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Relationship between cognition and age at onset of first-episode psychosis: comparative study between adolescents, young adults, and adults

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Abstract

Psychotic disorders typically manifest from late adolescence to early adulthood, and an earlier onset might be associated with greater symptom severity and a worse long-term prognosis. This study aimed to compare the cognitive characteristics of patients with first-episode psychosis (FEP) by their age at onset. We included 298 patients diagnosed with FEP and classified them as having an early onset (EOS), youth onset (YOS), or adult onset (AOS) based on age limits of ≤ 18 years (N = 61), 19–24 years (N = 121), and ≥ 25 years (N = 116), respectively. Socio-demographic and clinical variables included age at baseline, gender, socio-economic status, antipsychotic medication, DSM-IV diagnoses assessed by clinical semi-structured interview, psychotic symptom severity, and age at onset. Neuropsychological assessment included six cognitive domains: premorbid intelligence, working memory, processing speed, verbal memory, sustained attention, and executive functioning. The EOS group had lower scores than the YOS or AOS groups in global cognition, executive functioning, and sustained attention. Although the scores in the YOS group were intermediate to those in the EOS and AOS groups for most cognitive factors, no statistically significant differences were detected between the YOS and AOS groups. Age at onset results in specific patterns of cognitive interference. Of note, impairment appears to be greater with EOS samples than with either YOS or AOS samples. A longitudinal study with a larger sample size is needed to confirm our findings.

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Acknowledgements

The authors are extremely grateful to all participants. PEPs Study is coordinated by MB and is part of the coordinated-multicenter project, funded by the Ministerio de Economía y Competitividad (PI08/0208; PI11/00325; PI14/00612), Instituto de Salud Carlos III – Fondo Europeo de Desarrollo Regional. Unión Europea. Una manera de hacer Europa, Centro de Investigación Biomédica en Red de salud Mental, CIBERSAM, by the CERCA Program/Generalitat de Catalunya And Secretaria d’Universitats i Recerca del Departament d’Economia I Coneixement (2017SGR1355, 2017SGR1365; 2017SGR881). Departament de Salut de la Generalitat de Catalunya, Pla Estratègic de Recerca i Innovació en Salut (PERIS) 2016–2020, modalitat Projectes de recerca orientats a l’atenció primària, amb el codi d’expedient SLT006/17/00345. MB is also grateful for the support of the Institut de Neurociències, Universitat de Barcelona. PEPs Group Members—Santiago Madero: Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, August Pi I Sunyer Biomedical Research Institute-IDIBAPS), Barcelona, Spain; Gerard Anmella: Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, August Pi I Sunyer Biomedical Research Institute-IDIBAPS), Barcelona, Spain; Renzo Abregu: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Child and Adolescent Psychiatry. Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM; Marta Rapado-Castro: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Child and Adolescent Psychiatry. Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM, School of Medicine, Universidad Complutense; Anna Alonso-Solís: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Eva Grasa: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Iñaki Zorrilla: BIOARABA. Department of Psychiatry. UPV/EHU. Vitoria, Spain; Itxaso Gonzalez-Ortega: BIOARABA. Department of Psychiatry. UPV/EHU. Vitoria, Spain; Pedro Saz: Department of Medicine and Psychiatry. Zaragoza University. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza; Concepción De-la-Camara: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Medicine and Psychiatry. Zaragoza University. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza; Jose Escarti: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Psychiatry, Hospital Clínico Universitario de Valencia. Biomedical Research Institute INCLIVA, Valencia, Spain , School of Medicine, Universidad de Valencia, Valencia, Spain; Jon-Iñaki Etxeandia-Pradera: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Psychiatry, Hospital Clínico Universitario de Valencia. Biomedical Research Institute INCLIVA, Valencia, Spain ; Laura Martínez: Hospital del Mar, Department of Psychiatry; Teresa Legido: Hospital del Mar, Department of Psychiatry, Medical Research Institute (IMIM), Neuroscience group; Maria Sagué-Vilavella: Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic, Barcelona, Catalonia, Spain; Laura Montejo: Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic, Barcelona, Catalonia, Spain; Gisela Sugranyes: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, August Pi I Sunyer Biomedical Research Institute-IDIBAPS), Barcelona, Spain, Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain. 2017SGR881; Patricia Camprodon-Boadas: Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain. 2017SGR881, Fundacio Clinic per a la Recerca Biomèdica, Barcelona, Spain; Fernando Contreras: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Bellvitge Biomedical Research Institute IDIBELL, Department of Psychiatry- Bellvitge University Hospital, Hospitalet de Llobregat- Barcelona, Spain; Cristina Saiz-Masvidal: Bellvitge Biomedical Research Institute IDIBELL, Department of Psychiatry- Bellvitge University Hospital, Hospitalet de Llobregat- Barcelona, Spain, University of Barcelona, Department of Clinical Sciences- School of Medicine, Barcelona, Spain; Elisa Seijo: Unidad de Hospitalización Infanto-Juvenil. Hospital Universitario Central de Asturias (HUCA). Servicio de Salud del Principado de Asturias (SESPA). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Teresa Bobes: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Centro de Salud Mental II de Oviedo, Servicio de Salud del Principado de Asturias (SESPA). Universidad de Oviedo. Instituto de Investigación Sanitaria del Prin- cipado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (IN- EUROPA); Miguel Gutierrez: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Araba University Hospital, Bioaraba Research Institute, University of the Basque Country (UPV/EHU) Vitoria, Spain; Arantzazu Zabala: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, University of the Basque Country (UPV/EHU), Department of Neurosciences. BioCruces Health Research Institute. Vizcaya, Spain; Roberto Rodríguez-Jiménez: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain, CogPsy Group, Universidad Complutense de Madrid (UCM), Madrid, Spain; Jusdith Usall: Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona; Anna Butllosa: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Institut de Recerca Sant Joan de Déu, Esplugues del Llobregat, Barcelona, Spain; Luis Sanchez-Pastor: Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Salvador Sarro: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Edith Pomarol: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain; Angela Ibañez: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS. Universidad de Alcalá, Madrid, Spain; Ruth Lorente-Omeña: IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Vicente Balanza: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Universidad de Valencia, Valencia, Spain.

