Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-09T03:27:31.666Z Has data issue: false hasContentIssue false

Comparison of cognitive functions between first-episode schizophrenia patients, their unaffected siblings and individuals at clinical high-risk for psychosis

Published online by Cambridge University Press:  18 September 2018

Angel On Ki Chu
Affiliation:
Queen Mary Hospital, Pokfulam, Hong Kong
Wing Chung Chang*
Affiliation:
Queen Mary Hospital, Pokfulam, Hong Kong Hong Kong Jockey Club Building for Interdisciplinary Research, Pokfulam, Hong Kong
Sherry Kit Wa Chan
Affiliation:
Queen Mary Hospital, Pokfulam, Hong Kong Hong Kong Jockey Club Building for Interdisciplinary Research, Pokfulam, Hong Kong
Edwin Ho Ming Lee
Affiliation:
Queen Mary Hospital, Pokfulam, Hong Kong
Christy Lai Ming Hui
Affiliation:
Queen Mary Hospital, Pokfulam, Hong Kong
Eric Yu Hai Chen
Affiliation:
Queen Mary Hospital, Pokfulam, Hong Kong Hong Kong Jockey Club Building for Interdisciplinary Research, Pokfulam, Hong Kong
*
Author for correspondence: Wing Chung Chang, E-mail: changwc@hku.hk

Abstract

Background

Cognitive impairment is a core feature of schizophrenia and has been observed in both familial (FHR) and clinical high-risk (CHR) samples. Nonetheless, there is a paucity of research directly contrasting cognitive profiles in these two high-risk states and first-episode schizophrenia. This study aimed to compare cognitive functions in patients with first-episode schizophrenia-spectrum disorder (FES), their unaffected siblings (FHR), CHR individuals and healthy controls.

Method

A standardized battery of cognitive assessments was administered to 69 FES patients, 71 help-seeking CHR individuals without family history of psychotic disorder, 50 FHR participants and 68 controls. FES and CHR participants were recruited from territory-wide early intervention service for psychosis in Hong Kong. CHR status was ascertained using Comprehensive Assessment of At-Risk Mental State.

Results

Among four groups, FES patients displayed the largest global cognitive impairment and had medium-to-large deficits across all cognitive tests relative to controls. CHR and FHR participants significantly underperformed in most cognitive tests than controls. Among various cognitive tests, digit symbol coding demonstrated the greatest magnitude of impairment in FES and CHR groups compared with controls. No significant difference between two high-risk groups was observed in global cognition and all individual cognitive tests except digit symbol coding which showed greater deficits in CHR than in FHR participants.

