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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    • "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.
    Full-text · Article · Aug 2014 · Psychiatry Research
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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.
    Full-text · Article · Sep 2013 · BioMed Research International
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    • "In most cases, the development of signs of CHR is associated with significant changes in functioning. These changes include new difficulties concentrating in school, withdrawal from friends and extracurricular activities, changes in self-care and declining grades, reduced motivation, depression and anxiety, and declining school performance (Cornblatt et al., 2007; Niendam et al., 2007; Seidman et al., 2010). Such changes are often what attract initial concern by the school, pediatricians, and parents. "
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    ABSTRACT: The idea of a clinical high risk (CHR) for psychosis has focused attention on early intervention to prevent or attenuate psychosis. However, many clinicians may still not be very familiar with the concept of CHR. Current studies have not allowed for an in-depth examination of the challenges and the strategies of working with youth from the range of racial/ethnic minority families, Asian American families in particular. The purpose of this article was three-fold. First, we critically review Asian cultural values and beliefs about mental illness, psychosis in particular, while highlighting specific challenges that Asian American families encounter. Second, we provide a clinical case to illustrate these challenges and inform clinical practice when working with Asian youth at risk for psychosis and their families. Third, practical and easy-to-follow clinical strategies are provided. Implications for clinical practice and directions for future research are presented.
    Full-text · Article · May 2013 · The Journal of nervous and mental disease
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