The role of symptoms and insight in mediating cognition and functioning in first episode psychosis

H, Lee; Hui, Christy Lai Ming; Chan, Karen Pui Kei; Chan, Pui Ying; Law, Eunice Y.L.; Chong, Catherine Shiu‐yin; Chang, Wing Chung; Lee, Wing King; Lo, Alison Wai Fan; Pang, Elizabeth; Cheung, Eric F.C.; Yiu, Michael Gar Chung; Chung, Dicky W. S.; Ng, Roger; Yeung, Wai-Song; Lo, William Tak Lam; Chen, Eric

doi:10.1016/j.schres.2018.11.009

Cited by 18 publications

(15 citation statements)

References 34 publications

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“…Our finding showing a significant association between verbal learning and global functioning is in accordance with two previous studies of patients with EOS [ 19 , 29 ]. Our results are also in accordance with two previous studies including adult schizophrenia patients, showing that negative symptoms mediated the relationship between neurocognitive performance and global functioning, while positive symptoms did not [ 39 , 40 ]. To the best of our knowledge, our study is the first to show that disorganized symptoms, as a separate construct from other positive symptoms, mediated the relationship between verbal learning and global functioning.…”

Section: Discussionsupporting

confidence: 93%

“…Stronger associations have also been found between negative symptoms and impaired functional outcome in EOP [ 36 ] and adult schizophrenia [ 37 , 38 ], compared to positive symptoms. A recent study of adult first-episode psychosis patients and a former meta-analysis found that negative symptoms partially mediated the relationship between neurocognitive performance and global functioning in adult patients, while no significant association was found for reality-distorted positive symptoms [ 39 , 40 ]. Disorganized symptoms were not assessed in these studies.…”

Section: Introductionmentioning

confidence: 99%

“…Based on previous research in adolescent schizophrenia [ 19 , 29 ], we hypothesized that speed of processing, verbal learning, attention, working memory and global cognition would be associated with global functioning in EOP. Furthermore, based on a previous systematic review [ 35 ] and research in adult schizophrenia [ 39 , 40 ], we hypothesized that the Negative and Disorganized/concrete symptom factors would mediate this relationship, while no significant mediation effects would be found for positive symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis

Smelror

Rund

Lonning

et al. 2020

Eur Child Adolesc Psychiatry

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Neurocognitive deficits are associated with impaired global functioning and psychotic symptoms. However, whether symptoms can mediate the relationship between neurocognition and global functioning in adolescent psychosis is unclear. Here, we investigated if symptoms assessed with the Positive And Negative Syndrome Scale (PANSS), mediated the relationship between neurocognitive performance and global functioning in adolescents with non-affective early-onset psychotic disorders (EOP). Sixty-one adolescent EOP patients (age 12–18 years) from 2 Norwegian clinical cohorts were included. Linear regression models were applied to investigate associations between neurocognitive domains from the MATRICS Consensus Cognitive Battery (MCCB) and global functioning. PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. Using the INDIRECT macro for SPSS, mediation effects were tested using bootstrapping with 95% bias corrected confidence intervals. Verbal learning was positively associated with global functioning (P < 0.001) and negatively associated with the disorganized symptom factor (P = 0.002), controlling for age, sex and cohort. Testing of indirect effects, controlling for age, sex and cohort, showed that the Negative (point estimate = 1.56, 95% CI 0.22, 3.47) and Disorganized (point estimate = 1.24, 95% CI 0.05, 3.69) symptom factors significantly mediated the relationship between verbal learning and global functioning. We found that verbal learning, negative and disorganized symptoms influenced global functioning in adolescents with EOP, while reality-distorted positive symptoms did not. These results suggest that assessing these domains in EOP is helpful for planning treatment and rehabilitation programs focusing on functional outcome.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis

Smelror

Rund

Lonning

et al. 2020

Eur Child Adolesc Psychiatry

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“…Furthermore, some prospective studies reported the effect of cognition on functioning to be mediated by negative and general symptomatology ( 39 , 40 ), and Gonzalez-Blanco et al ( 15 ) also found a significant effect of general psychopathology on PSP total score, as we did. Thus, further research is required to elucidate the real contribution of the TMT-B on real-world functioning.…”