Conclusion

Clinical and familial risk groups experienced largely comparable cognitive impairment that was intermediate between FES and controls. Digit symbol coding may have the greatest discriminant capacity in distinguishing FES and CHR from healthy controls, and between two high-risk samples.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aas, M, Dazzan, P, Mondelli, V, Melle, I, Murray, RM and Pariante, CM (2014) A systematic review of cognitive function in first-episode psychosis, including a discussion on childhood trauma, stress, and inflammation. Frontiers in Psychiatry 4, 182.Google Scholar
Addington, J and Barbato, M (2012) The role of cognitive functioning in the outcome of those at clinical high risk for developing psychosis. Epidemiology and Psychiatric Sciences 21, 335342.Google Scholar
Agnew-Blais, J and Seidman, LJ (2013) Neurocognition in youth and young adults under age 30 at familial risk for schizophrenia: a quantitative and qualitative review. Cognitive Neuropsychiatry 18, 4482.Google Scholar
American Psychiatry Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Blokland, GAM, Hesholam-Gately, RI, Toulopoulou, T, Del Re, EC, Lam, M, DeLisi, LE, Donohoe, G, Walters, JTR, GENUS Consortium, Seidman, LJ and Petryshen, TL (2017) Heritability of neuropsychological measures in schizophrenia and nonpsychiatric populations: a systematic review and meta-analysis. Schizophrenia Bulletin 43, 788800.Google Scholar
Bora, E (2015) Neurodevelopmental origin of cognitive impairment in schizophrenia. Psychological Medicine 45, 19.Google Scholar
Bora, E and Murray, RM (2014) Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophrenia Bulletin 40, 744755.Google Scholar
Bora, E, Lin, A, Yung, AR, McGorry, PD and Pantelis, C (2014) Cognitive deficits in youth with familial and clinical high risk to psychosis: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 130, 115.Google Scholar
Bowie, CR, Reichenberg, A, Patterson, TL, Heaton, RK and Harvey, PD (2006) Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry 163, 418425.Google Scholar
Bowie, CR, Leung, WW, Reichenberg, A, McClure, MM, Patterson, TL, Heaton, RK and Harvey, PD (2008) Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biological Psychiatry 63, 505511.Google Scholar
Cannon, TD, Yu, C, Addington, J, Bearden, CE, Cadenhead, KS, Cornblatt, BA, Heissen, R, Jeffries, C, Mathalon, DH, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW and Kattane, M (2016) An individualized risk calculator for research in prodromal psychosis. American Journal of Psychiatry 173, 980988.Google Scholar
Carrion, RE, Goldberg, TE, McLaughlin, D, Auther, AM, Correll, CU and Cornblatt, BA (2011) Impact of neurocognition on social and role functioning in individuals at clinical high risk for psychosis. American Journal of Psychiatry 168, 806813.Google Scholar
Chang, WC, Hui, CLM, Wong, GHY, Chan, SKW, Lee, EHM and Chen, EYH (2013) Symptomatic remission and cognitive impairment in first-episode schizophrenia: a prospective 3-year follow-up study. Journal of Clinical Psychiatry 74, e1046e1053.Google Scholar
Chen, EYH, Hui, CLM, Dunn, ELW, Miao, MY, Yeung, WS, Wong, CK, Chan, WF and Tang, WN (2005) A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients. Schizophrenia Research 77, 99104.Google Scholar
Chung, DWS and Chen, EYH (2013) Early psychosis services in an Asian urban setting: EASY and other services in Hong Kong. In Chen, EYH, Chan, GHK and Wong, GHY (eds) Early Psychosis Intervention: A Culturally Adaptive Clinical Guide, pp. 1727. Hong Kong: Hong Kong University Press.Google Scholar
Cotter, J, Drake, R, Bucci, S, Frith, J, Edge, D and Yung, AR (2014) What drives poor functioning in the at-risk mental state? A systematic review. Schizophrenia Research 159, 267277.Google Scholar
Davidson, M, Galderisi, S, Weiser, M, Werbeloff, N, Fleischhacker, WW, Keefe, RS, Boter, H, Keet, IP, Prelipceanu, D, Rybakowski, JK, Libiger, J, Hummer, M, Dollfus, S, López-Ibor, JJ, Hranov, LG, Gaebel, W, Peuskens, J, Lindefors, N, Riecher-Rössler, A and Kahn, RS (2009) Cognitive effects of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: a randomized, open-label clinical trial (EUFEST). American Journal of Psychiatry 166, 675682.Google Scholar
De Herdt, A, Wampers, M, Vancampfort, D, De Hert, M, Vanhees, L, Demunter, H, Van Bouwel, L, Brunner, E and Probst, M (2013) Neurocognition in clinical high risk young adults who did or did not convert to a first schizophrenic psychosis: a meta-analysis Schizophrenia Research 149, 4855.Google Scholar
Dickinson, D (2008) Digit symbol coding and general cognitive ability in schizophrenia: worth another look?. British Journal of Psychiatry 193, 354356.Google Scholar
Dickinson, D, Ramsey, MB and Gold, JM (2007) Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry 64, 111.Google Scholar
