Open Access
Duration of untreated negative and positive symptoms of psychosis and cognitive impairment in first episode psychosis
(Elsevier, 2012) Cuesta, Manuel J.; García de Jalón, Elena; Campos, María S.; Ibáñez, Berta; Sánchez Torres, Ana María; Peralta Martín, Víctor; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background: Duration of untreated psychosis (DUP) has been significantly associated with poor clinical and social outcomes in First Episode Psychosis (FEP) patients, but an association with cognitive outcomes has not been clearly established. Method: Seventy-seven consecutively admitted, drug-naïve patients with FEP were assessed at baseline and at 1 month and 6 months. Underlying dimensions of DUP (general prodrome and positive, negative and disorganisation symptoms) were assessed using the Symptom Onset in Schizophrenia (SOS) inventory (Perkins et al., 2000). To assess the effect of DUP on the neuropsychological status of the patients, a linear mixed-effect model was fitted to each neuropsychological dimension. These models included a dichotomised version of DUP (short versus long duration) as a fixed effect, several adjusting variables to account for patient differences, and a random effect to incorporate the longitudinal structure of the data. Results: Patients with a short duration of untreated negative symptoms (DUNS) or a short duration of untreated positive symptoms (DUPS) outperformed patients with a long duration of untreated symptoms on memory tasks and a pre-attentional visual task but not on measures of verbal fluency, attention, reaction time, visual processing and executive functions. Conclusions: This study provides additional support for an early intervention to shorten DUP to facilitate a better outcome in memory and attentional domains of FEP patients.
Open Access
Premorbid adjustment and clinical correlates of cognitive impairment in first-episode psychosis: the PEPsCog study
(Elsevier, 2015) Cuesta, Manuel J.; Sánchez Torres, Ana María; Cabrera, Bibiana; Bioque, Miquel; Merchán-Naranjo, Jessica; Corripio, Iluminada; González Pinto, Ana; Lobo, Antonio; Bombín, Igor; Serna, Elena de la; Sanjuán, Julio; Parellada, Mara; Sáiz-Ruiz, Jerónimo; Bernardo, Miguel; PEPs Group; Ciencias de la Salud; Osasun Zientziak
Background: The extent to which socio-demographic, clinical, and premorbid adjustment variables contribute to cognitive deficits in first-episode schizophrenia spectrum disorders remains to be ascertained. Aims: To examine the pattern and magnitude of cognitive impairment in first-episode psychosis patients, the profile of impairment across psychosis subtypes and the associations with premorbid adjustment. Methods: 226 first-episode psychosis patients and 225 healthy controls were assessed in the PEPsCog study, as part of the PEPs study. Results: Patients showed slight to moderate cognitive impairment, verbal memory being the domain most impaired compared to controls. Broad affective spectrum patients had better premorbid IQ and outperformed the schizophrenia and other psychosis groups in executive function, and had better global cognitive function than the schizophrenia group. Adolescent premorbid adjustment together with age, gender, parental socio-economic status, and mean daily antipsychotic doses were the factors that best explained patients' cognitive performance. General and adolescent premorbid adjustment, age and parental socio-economic status were the best predictors of cognitive performance in controls. Conclusions: Poorer premorbid adjustment together with socio-demographic factors and higher daily antipsychotic doses were related to a generalized cognitive impairment and to a lower premorbid intellectual reserve, suggesting that neurodevelopmental impairment was present before illness onset.
Open Access
Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis
(Cambridge University Press, 2020) González-Ortega, Itxaso; González Pinto, Ana; Alberich, Susana; Echeburúa, Enrique; Bernardo, Miguel; Cabrera, Bibiana; Amoretti, Silvia; Lobo, Antonio; Arango, Celso; Corripio, Iluminada; Vieta, Eduard; Serna, Elena de la; Rodríguez-Jiménez, Roberto; Segarra, R.; López-Ilundain, José M.; Sánchez Torres, Ana María; Cuesta, Manuel J.; PEPs Group; Ciencias de la Salud; Osasun Zientziak
Background. Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. Methods The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. Results. At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (—10.215 to —0.337) and (—4.731 to —0.605) respectively). Conclusions. Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
Open Access
Cognitive intraindividual variability, cognitive impairment and psychosocial functioning in first-episode psychosis patients
(Elsevier, 2023-09-08) Sánchez Torres, Ana María; García de Jalón, Elena; Gil Berrozpe, Gustavo José; Peralta Martín, Víctor; Cuesta Zorita, Manuel Jesús; PEPsNa Group; Ciencias de la Salud; Osasun Zientziak
Cognitive intraindividual variability (IIV) refers to fluctuations in performance across tasks (i.e. dispersion) or in a single task on multiple occasions (i.e. inconsistency). Little is known about IIV in patients with first-episode psychosis (FEP). We aimed to explore the association between IIV and both global cognitive performance and psychosocial functioning in a sample of 103 FEP patients. Patients were recruited at discharge from the PEPsNa program, a FEP follow-up intervention program lasting 24 months. The Social and Occupational Functioning Scale (SOFAS) and the Cognitive Assessment Interview (CAI-Sp) were employed for assessing psychosocial functioning. Cognitive assessments were performed using the MATRICS Cognitive Assessment Battery (MCCB), and the variability in the cognitive functions assessed with the MCCB was used to calculate the IIV. Significant correlations were obtained between IIV and global MCCB scores, the CAI-Sp and the SOFAS. We found significant differences in psychosocial functioning and cognitive performance between patients with high and low IIV. A higher IIV in FEP patients was related both to worse psychosocial functioning and worse global cognitive performance. Unlike global cognitive performance, IIV was not related to clinical characteristics, suggesting that it could be an indicator of cognitive impairment even in the absence of global impairment.
