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Investigating cognitive deficits and symptomatology across pre-morbid adjustment patterns in first-episode psychosis

Published online by Cambridge University Press:  07 September 2009

L. Béchard-Evans ,
S. Iyer ,
M. Lepage ,
R. Joober  and
A. Malla
L. Béchard-Evans
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada
S. Iyer
Affiliation:
Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health Institute, Montreal, Quebec, Canada
M. Lepage
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada
R. Joober
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada
A. Malla*
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada
*
*Address for correspondence: Professor A. Malla, M.B.B.S., F.R.C.PC, Department of Psychiatry, McGill University, 6875 Boulevard Lasalle, Montreal, Quebec, Canada H4H 1R3. (Email: ashok.malla@douglas.mcgill.ca)
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Abstract

Background

Cognitive deficits in schizophrenia are well established and are known to be present during the first episode of a psychotic disorder. In addition, consistent heterogeneity within these impairments remains unexplained. One potential source of variability may be the level of pre-morbid adjustment prior to the onset of first-episode psychosis (FEP).

Method

Ninety-four FEP patients and 32 healthy controls were assessed at baseline on several neuropsychological tests comprising six cognitive domains (verbal memory, visual memory, working memory, processing speed, reasoning/problem-solving and attention) and an abbreviated version of the full IQ. A global neurocognitive domain was also computed. Pre-morbid adjustment patterns were divided into three distinct groups: stable-poor, stable-good and deteriorating course.

Results

Based on a cut-off of 0.8 for effect size, the stable-poor pre-morbid adjustment group was significantly more impaired on most cognitive domains and full IQ compared to the deteriorating group, who were more severely impaired on all measures compared to the stable-good group. The type of cognitive deficit within each subgroup did not differ and the results indicate that a global neurocognition measure may reliably reflect the severity of cognitive impairment within each subgroup.

Conclusions

Pre-morbid adjustment patterns prior to onset of psychosis are associated with severity but not type of cognitive impairment. Patients in the stable-poor group are generally more impaired compared to the deteriorating group, who are, in turn, more impaired than the stable-good group.

Keywords

Cognitionfirst-episode psychosispre-morbid adjustment
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 5 , May 2010 , pp. 749 - 759
Copyright
Copyright © Cambridge University Press 2009

