Neuropsychological Functioning in First-Break, Never-Medicated Adolescents With Psychosis

Columbia University, New York, New York, United States
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 10/2004; 192(9):615-22. DOI: 10.1016/S0920-9964(03)80902-7
Source: PubMed


The purpose of the current study was to examine neuropsychological functioning in a group of never-medicated first-break adolescents with psychosis. It is the first report of cognition in a sample of adolescents with psychosis in which all patients were drug-naive. Twenty-nine adolescent patients (mean age = 16.07; SD = 2.00; 15 male and 14 female patients) experiencing their first psychotic episode and 17 age-matched and sex-matched normal volunteers (mean age = 16.88; SD = 2.39; 9 male and 8 female subjects) were recruited and assessed with a neuropsychological battery. Measures of attention, memory, language, executive functioning, perceptual motor processing, and motor speed were obtained. Psychiatric symptomatology, estimated verbal IQ, and parental socioeconomic status were also determined. Patients with psychosis were significantly more impaired than normal volunteers; effect sizes were greatest in the areas of executive functioning, attention, and memory, and significantly smaller in areas of language, perceptual motor processing, and motor speed. The pattern was not altered when differences in verbal IQ and parental socioeconomic status were controlled. Sex and age interactions indicated that younger male patients were particularly impaired. The findings demonstrate neuropsychological deficits in adolescents with psychosis and suggest that cognitive deficits are core symptoms in psychotic disorders.

34 Reads
  • Source
    • "Volume of cortical and subcortical structures and cortical and corpus callosum anisotropy in the adult patients and adult healthy controls have also been previously published by our group (Mitelman et al., 2005a, 2005b, 2005c, 2005d, 2006, 2009). Neurocognitive functioning of the adolescent patients has been described by Brickman et al. (2004). All participants received the PANSS on the day of their scan to assess clinical symptom severity. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The corpus callosum has been implicated as a region of dysfunctional connectivity in schizophrenia, but the association between age and callosal pathology is unclear. Magnetic resonance imaging (MRI) and diffusion-tensor imaging (DTI) were performed on adults (n=34) and adolescents (n=17) with schizophrenia and adult (n=33) and adolescent (n=15) age- and sex-matched healthy controls. The corpus callosum was manually traced on each participant׳s MRI, and the DTI scan was co-registered to the MRI. The corpus callosum was divided into five anteroposterior segments. Area and anisotropy were calculated for each segment. Both patient groups demonstrated reduced callosal anisotropy; however, the adolescents exhibited reductions mostly in anterior regions while the reductions were more prominent in posterior regions of the adults. The adolescent patients showed greater decreases in absolute area as compared with the adult patients, particularly in the anterior segments. However, the adults showed greater reductions when area was considered relative to whole brain white matter volume. Our results suggest that the initial stages of the illness are characterized by deficiencies in frontal connections, and the chronic phase is characterized by deficits in the posterior corpus callosum; or, alternatively, adolescent-onset schizophrenia may represent a different or more severe form of the illness. Published by Elsevier Ireland Ltd.
    Full-text · Article · Jan 2015 · Psychiatry Research: Neuroimaging
  • Source
    • "A majority of the patients had the diagnosis of schizophrenia (89.60%), 2.26% were diagnosed with schizoaffective disorder, 1.35% with schizophreniform disorder and 5.15% included mixed samples of schizophrenia, and schizoaffective and schizophreniform disorder. One study (Brickman et al., 2004) included a majority of patients with schizophrenia (18 individuals) but also some individuals diagnosed with bipolar disorder (5 individuals), major depression with psychosis (1 individual) and psychosis not otherwise specified (NOS) (1 individual ). With the exception of 3 studies including a total of 43 patients where information was lacking, all included studies had enrolled first episode schizophrenia patients, here defined as patients in their first contact with psychiatry. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive deficits represent a significant characteristic of schizophrenia. However, a majority of the clinical studies have been conducted in antipsychotic drug treated patients. Thus, it remains unclear if significant cognitive impairments exist in the absence of medication. This is the first meta-analysis of cognitive findings in drug-naïve patients with schizophrenia. Cognitive data from 23 studies encompassing 1106 patients and 1385 controls published from 1992 to 2013 were included. Tests were to a large extent ordered in cognitive domains according to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery. Analysis was performed with STATA using the random-effects model and heterogeneity as well as Egger's publication bias was assessed. Overall the results show that patients performed worse than healthy controls in all cognitive domains with medium to large effect sizes. Verbal memory, speed of processing and working memory were three of the domains with the greatest impairments. The pattern of results is in line with previous meta-analytic findings in antipsychotic treated patients. The present meta-analysis confirms the existence of significant cognitive impairments at the early stage of the illness in the absence of antipsychotic medication.
    Full-text · Article · Jul 2014 · Schizophrenia Research
  • Source
    • "associated with treatment refractory negative symptoms and poor functional outcome (Green, 1996; Kerns et al., 2008; Williams et al., 2008). Studies of executive functioning in EOS suggest that impairments also are common here, (Oie and Rund, 1999; Ueland et al., 2004; Holmén et al., 2010; Jepsen et al., 2010) and with indications of more prominent deficits in EOS than in AOS patients (Basso et al., 1997; Brickman et al., 2004; Tuulio-Henriksson et al., 2004). The latter studies have however evaluated EOS patients as adults and thus with long durations of illness. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The goal of this study was to investigate differences in executive functioning between patients with early-onset and adult-onset schizophrenia spectrum psychoses at the time of first treatment. Methods: Neuropsychological tests covering executive functioning domains were performed for 20 adolescents with early-onset schizophrenia (EOS) close to first treatment and 90 first episode patients with adult onset schizophrenia (AOS) in addition to 66 adolescent- and 127 adult age and gender matched healthy controls. Results: Both EOS and AOS patients had significantly poorer executive performance than their age- and gender matched healthy counterparts. Both healthy adolescent controls and EOS patients had poorer executive performance than their adult counterparts. However, there were no differences in executive functioning between EOS and AOS patients after controlling for the levels of their age matched healthy control groups. Substituting EOS/AOS status with other age-at-onset thresholds had no effect. Conclusions: We find the same relative levels of executive dysfunction in EOS- and AOS groups at the time of first treatment. This does not necessarily contradict previous findings of more severe dysfunction in EOS patients over time, but indicates an interaction between the disorder and the maturational processes that only can be investigated through longitudinal studies.
    Full-text · Article · Oct 2012 · Schizophrenia Research
Show more