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The impact of psychosis on the course of cognition: a prospective, nested case-control study in individuals at clinical high-risk for psychosis

Published online by Cambridge University Press:  14 July 2015

R. E. Carrión ,
D. McLaughlin ,
A. M. Auther ,
R. Olsen ,
C. U. Correll  and
B. A. Cornblatt
R. E. Carrión*
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
D. McLaughlin
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA
A. M. Auther
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
R. Olsen
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA
C. U. Correll
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
B. A. Cornblatt
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, USA Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
*
*Address for correspondence: R. E. Carrión, Ph.D., Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, New York 11004, USA. (Email: RCarrion@NSHS.edu)
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Abstract

Background

Although cognitive deficits in patients with schizophrenia are rooted early in development, the impact of psychosis on the course of cognitive functioning remains unclear. In this study a nested case-control design was used to examine the relationship between emerging psychosis and the course of cognition in individuals ascertained as clinical high-risk (CHR) who developed psychosis during the study (CHR + T).

Method

Fifteen CHR + T subjects were administered a neurocognitive battery at baseline and post-psychosis onset (8.04 months, s.d. = 10.26). CHR + T subjects were matched on a case-by-case basis on age, gender, and time to retest with a group of healthy comparison subjects (CNTL, n = 15) and two groups of CHR subjects that did not transition: (1) subjects matched on medication treatment (i.e. antipsychotics and antidepressants) at both baseline and retesting (Meds-matched CHR + NT, n = 15); (2) subjects unmedicated at both assessments (Meds-free CHR + NT, n = 15).

Results

At baseline, CHR + T subjects showed large global neurocognitive and intellectual impairments, along with specific impairments in processing speed, verbal memory, sustained attention, and executive function. These impairments persisted after psychosis onset and did not further deteriorate. In contrast, CHR + NT subjects demonstrated stable mild to no impairments in neurocognitive and intellectual performance, independent of medication treatment.

Conclusions

Cognition appears to be impaired prior to the emergence of psychotic symptoms, with no further deterioration associated with the onset of psychosis. Cognitive deficits represent trait risk markers, as opposed to state markers of disease status and may therefore serve as possible predictors of schizophrenia prior to the onset of the full illness.

Keywords

Clinical high risklinear mixed-effects modelsnested case-control studyneurocognitionprodromalpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 15 , November 2015 , pp. 3341 - 3354
Copyright
Copyright © Cambridge University Press 2015 