Author information

Authors and Affiliations

  1. Biomedical Research Network Center for Mental Health (CIBERSAM), Barcelona, Spain

    E. De la Serna, O. Puig, G. Mezquida, S. Amoretti, A. Gonzalez-Pinto, I. Corripio, E. Vieta, I. Baeza, D. Berge, R. Penadés, M. Bernardo & J. Castro-Fornieles

  2. Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clinic of Barcelona, CIBERSAM, 2017SGR881, C/Villarroel, 170, 08036, Barcelona, Spain

    E. De la Serna, O. Puig, I. Baeza & J. Castro-Fornieles

  3. August Pi i Sunyer Biomedical Research Institute, IDIBAPS, Barcelona, Spain

    G. Mezquida, S. Amoretti, I. Baeza, R. Penadés, M. Bernardo & J. Castro-Fornieles

  4. Department of Medicine, Neuroscience Institute, University of Barcelona, Barcelona, Spain

    G. Mezquida, S. Amoretti, I. Baeza, R. Penadés, M. Bernardo & J. Castro-Fornieles

  5. Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain

    G. Mezquida, S. Amoretti, R. Penadés & M. Bernardo

  6. Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    L. Moreno-Izco, A. Sanchez-Torres & M. J. Cuesta

  7. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    J. Merchan-Naranjo

  8. School of Psychology, Complutense University, Madrid, Spain

    J. Merchan-Naranjo & M. Molina-García

  9. Department of Medicine and Psychiatry, Hospital Clínico Universitario and Instituto de Investigación Sanitaria (IIS), Universidad de Zaragoza, Aragón, Zaragoza, Spain

