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The longitudinal effect of antipsychotic burden on psychosocial functioning in first-episode psychosis patients: the role of verbal memory

Published online by Cambridge University Press:  24 April 2020

Alejandro Ballesteros ,
Ana M. Sánchez Torres Open the ORCID record for Ana M. Sánchez Torres [Opens in a new window] ,
Jose López-Ilundáin ,
Gisela Mezquida ,
Antonio Lobo Open the ORCID record for Antonio Lobo [Opens in a new window] ,
Ana González-Pinto Open the ORCID record for Ana González-Pinto [Opens in a new window] ,
Laura Pina-Camacho Open the ORCID record for Laura Pina-Camacho [Opens in a new window] ,
Iluminada Corripio Open the ORCID record for Iluminada Corripio [Opens in a new window] ,
Eduard Vieta Open the ORCID record for Eduard Vieta [Opens in a new window]  and
Elena de la Serna Open the ORCID record for Elena de la Serna [Opens in a new window]
...Show all authors
Alejandro Ballesteros
Affiliation:
Red de Salud Mental de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
Ana M. Sánchez Torres
Affiliation:
Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
Jose López-Ilundáin
Affiliation:
Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
Gisela Mezquida
Affiliation:
Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
Antonio Lobo
Affiliation:
Department of Medicine and Psychiatry, Zaragoza University, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
Ana González-Pinto
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain BIOARABA Health Research Institute, OSI Araba, University Hospital, University of the Basque Country, Vitoria, Spain
Laura Pina-Camacho
Affiliation:
Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
Iluminada Corripio
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
Eduard Vieta
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain Unidad de Trastornos bipolares y depresivos, Hospital Clínic, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
Elena de la Serna
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, Spain
Anna Mané
Affiliation:
Hospital del Mar Medical Research Institute (IMIM), CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
Miquel Bioque
Affiliation:
Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
Lucía Moreno-Izco
Affiliation:
Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
Ana Espliego
Affiliation:
Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
Ruth Lorente-Omeñaca
Affiliation:
Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
Silvia Amoretti
Affiliation:
Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
Miguel Bernardo
Affiliation:
Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
Manuel J. Cuesta*
Affiliation:
Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
*
Author for correspondence: Manuel J. Cuesta, E-mail: mcuestaz@navarra.es
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Abstract

Background

Previous literature supports antipsychotics’ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning.

Methods

A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables.

Results

Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011–0.0091) and (b = 0.0026, 95% CI 0.0001–0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033–0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden.

Conclusion

CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.

Keywords

Antipsychoticscognitiondopaminergic receptor blockade burdenfirst episode psychosisfunctioning
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 12 , September 2021 , pp. 2044 - 2053
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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