
- Vol 38, Issue 2
- Volume 02
The Troublesome Tale of Cognitive Deficits in Patients at CHR for Psychosis
Is it possible to use cognitive testing, which is brief, easily performed, reliable, and noninvasive, to identify individuals at risk for psychosis?
CLINICAL
Case Vignette
“George” is a 15-year-old male in the 10th grade who is being evaluated by his school psychologist for declining academic performance. Last year, he earned grades of all As and Bs, but this year he has mostly Bs and Cs, with one D in an advanced math class. George has a 4-year history of generalized anxiety disorder, for which he takes a low-dose selective serotonin reuptake inhibitor. He has no active medical problems. He does not currently use tobacco, alcohol, or illicit drugs but admits to trying marijuana once at a party in the past year. There is no history of physical, sexual, or verbal abuse. He has a maternal aunt with chronic schizophrenia. His mother had gestational diabetes mellitus during her pregnancy with him, which was otherwise without complications. She states that he had frequent infections as a child and seemed to “get sick easily.” He has been slightly more irritable recently. George reports having a few close friends.
On interview, his affect is slightly restricted, but it brightens when he talks about his hobby (origami). He reported hearing whispering voices on a few occasions at night, which he attributed to noises outside his bedroom window. He reports this academic year it is harder for him to concentrate at school.
Cognitive deficits are a well-replicated
A total of 217 participants at CHR and 133 healthy controls from the SHARP study completed the MATRICS Consensus Cognitive Battery (MCCB) at baseline and provided complete clinical data. These patients represented more than 90% of the patients who provided 1-year assessment data. The mean age of participants was aged 18.6 years; 47% were male; and all were lifetime psychotropic naïve at study entry. Subsequently, 80% of patients at CHR received antipsychotic medications. Inclusion criteria for all participants were aged 13 to 45 years, at least 6 years of education, and an available legal guardian for patients 18 years or younger. Participants with an
Raw scores on the MCCB were converted to Z-scores based on healthy control scores. The CHR group was divided into CHR-NC (n = 155) and CHR-C (n = 41) based on the 1-year follow-up assessment. In other analyses, the CHR group was trichotomized to 3 clinical outcomes at 1-year: CHR-remission (n = 102), CHR-symptomatic (n = 37), and CHR-poor outcome (n = 57). The CHR-remission group included patients with spontaneous remission or improvement with antipsychotic medication to mildly impaired ranges or better (Structured Interview for Prodromal Syndromes [SIPS] positive symptom scores ≤ 2) and global function at least 60 at follow-up. The CHR-symptomatic group included medicated participants with SIPS positive
There were no significant differences regarding age, sex, or education between CHR and healthy control groups.
Compared with controls, CHR-remission and CHR-poor outcome scores were lower for all MCCB subsets (medium- to large-effect sizes for poor outcome, d = 0.35-1.91), and CHR-symptomatic scores were lower for 6 of 8 MCCB subsets (effect sizes d = 0.50-93). Furthermore, Brief Visuospatial Memory Test-Revised scores were significantly lower in the CHR-poor outcome versus CHR-remission group (medium effect size, d = 0.53).
The authors noted that an educated, mostly urban Chinese sample of patients at CHR had cognitive impairments of a similar magnitude to a western prodromal consortium (the North American Prodrome Longitudinal Study [
Matters to consider
An important question follows: what is the evidence for the feasibility and efficacy of strategies or treatment for cognitive impairments in patients at CHR of psychosis? Do they forestall or decrease conversion to psychosis, or are they associated with improvements in other outcomes? To date, there are small studies that have investigated cognitive interventions in this population. Several studies have investigated computer-based
This study demonstrates the feasibility of harmonizing measures across different geographical locations for the reliable and valid assessment of cognition in patients at CHR of psychosis. Furthermore, findings replicate, and therefore reinforce, earlier studies, as the pattern and magnitude of cognitive impairments in patients at CHR were similar between the SHARP study and the
Based on these data, cognitive impairments represent an important, viable target for intervention in this population.
An earlier version of this article titled "
Dr Miller is professor, Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA. He is the schizophrenia section chief for Psychiatric TimesTM. The author reports that he receives research support from Augusta University, the National Institute of Mental Health, the Brain and Behavior Research Foundation, and the Stanley Medical Research Institute.
References
1. Agnew-Blais J, Seidman LJ. Neurocognition in youth and young adults under age 30 at familial risk for schizophrenia: a quantitative and qualitative review. Cogn Neuropsychiatry. 2013;18(1-2):44-82.
2. Gur RC, Calkins ME, Satterthwaite TD, et al.
3. Fusar-Poli P, Deste G, Smieskova R, et al.
4. Bolt LK, Amminger GP, Farhall J, et al. Neurocognition as a predictor of transition to psychotic disorder and functional outcomes in ultrahigh risk participants: findings from the NEURAPRO randomized clinical trial. Schizophr Res. 2019;206:67-74.
5. Seidman LJ, Shapiro DI, Stone WS, et al. Association of neurocognition with transition to psychosis: Basline functioning in the second phase of the North American Prodrome Longitudinal Study. JAMA Psychiatry. 2016;73:1239-1248.
6. Cui H, Giuliano AJ, Zhang T, et al.
7. Rauchensteiner S, Kawohl W, Ozgurdal S, et al. Testperformance after cognitive training in persons at risk mental state of schizophrenia and patients with schizophrenia. Psychiatry Res. 2011;185:334-339.
8. Hooker CI, Carol EE, Eisenstein TJ, et al.
9. Piskulic D, Barbato M, Liu L, Addington J.
10. Loewy R, Fisher M, Schlosser DA, et al. Intensive Auditory Cognitive Training Improves Verbal Memory in Adolescents and Young Adults at Clinical High Risk for Psychosis. Schizophr Bull. 2016;42:S118-26.
11. Friedman-Yakoobian MS, Parrish EM, Eack SM, et al.
12. Friedman-Yakoobian MS, Parrish EM, Thomas A, et al. An integrated neurocognitive and social-cognitive treatment for youth at clinical high risk for psychosis: Cognition for Learning and for Understanding Everyday Social Situations (CLUES). Schizophr Res. 2019;208:55-59.❒
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