Open Access
Effect of polygenic risk score, family load of schizophrenia and exposome risk score, and their interactions, on the long-term outcome of first-episode psychosis
(Cambridge University Press, 2023) Cuesta, Manuel J.; Papiol, S.; Ibáñez Beroiz, Berta; García de Jalón, Elena; Sánchez Torres, Ana María; Gil Berrozpe, Gustavo José; Moreno-Izco, Lucía; Zarzuela, Amalia; Fañanás, Lourdes; Peralta Martín, Víctor; SEGPEPs Group; Ciencias de la Salud; Osasun Zientziak
Background. Consistent evidence supports the involvement of genetic and environmental factors, and their interactions, in the etiology of psychosis. First-episode psychosis (FEP) comprises a group of disorders that show great clinical and long-term outcome heterogeneity, and the extent to which genetic, familial and environmental factors account for predicting the long-term outcome in FEP patients remains scarcely known. Methods. The SEGPEPs is an inception cohort study of 243 first-admission patients with FEP who were followed-up for a mean of 20.9 years. FEP patients were thoroughly evaluated by standardized instruments, with 164 patients providing DNA. Aggregate scores estimated in large populations for polygenic risk score (PRS-Sz), exposome risk score (ERS-Sz) and familial load score for schizophrenia (FLS-Sz) were ascertained. Long-term functioning was assessed by means of the Social and Occupational Functioning Assessment Scale (SOFAS). The relative excess risk due to interaction (RERI) was used as a standard method to estimate the effect of interaction of risk factors. Results. Our results showed that a high FLS-Sz gave greater explanatory capacity for longterm outcome, followed by the ERS-Sz and then the PRS-Sz. The PRS-Sz did not discriminate significantly between recovered and non-recovered FEP patients in the long term. No significant interaction between the PRS-Sz, ERS-Sz or FLS-Sz regarding the long-term functioning of FEP patients was found. Conclusions. Our results support an additive model of familial antecedents of schizophrenia, environmental risk factors and polygenic risk factors as contributors to a poor long-term functional outcome for FEP patients.
Open Access
Individual trajectories of cognitive performance in first episode psychosis: a 2-year follow-up study
(Springer, 2018) Sánchez Torres, Ana María; Moreno-Izco, Lucía; Lorente Omeñaca, Ruth; Cabrera, Bibiana; Lobo, Antonio; González Pinto, Ana; Merchán-Naranjo, Jessica; Corripio, Iluminada; Vieta, Eduard; Serna, Elena de la; Butjosa, Anna; Contreras, Fernando; Sarró, Salvador; Mezquida, Gisela; Ribeiro Fernández, María; Bernardo, Miguel; Cuesta, Manuel J.; PEPs Group; Ciencias de la Salud; Osasun Zientziak
Individual changes over time in cognition in patients with psychotic disorders have been studied very little, especially in the case of frst episode psychosis (FEP). We aimed to establish whether change in individual trajectories in cognition over 2 years of a sample of 159 FEP patients was reliable and clinically signifcant, using the reliable change index (RCI) and clinically signifcant change (CSC) methods. We also studied a sample of 151 matched healthy controls. Patients and controls were assessed with a set of neuropsychological tests, as well as premorbid, clinical and functionality measures. We analysed the course of cognitive measures over time, using analysis of variance, and the individual trajectories in the cognitive measures with the regression-based RCI (RCISRB) and the CSC. The RCISRB showed that between 5.4 and 31.2% of the patients showed deterioration patterns, and between 0.6 and 8.8% showed improvement patterns in these tests over time. Patients showing better cognitive profles according to RCISRB (worsening in zero to two cognitive measures) showed better premorbid, clinical and functional profles than patients showing deterioration patterns in more than three tests. When combining RCISRB and CSC values, we found that less than 10% of patients showed improvement or deterioration patterns in executive function and attention measures. These results support the view that cognitive impairments are stable over the frst 2 years of illness, but also that the analysis of individual trajectories could help to identify a subgroup of patients with particular phenotypes, who may require specifc interventions.