al., in press), reasoning and problem solving (Niendam et al., 2006b; Meyer et al., in press), spatial working memory (Goghari et al., 2014), information processing (Perez et al., 2012) and executive function (Niendam et al., 2007a; Meyer et al., in press) have all been significantly correlated with increased functional impairment in cross-sectional studies. Regression analyses indicate that verbal learning and memory (Niendam et al., 2006b) and composite neurocognitive performance (Meyer et al., in press) account for unique variance in social and role functioning independently of negative symptoms. "
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    ABSTRACT: Background: Transition to psychotic disorder has been the traditional outcome of interest for research in the at-risk mental state (ARMS). However, there is growing recognition that individuals with ARMS may function poorly regardless of whether they develop psychosis. We aimed to review the literature to determine whether there are specific factors associated with, or predictive of, functional impairment in the ARMS population. Method: An electronic database search of MEDLINE, PsycINFO and Embase from inception until May 2014 was conducted using keyword search terms synonymous with the at-risk mental state and functioning. Eligible studies were original peer-reviewed English language research articles with populations that met validated at-risk diagnostic criteria and examined the cross-sectional or longitudinal association between any variable and a measure of functioning. Results: Seventy-two eligible studies were identified. Negative symptoms and neurocognitive impairment were associated with poor functioning in cross-sectional studies. Negative and disorganised symptoms, neurocognitive deficits and poor functioning at baseline were predictive of poor functional outcome in longitudinal studies. Positive symptoms were unrelated to functioning in both cross-sectional and longitudinal studies. Functional disability was persistent and resistant to current treatments. Conclusions: Negative and disorganised symptoms and cognitive deficits pre-date frank psychotic symptoms and are risk factors for poor functioning. This is consistent with a subgroup of ARMS individuals potentially having neurodevelopmental schizophrenia. Treatments aimed at improving functioning must be considered a priority on par with preventing transition to psychosis in the development of future interventions in the ARMS group.
    Schizophrenia Research 09/2014; 159(2-3). DOI:10.1016/j.schres.2014.09.012 · 3.92 Impact Factor
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    • "That is, we sought to provide information on how these measures might or might not overlap with clinically meaningful indicators of realworld functioning. We predicted that negative and disorganized, but not positive, symptoms would be associated with deficits in social and role functioning in both samples, consistent with the broader literature (Cornblatt et al., 2007; Niendam et al., 2007; Corcoran et al., 2011; Fulford et al., 2013). With these data we hope to provide guidance for early psychosis researchers in selecting among the most widely used symptom-rating scales to best suit the needs of their particular studies in this population. "
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    ABSTRACT: Symptom assessment in early psychosis research typically relies on scales validated in chronic schizophrenia samples. Our goal was to inform investigators who are selecting symptom scales for early psychosis research. We described measure characteristics, baseline scores, and scale inter-relationships in clinical-high-risk (CHR) and recent-onset psychotic disorder (RO) samples using the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms; for the CHR group only, we included the Scale of Prodromal Symptoms. For investigators selecting symptom measures in intervention or longitudinal studies, we also examined the relationship of symptom scales with psychosocial functioning. In both samples, symptom subscales in the same domain, across measures, were moderately to highly intercorrelated. Within all measures, positive symptoms were not correlated with negative symptoms, but disorganized symptoms overlapped with both positive and negative symptoms. Functioning was significantly related to negative and disorganized, but not positive, symptoms in both samples on most measures. Findings suggest strong overlap in symptom severity ratings among the most common scales. In recent-onset samples, each has strengths and weaknesses. In CHR samples, they appear to add little information above and beyond the SOPS.
    Psychiatry Research 08/2014; 220(3). DOI:10.1016/j.psychres.2014.07.047 · 2.47 Impact Factor
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    • "Relatively fewer longitudinal studies on neuropsychological functioning in at-risk subjects have revealed an association between greater cognitive impairment at baseline and subsequent conversion to psychosis [45, 46], specifically, the decline in verbal abilities, memory, and intellectual functions [42, 43, 47, 48]. Niendam et al. [49] found that high-risk subjects improved over an 8-month period on measures of information processing speed, as well as visual and verbal learning/memory. However, the study of Hawkins et al. [50] in which participants were assessed at entry and at 6 and 12 months failed to prove a decline of the cognitive functioning during the period of transition to psychosis. "
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    ABSTRACT: Recent interest in the early course of schizophrenia accentuated altered cognition prior to the onset. Ultrahigh risk (UHR) individuals with attenuated positive symptoms and transient psychotic episodes demonstrate neurocognitive deficits across multiple domains such as memory, executive functioning, and processing speed which are consistent with similar disturbances identified in patients with a first episode of schizophrenia. Cognitive remediation (CR) approaches representing a broad set of activities are aimed to restore or improve cognitive functioning. CR proved to be effective in modulating the cognitive dysfunction in schizophrenia but is rarely used in ultrahigh risk individuals. From the clinical prospective, a better understanding of cognitive functioning in at-risk states is essential for the development of optimal early intervention models. In the review, we highlight the intervention targets, notably the specific cognitive deficits in at risk individuals which preceed the transition to psychosis and emphasize the need of the additional studies using CR approaches in UHR group aiming to enhance cognition and therefore mediate functional improvement.
    BioMed Research International 09/2013; 2013:819587. DOI:10.1155/2013/819587 · 3.17 Impact Factor
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