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Visual working memory deterioration preceding relapse in psychosis

Published online by Cambridge University Press:  16 June 2016

C. L. M. Hui ,
Y. K. Li ,
A. W. Y. Li ,
E. H. M. Lee ,
W. C. Chang ,
S. K. W. Chan ,
S. Y. Lam ,
A. E. Thornton ,
P. Sham  and
W. G. Honer
...Show all authors
C. L. M. Hui*
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China
Y. K. Li
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China
A. W. Y. Li
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China
E. H. M. Lee
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China
W. C. Chang
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, People's Republic of China
S. K. W. Chan
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, People's Republic of China
S. Y. Lam
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China
A. E. Thornton
Affiliation:
Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
P. Sham
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, People's Republic of China
W. G. Honer
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
E. Y. H. Chen
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People's Republic of China State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, People's Republic of China
*
*Address for correspondence: C. L. M. Hui, Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, People's Republic of China. (Email: christy@lmhui.com)
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Abstract

Background

Relapse is distressingly common after the first episode of psychosis, yet it is poorly understood and difficult to predict. Investigating changes in cognitive function preceding relapse may provide new insights into the underlying mechanism of relapse in psychosis. We hypothesized that relapse in fully remitted first-episode psychosis patients was preceded by working memory deterioration.

Method

Visual memory and verbal working memory were monitored prospectively in a 1-year randomized controlled trial of remitted first-episode psychosis patients assigned to medication continuation (quetiapine 400 mg/day) or discontinuation (placebo). Relapse (recurrence of positive symptoms of psychosis), visual (Visual Patterns Test) and verbal (Letter–Number span test) working memory and stressful life events were assessed monthly.

Results

Remitted first-episode patients (n = 102) participated in the study. Relapsers (n = 53) and non-relapsers (n = 49) had similar baseline demographic and clinical profiles. Logistic regression analyses indicated relapse was associated with visual working memory deterioration 2 months before relapse [odds ratio (OR) 3.07, 95% confidence interval (CI) 1.19–7.92, P = 0.02], more stressful life events 1 month before relapse (OR 2.11, 95% CI 1.20–3.72, P = 0.01) and medication discontinuation (OR 5.52, 95% CI 2.08–14.62, P = 0.001).

Conclusions

Visual working memory deterioration beginning 2 months before relapse in remitted first-episode psychosis patients (not baseline predictor) may reflect early brain dysfunction that heralds a psychotic relapse. The deterioration was found to be unrelated to a worsening of psychotic symptoms preceding relapse. Testable predictors offer insight into the brain processes underlying relapse in psychosis.

Keywords

Early psychosispredictorsrelapseschizophreniaworking memory
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 11 , August 2016 , pp. 2435 - 2444
Copyright
Copyright © Cambridge University Press 2016 

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