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References

Addington, J, Addington, D (2002). Cognitive functioning in first-episode schizophrenia. Journal of Psychiatry and Neuroscience 27, 188–192.Google Scholar
Becker, HE, Nieman, DH, Wiltink, S, Dingemans, PM, van de Fliert, JR, Velthorst, E, de Haan, L, van Amelsvoort, Ta, Linszen, DH (2010). Neurocognitive functioning before and after the first psychotic episode: does psychosis result in cognitive deterioration? Psychological Medicine 40, 1599–1606.Google Scholar
Bilder, RM, Lipschutz-Broch, L, Reiter, G, Geisler, SH, Mayerhoff, DI, Lieberman, JA (1992). Intellectual deficits in first-episode schizophrenia: evidence for progressive deterioration. Schizophrenia Bulletin 18, 437–448.Google Scholar
Bora, E (2014). Developmental lag and course of cognitive deficits from the premorbid to postonset period in schizophrenia. American Journal of Psychiatry 171, 369.Google Scholar
Bora, E (2015). Neurodevelopmental origin of cognitive impairment in schizophrenia. Psychological Medicine 45, 1–9.Google Scholar
Bora, E, 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, 744–755.Google Scholar
Bowie, CR, McLaughlin, D, Carrión, RE, Auther, AM, Cornblatt, BA (2012). Cognitive changes following antidepressant or antipsychotic treatment in adolescents at clinical risk for psychosis. Schizophrenia Research 137, 110–117.Google Scholar
Cannon, TD, Bearden, CE, Hollister, JM, Rosso, IM, Sanchez, LE, Hadley, T (2000). Childhood cognitive functioning in schizophrenia patients and their unaffected siblings: a prospective cohort study. Schizophrenia Bulletin 26, 379–393.Google Scholar
Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, D, Tsuang, M, McGlashan, T, Heinssen, R (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 28–37.Google Scholar
Cannon, TD, Chung, Y, He, G, Sun, D, Jacobson, A, van Erp, TG, McEwen, S, Addington, J, Bearden, CE, Cadenhead, K, Cornblatt, B, Mathalon, DH, McGlashan, T, Perkins, D, Jeffries, C, Seidman, LJ, Tsuang, M, Walker, E, Woods, SW, Heinssen, R, North American Prodrome Longitudinal Study C (2015). Progressive reduction in cortical thickness as psychosis develops: a multisite longitudinal neuroimaging study of youth at elevated clinical risk. Biological Psychiatry 77, 147–157.Google Scholar
Carrión, RE, Goldberg, TE, McLaughlin, D, Auther, AM, Correll, CU, Cornblatt, BA (2011). Impact of neurocognition on social and role functioning in individuals at clinical high risk for psychosis. American Journal of Psychiatry 168, 806–813.Google Scholar
Carrión, RE, McLaughlin, D, Goldberg, TE, Auther, AM, Olsen, RH, Olvet, DM, Correll, CU, Cornblatt, Ba (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA Psychiatry 70, 1133–1142.Google Scholar
Caspi, A, Reichenberg, A, Weiser, M, Rabinowitz, J, Kaplan, Z, Knobler, H, Davidson-Sagi, N, Davidson, M (2003). Cognitive performance in schizophrenia patients assessed before and following the first psychotic episode. Schizophrenia Research 65, 87–94.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Cornblatt, BA, Auther, AM, Niendam, T, Smith, CW, Zinberg, J, Bearden, CE, Cannon, TD (2007). Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin 33, 688–702.Google Scholar
Cornblatt, BA, Green, MF, Walker, EF, Mittal, VA (1999). Etiology and Neurocognition. In Oxford Textbook of Psychopathology (ed. Blaney, P. H. and Millon, T.), pp. 298–332. Oxford University Press: New York, NY.Google Scholar
Cornblatt, BA, Lencz, T, Smith, CW, Correll, CU, Auther, AM, Nakayama, E (2003). The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophrenia Bulletin 29, 633–651.Google Scholar