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References

Addington, J, Addington, D (1993). Premorbid functioning, cognitive functioning, symptoms and outcome in schizophrenia. Journal of Psychiatry and Neuroscience 18, 18–23.Google ScholarPubMed
Addington, J, Addington, D (2002). Cognitive functioning in first-episode schizophrenia. Journal of Psychiatry and Neuroscience 27, 188–192.Google ScholarPubMed
Addington, J, Addington, D (2005). Patterns of premorbid functioning in first episode psychosis: relationship to 2-year outcome. Acta Psychiatrica Scandanivica 112, 40–46.CrossRefGoogle ScholarPubMed
Amminger, GP, Resch, F, Mutschlechner, R, Friedrich, MH, Ernst, E (1997). Premorbid adjustment and remission of positive symptoms in first-episode psychosis. European Child & Adolescent Psychiatry 6, 212–218.CrossRefGoogle ScholarPubMed
Bezchlibnyk-Butler, KZ, Jeffries, JJ (2007). Clinical Handbook of Psychotropic Drugs. Hogrefe & Huber: New York.Google Scholar
Bilder, RM, Goldman, RS, Robinson, D, Reiter, G, Bell, L, Bates, JA, Pappadopulos, E, Willson, DF, Alvir, JM, Woerner, MG, Geisler, S, Kane, JM, Lieberman, JA (2000). Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. American Journal of Psychiatry 157, 549–559.CrossRefGoogle ScholarPubMed
Brickenkamp, R (1998). The d2 Test of Attention. Hogrefe & Huber: Seattle, WA.Google Scholar
Buchanan, RW, Kirkpatrick, B, Heinrichs, DW, Carpenter, WT Jr. (1990). Clinical correlates of the deficit syndrome of schizophrenia. American Journal of Psychiatry 147, 290–294.Google ScholarPubMed
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.CrossRefGoogle ScholarPubMed
Carpenter, WT Jr., Heinrichs, DW, Wagman, AM (1988). Deficit and nondeficit forms of schizophrenia: the concept. American Journal of Psychiatry 145, 578–583.Google ScholarPubMed
Childers, SE, Harding, CM (1990). Gender, premorbid social functioning, and long-term outcome in DSM-III schizophrenia. Schizophrenia Bulletin 16, 309–318.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power for the Behavioral Sciences. Laurence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Dickinson, D, Ragland, JD, Calkins, ME, Gold, JM, Gur, RC (2006). A comparison of cognitive structure in schizophrenia patients and healthy controls using confirmatory factor analysis. Schizophrenia Research 85, 20–29.CrossRefGoogle ScholarPubMed
Fennig, S, Putnam, K, Bromet, EJ, Galambos, N (1995). Gender, premorbid characteristics and negative symptoms in schizophrenia. Acta Psychiatrica Scandinavica 92, 173–177.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1998). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P &SCID-I/NP), Version 2. Psychiatric Institute, Biometrics Research: New York.Google Scholar
Gupta, S, Rajaprabhakaran, R, Arndt, S, Flaum, M, Andreasen, NC (1995). Premorbid adjustment as a predictor of phenomenological and neurobiological indices in schizophrenia. Schizophrenia Research 16, 189–197.CrossRefGoogle ScholarPubMed
Haas, GL, Sweeney, JA (1992). Premorbid and onset features of first-episode schizophrenia. Schizophrenia Bulletin 18, 373–386.CrossRefGoogle ScholarPubMed
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445.CrossRefGoogle ScholarPubMed
Hill, SK, Schuepbach, D, Herbener, ES, Keshavan, MS, Sweeney, JA (2004). Pretreatment and longitudinal studies of neuropsychological deficits in antipsychotic-naive patients with schizophrenia. Schizophrenia Research 68, 49–63.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Keefe, RS, Mohs, RC, Losonczy, MF, Davidson, M, Silverman, JM, Horvath, TB, Davis, KL (1989). Premorbid sociosexual functioning and long-term outcome in schizophrenia. American Journal of Psychiatry 146, 206–211.Google ScholarPubMed
Kelley, ME, Gilbertson, M, Mouton, A, van Kammen, DP (1992). Deterioration in premorbid functioning in schizophrenia: a developmental model of negative symptoms in drug-free patients. American Journal of Psychiatry 149, 1543–1548.Google ScholarPubMed
Larsen, TK, Friis, S, Haahr, U, Johannessen, JO, Melle, I, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, PV, McGlashan, TH (2004). Premorbid adjustment in first-episode non-affective psychosis: distinct patterns of pre-onset course. British Journal of Psychiatry 185, 108–115.CrossRefGoogle ScholarPubMed
Larsen, TK, McGlashan, TH, Johannessen, JO, Vibe-Hansen, L (1996). First-episode schizophrenia: II. Premorbid patterns by gender. Schizophrenia Bulletin 22, 257–269.CrossRefGoogle ScholarPubMed
Levitt, JJ, O'Donnell, BF, McCarley, RW, Nestor, PG, Shenton, ME (1996). Correlations of premorbid adjustment in schizophrenia with auditory event-related potential and neuropsychological abnormalities. American Journal of Psychiatry 153, 1347–1349.Google ScholarPubMed
Malla, AK, Norman, RM, Manchanda, R, Townsend, L (2002). Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychological Medicine 32, 1109–1119.CrossRefGoogle ScholarPubMed
MATRICS (2003). Results of the MATRICS RAND panel meeting: average medians for the categories of each candidate test. In Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS). (http://www.matrics.ucla.edu/meetings/september-2003/RAND-Panel-Medians.pdf).Google Scholar
Mohamed, S, Paulsen, JS, O'Leary, D, Arndt, S, Andreasen, N (1999). Generalized cognitive deficits in schizophrenia: a study of first-episode patients. Archives of General Psychiatry 56, 749–754.CrossRefGoogle ScholarPubMed
Mukherjee, S (1991). Schizophrenia: more than two disease processes? American Journal of Psychiatry 148, 1756–1757.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Barch, DM, Gold, JM, Goldberg, TE, Green, MF, Heaton, RK (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research 72, 29–39.CrossRefGoogle ScholarPubMed
Rabinowitz, J, Harvey, PD, Eerdekens, M, Davidson, M (2006). Premorbid functioning and treatment response in recent-onset schizophrenia. British Journal of Psychiatry 189, 31–35.CrossRefGoogle ScholarPubMed
Reitan, RM (1985). The Halstead-Reitan Neuropsychological Test Battery. Neuropsychology Press: Tucson, AZ.Google Scholar
Riley, EM, McGovern, D, Mockler, D, Doku, VCK, O'Ceallaigh, S, Fannon, DG, Tennakoon, L, Santamaria, M, Soni, W, Morris, RG, Sharma, T (2000). Neuropsychological functioning in first-episode psychosis – evidence of specific deficits. Schizophrenia Research 43, 47–55.CrossRefGoogle ScholarPubMed
Rund, BR, Melle, I, Friis, S, Larsen, TK, Midboe, LJ, Opjordsmoen, S, Simonsen, E, Vaglum, P, McGlashan, T (2004). Neurocognitive dysfunction in first-episode psychosis: correlates with symptoms, premorbid adjustment, and duration of untreated psychosis. American Journal of Psychiatry 161, 466–472.CrossRefGoogle ScholarPubMed
Silverstein, ML, Mavrolefteros, G, Close, D (2002). Premorbid adjustment and neuropsychological performance in schizophrenia. Schizophrenia Bulletin 28, 157–165.CrossRefGoogle ScholarPubMed
Townsend, LA, Malla, AK, Norman, RM (2001). Cognitive functioning in stabilized first-episode psychosis patients. Psychiatry Research 104, 119–131.CrossRefGoogle ScholarPubMed
Wechsler, D (1981). Wechsler Adult Intelligence Scale Revised (WAIS-R), Manual. The Psychological Corporation: Cleveland, OH.Google Scholar
Wechsler, D (1997). Wechsler Memory Scale – Revised. The Psychological Corporation: New York.Google Scholar