Fusar-Poli, IP, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E and McGuire, P (2012a) Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.Google Scholar
Fusar-Poli, P, Deste, G, Smieskova, R, Barlati, S, Yung, AR, Howes, O, Stieglitz, RD, Vita, A, McGuire, P and Borgwardt, S (2012b) Cognitive functioning in prodromal psychosis: a meta-analysis. Archives of General Psychiatry 69, 562571.Google Scholar
Fusar-Poli, P, Bordwardt, S, Bechdolf, A, Addington, J, Riecher-Rössler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, De Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkötter, J, McGuire, P and Yung, A (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. Archives of General Psychiatry 70, 107120.Google Scholar
Giuliano, AJ, Li, H, Mesholam-Gately, RI, Sorenson, SM, Woodberry, KA and Seidman, LJ (2012) Neurocognition in the psychosis risk syndrome: a quantitative and qualitative review. Current Pharmaceutical Design 18, 399415.Google Scholar
Gold, JM, Carpenter, C, Randolph, C, Goldberg, TE and Weinberger, DR (1997) Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Archives of General Psychiatry 54, 159165.Google Scholar
Green, MF, Kern, RS, Braff, DL and Mintz, J (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff”? Schizophrenia Bulletin 26, 119136.Google Scholar
Häfner, H, Riecher-Rössler, A, Hambrecht, M, Maurer, K, Meissner, S, Schmidtke, A, Fätkenheuer, B, Löffler, W and van der Heiden, W (1992) IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209223.Google Scholar
Hauser, M, Zhang, JP, Sheridan, EM, Burdick, KE, Mogil, R, Kane, JM, Auther, A, Carrión, RE, Cornblatt, BA and Correll, CU (2017) Neuropsychological test performance to enhance identification of subjects at clinical high risk for psychosis and be most promising for predictive algorithms for conversion to psychosis: a meta-analysis. Journal of Clinical Psychiatry 78, e28e40.Google Scholar
Healey, KM, Bartholomeusz, CF and Penn, DL (2016) Deficits in social cognition in first-episode psychosis: a review of the literature. Clinical Psychology Review 50, 108137.Google Scholar
Heinrichs, RW and Zakzanis, WW (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426445.Google Scholar
Hong Kong Psychological Society (1989a) The Wechsler Adult Intelligence Scale-Revised (Cantonese Version). Hong Kong Psychological Society: Hong Kong.Google Scholar
Hong Kong Psychological Society (1989b) Wechsler Adult Memory Scale-Revised (Cantonese Version). Hong Kong Psychological Society: Hong Kong.Google Scholar
Hou, CL, Xiang, YT, Wang, ZL, Everall, I, Tang, Y, Yang, C, Xu, MZ, Correll, CU and Jia, FJ (2016) Cognitive functioning in individuals at ultra-high risk for psychosis, first-degree relatives of patients with psychosis and patients with first-episode schizophrenia. Schizophrenia Research 174, 7176.Google Scholar
Kahn, RS and Keefe, RSE (2013) Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry 70, 11071112.Google Scholar
Kay, SR, Opler, LA and Fiszbein, A (1987) Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.Google Scholar
Keefe, RSE, Bilder, RM, Davis, SM, Harvey, PD, Palmer, BW, Gold, JM, Meltzer, HY, Green, MF, Capuano, G, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Davis, CE, Hsiao, JK and Lieberman, JA, CATIE Investigators; Neurocognitive Working Group (2007) Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE trial. Archives of General Psychiatry 64, 633647.Google Scholar
Knowles, EEM, Weiser, M, David, AS, Glahn, DC, Davidson, M, Gold, J, Davidson, M and Reichenberg, A (2012) Dedifferentiation and substitute strategy: deconstructing the processing-speed impairment in schizophrenia. Schizophrenia Research 142, 129136.Google Scholar
Knowles, EEM, Weiser, M, David, AS, Glahn, DC, Davidson, M and Reichenberg, A (2015) The puzzle of processing speed, memory, and executive function impairment in schizophrenia: fitting the pieces together. Biological Psychiatry 78, 786793.Google Scholar
Lavoie, MA, Plana, I, Bedard, LJ, Godmaire-Duhaime, F, Jackson, PL and Achim, AM (2013) Social cognition in first-degree relatives of people with schizophrenia: a meta-analysis. Psychiatry Research 209, 129135.Google Scholar
Lewandowski, KE, Cohen, BM and Ongur, D (2011) Evolution of neuropsychological dysfunction during the course of schizophrenia and bipolar disorder. Psychological Medicine 23, 315336.Google Scholar
Lin, A, Yung, AR, Nelson, B, Brewer, WJ, Riley, R, Simmons, M, Pantelis, C and Wood, SJ (2013) Neurocognitive predictors of transition to psychosis: medium- to long-term findings from a sample at ultra-high risk for psychosis. Psychological Medicine 43, 23492360.Google Scholar
MacCabe, JH, Wicks, S, Lofving, S, David, AS, Berndtsson, Å, Gustafsson, JE, Allebeck, P and Dalman, C (2013) Decline in cognitive performance between age 13 and 18 years and the risk for psychosis in adulthood. JAMA Psychiatry 70, 261270.Google Scholar