Cornblatt, BA, Malhotra, AK (2001). Impaired attention as an endophenotype for molecular genetic studies of schizophrenia. American Journal of Medical Genetics 105, 11–15.Google Scholar
Correll, CU, Hauser, M, Auther, AM, Cornblatt, BA (2010). Research in people with psychosis risk syndrome: a review of the current evidence and future directions. Journal of Child Psychology and Psychiatry 51, 390–431.Google Scholar
David, AS, Malmberg, A, Brandt, L, Allebeck, P, Lewis, G (1997). IQ and risk for schizophrenia: a population-based cohort study. Psychological Medicine 27, 1311–1323.Google Scholar
Dickinson, D, Ramsey, ME, 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, 532–542.Google Scholar
Dixon, WJ, Tukey, JW (1968). Approximate behavior of the distribution of Winsorized t (Trimming/Winsorization 2). Technometrics 10, 83–98.Google Scholar
Elvevag, B, Goldberg, TE (2000). Cognitive impairment in schizophrenia is the core of the disorder. Critical Reviews in Neurobiology 14, 1–21.Google Scholar
Fusar-Poli, P, Deste, G, Smieskova, R, Barlati, S, Yung, AR, Howes, O, Stieglitz, R-D, Vita, A, McGuire, P, Borgwardt, S (2012 a). Cognitive functioning in prodromal psychosis: a meta-analysis. Archives of General Psychiatry 69, 562–571.Google Scholar
Fusar-Poli, P, Perez, J, Broome, M, Borgwardt, S, Placentino, A, Caverzasi, E, Cortesi, M, Veggiotti, P, Politi, P, Barale, F, McGuire, P (2007). Neurofunctional correlates of vulnerability to psychosis: a systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews 31, 465–484.Google Scholar
Fusar-Poli, P, Radua, J, McGuire, P, Borgwardt, S (2012 b). Neuroanatomical maps of psychosis onset: voxel-wise meta-analysis of antipsychotic-naive VBM studies. Schizophrenia Bulletin 38, 1297–1307.Google Scholar
Fusar-Poli, P, Smieskova, R, Kempton, MJ, Ho, BC, Andreasen, NC, Borgwardt, S (2013). Progressive brain changes in schizophrenia related to antipsychotic treatment? A meta-analysis of longitudinal MRI studies. Neuroscience and Biobehavioral Reviews 37, 1680–1691.Google Scholar
Glahn, DC, Kent, JW, Sprooten, E, Diego, VP, Winkler, AM, Curran, JE, McKay, DR, Knowles, EE, Carless, Ma, Göring, HHH, Dyer, TD, Olvera, RL, Fox, PT, Almasy, L, Charlesworth, J, Kochunov, P, Duggirala, R, Blangero, J (2013). Genetic basis of neurocognitive decline and reduced white-matter integrity in normal human brain aging. Proceedings of the National Academy of Sciences USA 110, 19006–19011.CrossRefGoogle ScholarPubMed
Gold, J (1998). Intellectual decline in schizophrenic patients. American Journal of Psychiatry 155, 995–996.Google Scholar
Gonzalez-Blanch, C, Crespo-Facorro, B, Alvarez-Jimenez, M, Rodriguez-Sanchez, JM, Pelayo-Teran, JM, Perez-Iglesias, R, Vazquez-Barquero, JL (2007). Cognitive dimensions in first-episode schizophrenia spectrum disorders. Journal of Psychiatric Research 41, 968–977.Google Scholar
Green, MF, Harvey, PD (2014). Cognition in schizophrenia: Past, present, and future. Schizophrenia Research: Cognition 1, e1–e9.Google Scholar
Green, MF, Nuechterlein, KH, Gold, JM, Barch, DM, Cohen, J, Essock, S, Fenton, WS, Frese, F, Goldberg, TE, Heaton, RK, Keefe, RSE, Kern, RS, Kraemer, H, Stover, E, Weinberger, DR, Zalcman, S, Marder, SR (2004). Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria. Biological Psychiatry 56, 301–307.Google Scholar
Gueorguieva, R, Krystal, JH (2004). Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Archives of General Psychiatry 61, 310–317.Google Scholar
Harvey, PD (2014). What is the evidence for changes in cognition and functioning over the lifespan in patients with schizophrenia? Journal of Clinical Psychiatry 75 (Suppl. 2), 34–38.Google Scholar
