Neuropsychological function at first episode in treatment-resistant psychosis: findings from the ÆSOP-10 study.
MacCabe, James H
Doody, Gillian A
Kaçar, Anil Şafak
Murray, Robin M
Cambridge University Press (CUP)
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Kravariti, E., Demjaha, A., Zanelli, J., Ibrahim, F., Wise, C., MacCabe, J. H., Reichenberg, A., et al. (2019). Neuropsychological function at first episode in treatment-resistant psychosis: findings from the ÆSOP-10 study.. Psychol Med, 49 (12), 2100-2110. https://doi.org/10.1017/S0033291718002957
BACKGROUND: Neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis. METHODS: We report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up. RESULTS: Compared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning (p values⩽0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample (t = -2.32; p = 0.022) and in the schizophrenia diagnostic subgroup (t = -2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance (p values<0.01-0.001) and those born outside the UK (p values<0.05). CONCLUSIONS: Verbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable - at a group level - at the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.
Humans, Linear Models, Follow-Up Studies, Cross-Sectional Studies, Intelligence, Psychotic Disorders, Schizophrenia, Neuropsychological Tests, Drug Resistance, Adolescent, Adult, Middle Aged, Female, Male, Young Adult, Executive Function, Spatial Memory, United Kingdom
The ÆSOP study has received funding support by the UK Medical Research Council (grant number G0500817) and the Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry at King’s College London. R.M.M. has received honoraria from Janssen, Astra-Zeneca, Lilly, BMS, and Roche. C.M. and R.M.M. have received funding support from the Wellcome Trust (grant no. HEALTH-F2-2009-241909) (Project EU-GEI) and the European Union (European Community’s Seventh Framework Program; grant no. HEALTH-F2-2009-241 909; Project EU-GEI). C.M. has further received funding from the Wellcome Trust (grant number WT087417). We thank the Stanley Medical Research Institute for their support.
External DOI: https://doi.org/10.1017/S0033291718002957
This record's URL: https://www.repository.cam.ac.uk/handle/1810/286263
Attribution 4.0 International
Licence URL: https://creativecommons.org/licenses/by/4.0/