    P. Ruiz

  10. Department of Psychiatry, UPV/EHU, BIOARABA, Vitoria, Spain

    A. Gonzalez-Pinto

  11. Psychiatry Department, Institut d’Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    I. Corripio

  12. Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic, Catalonia, Barcelona, Spain

    E. Vieta

  13. Neuroscience group, Hospital del Mar Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain

    D. Berge

  14. Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain

    M. J. Cuesta

Authors
  1. E. De la Serna
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  2. O. Puig
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  3. G. Mezquida
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  4. L. Moreno-Izco
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  5. J. Merchan-Naranjo
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  6. S. Amoretti
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  7. P. Ruiz
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  8. A. Gonzalez-Pinto
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  9. M. Molina-García
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  10. I. Corripio
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  11. E. Vieta
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  12. I. Baeza
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  13. D. Berge
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  14. R. Penadés
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  15. A. Sanchez-Torres
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  16. M. J. Cuesta
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  17. M. Bernardo
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  18. J. Castro-Fornieles
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Consortia

The PEP’s Group

  • Santiago Madero
  • , Gerard Anmella
  • , Renzo Abregu
  • , Marta Rapado-Castro
  • , Anna Alonso-Solís
  • , Eva Grasa
  • , Iñaki Zorrilla
  • , Itxaso Gonzalez-Ortega
  • , Pedro Saz
  • , Concepción De-la-Camara
  • , Jose Escarti
  • , Jon-Iñaki Etxeandia-Pradera
  • , Laura Martínez
  • , Teresa Legido
  • , Maria Sagué-Vilavella
  • , Laura Montejo
  • , Gisela Sugranyes
  • , Patricia Camprodon-Boadas
  • , Fernando Contreras
  • , Cristina Saiz-Masvidal
  • , Elisa Seijo
  • , Teresa Bobes
  • , Miguel Gutierrez
  • , Arantzazu Zabala
  • , Roberto Rodríguez-Jiménez
  • , Jusdith Usall
  • , Anna Butllosa
  • , Luis Sanchez-Pastor
  • , Salvador Sarro
  • , Edith Pomarol
  • , Angela Ibañez
  • , Ruth Lorente-Omeña
  •  & Vicente Balanza

Corresponding author

Correspondence to E. De la Serna.

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Conflict of interest

AG-P has received grants and served as consultant, advisor or CME speaker for the following entities: Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Sanofi-Aventis, Alter, Angelini, Exeltis, Takeda, the Spanish Ministry of Science and Innovation (CIBERSAM), the Ministry of Science (Carlos III Institute), the Basque Government, and the European Framework Program of Research. MM-G was supported by a Tatiana Pérez de Guzmán el Bueno predoctoral Fellowship. EV has received grants and served as consultant, advisor or CME speaker unrelated to the present work for the following entities: AB-Biotics, Abbott, Allergan, Angelini, Dainippon Sumitomo Pharma, Ferrer, GH Research, Gedeon Richter, Janssen, Lundbeck, Otsuka, Sage, Sanofi-Aventis, Sunovion, and Takeda. IB has received honoraria or travel support from Otsuka-Lundbeck, Angelini and Janssen, research support from Fundación Alicia Koplowitz and grants from Spanish Ministry of Health, Instituto de Salud Carlos III. MB has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of ABBiotics, Adamed, Angelini, Casen Recordati, Janssen-Cilag, Menarini, Lundbeck, Otsuka, Rovi and Takeda. ES and the remaining members of the PEPs group have no personal affiliations or financial relationships with any commercial interests to disclose relative to the article.

Additional information

The members of the PEPs Group members are listed in the Acknowledgements section.

Supplementary Information

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Supplementary file1 (DOCX 174 KB)

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De la Serna, E., Puig, O., Mezquida, G. et al. Relationship between cognition and age at onset of first-episode psychosis: comparative study between adolescents, young adults, and adults. Eur Child Adolesc Psychiatry 32, 639–649 (2023). https://doi.org/10.1007/s00787-021-01901-8

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