Hawkins, KA, Keefe, RSE, Christensen, BK, Addington, J, Woods, SW, Callahan, J, Zipursky, RB, Perkins, DO, Tohen, M, Breier, A, McGlashan, TH (2008). Neuropsychological course in the prodrome and first episode of psychosis: findings from the PRIME North America Double Blind Treatment Study. Schizophrenia Research 105, 1–9.Google Scholar
Jahshan, C, Heaton, RK, Golshan, S, Cadenhead, KS (2010). Course of neurocognitive deficits in the prodrome and first episode of schizophrenia. Neuropsychology 24, 109–120.Google Scholar
Keefe, RS, Harvey, PD (2012). Cognitive impairment in schizophrenia. In Novel Antischizophrenia Treatments (Handbook of Experimental Pharmacology) (ed. Geyer, M. A. and Gross, G.), pp. 11–37. Springer: Berlin, Heidelberg, Germany.Google Scholar
Keefe, RSE, Perkins, DO, Gu, H, Zipursky, RB, Christensen, BK, Lieberman, JA (2006). A longitudinal study of neurocognitive function in individuals at-risk for psychosis. Schizophrenia Research 88, 26–35.Google Scholar
Keshavan, MS, Berger, G, Zipursky, RB, Wood, SJ, Pantelis, C (2005). Neurobiology of early psychosis. British Journal of Psychiatry 48, s8–s18.Google Scholar
Lencz, T, Smith, CW, McLaughlin, D, Auther, A, Nakayama, E, Hovey, L, Cornblatt, BA (2006). Generalized and specific neurocognitive deficits in prodromal schizophrenia. Biological Psychiatry 59, 863–871.Google Scholar
Mallinckrodt, CH, Clark, WS, David, SR (2001). Accounting for dropout bias using mixed-effects models. Journal of Biopharmaceutical Statistics 11, 9–21.Google Scholar
McCulloch, CE, Searle, SR, Neuhaus, JM (2008). Generalized, Linear, and Mixed Models, 2nd edn. Wiley-Interscience: Hoboken, NJ.Google Scholar
McGlashan, TH (2006). Is active psychosis neurotoxic? Schizophrenia Bulletin 32, 609–613.Google Scholar
Meier, MH, Caspi, A, Reichenberg, A, Keefe, RSE, Fisher, HL, Harrington, H, Houts, R, Poulton, R, 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, 91–101.Google Scholar
Mesholam-Gately, RI, Giuliano, AJ, Goff, KP, Faraone, SV, Seidman, LJ (2009). Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 23, 315–336.Google Scholar
Meyer, EC, Carrión, RE, Cornblatt, BA, Addington, J, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF, Woods, SW, Heinssen, R, Seidman, LJ, group, N (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, 1452–1461.Google Scholar
Michel, C, Ruhrmann, S, Schimmelmann, BG, Klosterkotter, J, Schultze-Lutter, F (2014). A stratified model for psychosis prediction in clinical practice. Schizophrenia Bulletin 40, 1533–1542.Google Scholar
Miller, TJ, McGlashan, TH, Rosen, JL, Cadenhead, K, Cannon, T, Ventura, J, McFarlane, W, Perkins, DO, Pearlson, GD, Woods, SW (2003). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703–715.CrossRefGoogle ScholarPubMed
Miller, TJ, McGlashan, TH, Rosen, JL, Somjee, L, Markovich, PJ, Stein, K, Woods, SW (2002). Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: preliminary evidence of interrater reliability and predictive validity. American Journal of Psychiatry 159, 863–865.Google Scholar
Miller, TJ, McGlashan, TH, Woods, SW, Stein, K, Driesen, N, Corcoran, CM, Hoffman, R, Davidson, L (1999). Symptom assessment in schizophrenic prodromal states. Psychiatric Quarterly 70, 273–287.Google Scholar
Olvet, DM, Carrión, RE, Auther, AM, Cornblatt, BA (2015). Self-awareness of functional impairment in individuals at clinical high-risk for psychosis. Early Intervention Psychiatry 9, 100–107.Google Scholar
Orvaschel, H, Puig-Antich, J (1994). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version. Center for Psychological Studies, Nova Southeastern University: Fort Lauderdale, FL.Google Scholar