Mark, W and Toulopoulou, T (2016) Cognitive intermediate phenotype and genetic risk for psychosis. Current Opinion in Neurobiology 36, 2330.Google Scholar
Meier, MH, Caspi, A, Reichenberg, A, Keefe, RS, Fisher, HL, Harrington, H, Houts, R, Poulton, R and Moffitt, TE (2014) Neuropsychological decline in schizophrenia from the premorbid to the postonset period: evidence from a population-representative longitudinal study. American Journal of Psychiatry 171, 91101.Google Scholar
Mesholam-Gately, RL, Giuliano, AJ, Goff, KP, Faraone, SV and Seidman, LJ (2009) Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 23, 315336.Google Scholar
Meyer, EC, Carrion, RE, Cornblatt, BA, Addington, J, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF, Woods, SW, Heinssen, R and Seidman, LJ, NAPLS group. (2014) The relationship of neurocognition and negative symptoms to social and role functioning over time in individuals at clinical high risk in the first phase of the North American Prodrome Longitudinal Study. Schizophrenia Bulletin 40, 14521461.Google Scholar
Michel, C, Ruhrmann, S, Schimmelmann, BG, Klosterkotter, J and Schultze-Lutter, A (2014) A stratified model for psychosis: prediction in clinical practice. Schizophrenia Bulletin 40, 15331542.Google Scholar
Mukkala, S, Ilonen, T, Nordström, T, Miettunen, J, Loukkola, J, Barnett, JH, Murray, GK, Jääskeläinen, E, Mäki, P, Taanila, A, Moilanen, I, Jones, PB, Heinimaa, M and Veijola, J (2011) Different vulnerability indicators for psychosis and their neuropsychological characteristics in the Northern Finland 1986 Birth Cohort. Journal of Clinical and Experimental Neuropsychology 33, 385394.Google Scholar
Myles-Worsley, M, Ord, LM, Ngiralmau, H, Weaver, S, Blailes, F and Faraone, SV (2007) Palau early Psychosis Study: neurocognitive functioning in high-risk adolescents. Schizophrenia Research 89, 299307.Google Scholar
Nielsen, RE, Lavader, S, Kjaersdam, TG, Jensen, SO, Østergaard, CT and Leucht, S (2015) Second-generation antipsychotic effect on cognition in patients with schizophrenia – a meta-analysis of randomized clinical trials. Acta Psychiatrica Scandinavica 131, 185196.Google Scholar
Reichenberg, A, Caspi, A, Harrington, H, Houts, R, Keefe, RS, Murray, RM, Poulton, R and Moffitt, TE (2010) Static and dynamic cognitive deficits in childhood preceding adult schizophrenia: a 30-year study. American Journal of Psychiatry 167, 160169.Google Scholar
Seidman, LJ, Giuliano, AJ, Meyer, EC, Addington, J, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF, Woods, SW, Bearden, CE, Christensen, BK, Hawkins, K, Heaton, R, Keefe, RS, Heinssen, R and Cornblatt, BA, North American Prodrome Longitudinal Study (NAPLS) Group (2010) Neuropsychology of the prodrome to psychosis in the NAPLS Consortium: relationship to family history and conversion to psychosis. Archives of General Psychiatry 67, 578588.Google Scholar
Sitskoorn, MM, Aleman, A, Eibsch, SJH, Appels, MCM and Kahn, RS (2004) Cognitive deficits in relatives of patients with schizophrenia: a meta-analysis. Schizophrenia Research 71, 285295.Google Scholar
Snitz, BE, MacDonald, AW III and Carter, CS (2006) Cognitive deficits in unaffected first-degree relatives of schizophrenia patients: a meta-analytic review of putative endophenotypes. Schizophrenia Bulletin 32, 179194.Google Scholar
So, E, Kam, I, Leung, CM, Chung, D, Lui, Z and Fong, S (2003) The Chinese-bilingual SCID-I/P Project: Stage 1: reliability for mood disorders and schizophrenia. Hong Kong Journal of Psychiatry 13, 718.Google Scholar
Ucok, A, Direk, N, Koyuncu, A, Keskin-Ergen, Y, Yüksel, Ç, Güler, J, Karadayı, G, Akturan, E and Devrim-Üçok, M (2013) Cognitive deficits in clinical and familial high risk groups for psychosis are common as in first episode schizophrenia. Schizophrenia Research 151, 265269.Google Scholar
van Donkersgoed, RJM, Wunderink, L, Nieboer, R, Aleman, A and Pijnenborg, GHM (2015) Social cognition in individuals at ultra-high risk for psychosis: a meta-analysis. PLoS ONE 10, e0141075.Google Scholar
Wilkins, AJ, Shallice, T and McCarthy, R (1987) Frontal lesions and sustained attention. Neuropsychologia 25, 359365.Google Scholar
Yung, AR and McGorry, PD (1996) The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophrenia Bulletin 22, 353370.Google Scholar
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K and Buckby, J (2005) Mapping the onset of psychosis: the comprehensive assessment of at-risk mental state. Australian and New Zealand Journal of Psychiatry 39, 964971.Google Scholar
Supplementary material: File

Chu et al. supplementary material

Table S1

Download Chu et al. supplementary material(File)
File 14.9 KB
Supplementary material: File

Chu et al. supplementary material

Table S2

Download Chu et al. supplementary material(File)
File 14.6 KB