In high risk patients, cognitive deficits such as impaired working memory and declarative memory may be an early indicator of psychosis.
In a clinical high-risk state of psychosis, neurocognitive impairment may be an indicator of later psychotic disorder, according to new research published in JAMA Psychiatry. The case-control, observational trial was conducted across 8 university-based, outpatient programs studying the psychosis prodrome in North America. Seidman and colleagues1 leveraged 19 neuropsychological tests and 4 factors derived from factor analysis (eg, executive and visuospatial abilities, verbal abilities, attention and working memory abilities, declarative memory abilities) to measure neurocognitive dysfunction among 264 (137 male and 127 female) healthy control patients and 689 (398 male and 291 female) clinical high-risk patients aged 12 to 35 years.
Patients at high risk were significantly impaired on attention and working memory abilities and declarative memory abilities. In addition, those patients in whom psychosis developed had significantly worse attention and working memory abilities and declarative memory abilities. The researchers further found that in those who transitioned to psychosis, time to conversion was significantly predicted by high verbal (premorbid) abilities, impaired declarative memory abilities, and a combined score of unusual thought content or delusional ideas and suspiciousness or persecutory ideas items.
“To our knowledge, this is the largest and most definitive study of cognition in the high-risk period before onset of psychosis/schizophrenia,” Larry J. Seidman, PhD, a psychologist at Beth Israel Deaconess Medical Center and Professor of Psychology at Harvard Medical School, said. “This is part of a paradigm shift in the way we are focusing on the earlier, prodromal phase of the disorder in an effort to identify those most likely to develop psychosis.”2
Ultimately, his group is interested in assisting clinicians in identifying those most at risk and then “developing interventions to improve a person’s chances for not getting it, making it milder or delaying it.” He added, “We are also testing a number of cognitive remediation and enhancement treatments to determine their role in the evolution of the illness. There’s more evidence suggesting that early intervention reduces the number of people who transition to schizophrenia.”
1. Seidman LJ, Shapiro DI, Stone WS, et al. Association of neurocognition with transition to psychosis: baseline functioning in the second phase of the North American Prodrome Longitudinal Study. JAMA Psychiatry. 2016;73:1239-1248.
2. Beth Israel Deaconess Medical Center. Neurocognitive deficits may be a red flag for psychosis. http://www.bidmc.org/News/PRLandingPage/2016/November/Seidman-Neurocognitive-Deficits.aspx. Accessed December 5, 2016.