Pantelis, C, Velakoulis, D, McGorry, PD, Wood, SJ, Suckling, J, Phillips, LJ, Yung, AR, Bullmore, ET, Brewer, W, Soulsby, B, Desmond, P, McGuire, PK (2003). Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet 361, 281–288.Google Scholar
Pukrop, R, Ruhrmann, S, Schultze-Lutter, F, Bechdolf, A, Brockhaus-Dumke, A, Klosterkotter, J (2007). Neurocognitive indicators for a conversion to psychosis: comparison of patients in a potentially initial prodromal state who did or did not convert to a psychosis. Schizophrenia Research 92, 116–125.Google Scholar
Reichenberg, A, Caspi, A, Harrington, H, Houts, R, Keefe, RSE, Murray, RM, Poulton, R, Moffitt, TE (2010). Static and dynamic cognitive deficits in childhood preceding adult schizophrenia: a 30-year study. American Journal of Psychiatry 167, 160–169.Google Scholar
Reichenberg, A, Weiser, M, Rabinowitz, J, Caspi, A, Schmeidler, J, Mark, M, Kaplan, Z, Davidson, M (2002). A population-based cohort study of premorbid intellectual, language, and behavioral functioning in patients with schizophrenia, schizoaffective disorder, and nonpsychotic bipolar disorder. American Journal of Psychiatry 159, 2027–2035.Google Scholar
Ruhrmann, S, Schultze-Lutter, F, Salokangas, RK, Heinimaa, M, Linszen, D, Dingemans, P, Birchwood, M, Patterson, P, Juckel, G, Heinz, A, Morrison, A, Lewis, S, von Reventlow, HG, Klosterkotter, J (2010). Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Archives of General Psychiatry 67, 241–251.Google Scholar
Schwartzman, AE, Douglas, VI (1962). Intellectual loss in schizophrenia. I. Candian Journal of Psychiatry 16, 1–10.Google Scholar
Seidman, LJ, Buka, SL, Goldstein, JM, Tsuang, MT (2006). Intellectual decline in schizophrenia: evidence from a prospective birth cohort 28 year follow-up study. Journal of Clinical and Experimental Neuropsychology 28, 225–242.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, Cornblatt, BA, North American Prodrome Longitudinal Study G (2010). Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis. Archives of General Psychiatry 67, 578–588.Google Scholar
Szöke, A, Trandafir, A, Dupont, M-E, Méary, A, Schürhoff, F, Leboyer, M (2008). Longitudinal studies of cognition in schizophrenia: meta-analysis. British Journal of Psychiatry 192, 248–257.Google Scholar
Verbeke, G, Molenberghs, G (2000). Linear mixed models for longitudinal data. Springer Series in Statistics, xxii, 568 p.Google Scholar
Walder, DJ, Holtzman, CW, Addington, J, Cadenhead, K, Tsuang, M, Cornblatt, B, Cannon, TD, McGlashan, TH, Woods, SW, Perkins, DO, Seidman, LJ, Heinssen, R, Walker, EF (2013). Sexual dimorphisms and prediction of conversion in the NAPLS psychosis prodrome. Schizophrenia Research 144, 43–50.Google Scholar
Wechsler, D (1981). Wechsler Adult Intelligence Scale, Revised. The Psychological Corporation: New York, NY.Google Scholar
Wechsler, D (1991). Wechsler Intelligence Scale for Children. The Psychological Corporation: San Antonio, TX.Google Scholar
Weinberger, DR (1987). Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry 44, 660–669.Google Scholar
Wood, SJ, Brewer, WJ, Koutsouradis, P, Phillips, LJ, Francey, SM, Proffitt, TM, Yung, AR, Jackson, HJ, McGorry, PD, Pantelis, C (2007). Cognitive decline following psychosis onset: data from the PACE clinic. British Journal of Psychiatry 51, s52–57.Google Scholar
Woodberry, KA, McFarlane, WR, Giuliano, AJ, Verdi, MB, Cook, WL, Faraone, SV, Seidman, LJ (2013). Change in neuropsychological functioning over one year in youth at clinical high risk for psychosis. Schizophrenia Research 146, 87–94.Google Scholar
Zipursky, RB, Reilly, TJ, Murray, RM (2013). The myth of schizophrenia as a progressive brain disease. Schizophrenia Bulletin 39, 1363–1372.Google Scholar
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