Section: Discussionsupporting

confidence: 85%

Real-World Functioning in Patients With Schizophrenia: Beyond Negative and Cognitive Symptoms

et al. 2021

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Introduction: Interest in the idea of recovery for certain patients with schizophrenia has been growing over the last decade. Improving symptomatology and functioning is crucial for achieving this. Our study aims to identify those factors that substantially contribute to real-world functioning in these patients.Methods: We carried out a cross-sectional study in stable outpatients with schizophrenia on maintenance antipsychotic monotherapy. Patients: We studied 144 outpatients with schizophrenia (DSM-IV-TR criteria) meeting the following criteria: (1) 18–65 years of age; (2) being clinically stable for at least the previous three months; (3) on maintenance antipsychotic monotherapy (prescriptions ≤ 10 mg olanzapine, ≤200 mg quetiapine, or ≤100 mg levomepromazine as hypnotics were also allowed); and (4) written informed consent. Assessment: We collected information on demographic and clinical variables by using an ad hoc questionnaire. For psychopathology, we employed the Spanish versions of the following psychometric instruments: the Positive and Negative Syndrome Scale (PANSS), the Brief Negative Symptom Scale (BNSS-Sp), and the Calgary Depression Scale (CDS). In addition, cognitive domains were assessed using the Verbal Fluency Test (VFT), the Digit Symbol Substitution Test (DSST), and the Trail Making Test, parts A and B (TMT-A and TMT-B). Finally, we employed the Spanish versions of the University of California San Diego Performance-based Skills Assessment (Sp-UPSA) and the Personal and Social Performance (PSP) for assessing functional capacity and real-world functioning, respectively. Statistical analysis: A forward stepwise regression was conducted by entering those variables significantly associated with PSP total score into the univariate analyses (Student's t-test, ANOVA with Duncan's post-hoc test, or bivariate Pearson correlation).Results: A total of 144 patients; mean age 40 years, 64% males, mean length of illness 12.4 years, PSP total score 54.3. The final model was a significant predictor of real-world functioning [F(7, 131) = 36.371, p < 0.001] and explained 66.0% of the variance. Variables retained in the model: BNSS-Sp abulia, asociality, and blunted affect, PANSS general psychopathology, Sp-UPSA transportation, TMT-B, and heart rate.Conclusion: Our model will contribute to a more efficient and personalized daily clinical practice by assigning specific interventions to each patient based on specific impaired factors in order to improve functioning.

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“…Cognitive deficits are present in psychotic disorders (Fatouros‐Bergman et al, 2014; Heinrichs & Zakzanis, 1998; Schaefer et al, 2013) and seem to influence the evolution and prognosis of the disease (Grau et al, 2016; Lee et al, 2018). They are related to poor functioning and they can interfere with psychological interventions, reducing the benefit that patients receive (Kurtz & Tolman, 2011; Zhang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Cognitive functioning in first episode psychosis. Gender differences and relation with clinical variables

Vila‐Badia

Cacho

Butjosa

et al. 2020

Early Intervention Psych

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Aims to study the differences in cognitive functioning in patients and controls. In addition, study the influence of symptoms, cannabis consumption, chlorpromazine doses, DUP and IQ in cognitive performance in patients, both in the total sample and divided by gender. Methods 70 first episode psychosis patients and 63 healthy controls (HC) participated in the study and were assessed with the MATRICS battery and the Vocabulary subtest of WAIS‐IV. Symptoms in FEP patients were evaluated with the Emsley factors of the PANSS scale. Results patients showed lower scores than controls in all cognitive domains studied. There were no significant differences between FEP men and FEP women, but we found gender differences in favour of women in processing speed, working memory and composite total scored domains in the HC group. Finally, symptoms and Chlorpromazine doses showed an influence on cognitive performance in the total FEP sample. When splitting the sample by gender, positive symptoms may be more detrimental to women's cognitive functioning, while disorganized symptoms may play the most important role in cognitive performance in men. Conclusions patients showed worse cognitive performance in all cognitive domains compared to healthy controls. In our FEP sample, gender does not seem to influence cognitive performance measured with the MATRICS. Severity of symptoms influences positively in cognitive performance. The dose of Chlorpromazine and symptoms are influential variables to be taken into account in cognition rehabilitation programs.

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The role of symptoms and insight in mediating cognition and functioning in first episode psychosis

Cited by 18 publications

References 34 publications

Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis

Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis

Real-World Functioning in Patients With Schizophrenia: Beyond Negative and Cognitive Symptoms

Cognitive functioning in first episode psychosis. Gender differences and relation with clinical variables

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