Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Keshavan, Matcheri S.; Eack, Shaun M.

doi:10.1002/wps.21091

World Psychiatry

2023

DOI: 10.1002/wps.21091

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Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Matcheri S. Keshavan

Shaun M. Eack

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2024

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“…The development of early intervention programmes for psychosis could benefit from the identification of factors and pathways that influence functioning. It should be emphasized that combining approaches targeting neurocognition and social cognition with those targeting psychopathology offer synergistic benefits and may be essential for achieving long-term improvements in patient' functioning (109)(110)(111)(112)(113).…”

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confidence: 99%

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

Giordano,

Pezzella,

Mucci

et al. 2024

Front. Psychiatry

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IntroductionIn this study we assessed the contribution of psychopathology, including the two domains of negative symptoms (motivational deficit and expressive deficit), processing speed as an index of neurocognition, and emotion recognition, as an index of social cognition, to poor functional outcomes in people with schizophrenia.MethodsThe Positive and Negative Syndrome Scale was used to evaluate positive symptoms and disorganization and the Brief Negative Symptom Scale to assess negative symptoms. The Symbol Coding and the Trail Making Test A and B were used to rate processing speed and the Facial Emotion Identification Test to assess emotion recognition. Functional outcome was assessed with the Personal and Social Performance Scale (PSP). Regression analyses were performed to identify predictors of functional outcome. Mediation analyses was used to investigate whether social cognition and negative symptom domains fully or partially mediated the impact of processing speed on functional outcome.ResultsOne hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive deficit predicted global functioning and together with motivational deficit fully mediated the effects of neurocognition on it. Motivational deficit was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational deficit and neurocognitive impairment predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome.ConclusionsOur results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive deficits on different domains of functioning. Our results suggest that both negative symptoms and social cognition should be targeted by psychosocial interventions to enhance the functional impact of neurocognitive remediation.

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confidence: 99%

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

Giordano,

Pezzella,

Mucci

et al. 2024

Front. Psychiatry

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Illness-related variables and abnormalities of resting-state brain activity in schizophrenia

Giuliani,

Pezzella,

Giordano

et al. 2024

Front. Psychiatry

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BackgroundThe development of neuroimaging biomarkers in patients with schizophrenia (SCZ) requires a refined clinical characterization. A limitation of the neuroimaging literature is the partial uptake of progress in characterizing disease-related features, particularly negative symptoms (NS) and cognitive impairment (CI). In the present study, we assessed NS and CI using up-to-date instruments and investigated the associations of abnormalities in brain resting-state (rs)-activity with disease-related features.MethodsSixty-two community-dwelling SCZ subjects participated in the study. Multiple regression analyses were performed with the rs-activity of nine regions of interest as dependent variables and disease-related features as explanatory variables.ResultsAttention/vigilance deficits were negatively associated with dorsal anterior cingulate rs-activity and, together with depression, were positively associated with right dorsolateral prefrontal cortex rs-activity. These deficits and impairment of Reasoning/problem-solving, together with conceptual disorganization, were associated with right inferior parietal lobule and temporal parietal junction rs-activity. Independent of other features, the NS Expressive Deficit domain was associated with the left ventral caudate, while the Motivational Deficit was associated with the dorsal caudate rs-activity.ConclusionNeurocognitive deficits and the two negative symptom domains are associated with different neural markers. Replications of these findings could foster the identification of clinically actionable biomarkers of poor functional outcomes.

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Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Cited by 2 publications

References 9 publications

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

Illness-related variables and abnormalities of resting-state brain activity in schizophrenia

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