Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-19T22:22:05.725Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychological deficits in participants at clinical high risk for psychosis recruited from the community: relationships to functioning and clinical symptoms

Published online by Cambridge University Press:  13 March 2019

Kate Haining ,
Claire Matrunola ,
Lucy Mitchell ,
Ruchika Gajwani ,
Joachim Gross ,
Andrew I. Gumley ,
Stephen M. Lawrie ,
Matthias Schwannauer ,
Frauke Schultze-Lutter  and
Peter J. Uhlhaas Open the ORCID record for Peter J. Uhlhaas [Opens in a new window]
Kate Haining
Affiliation:
Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, UK
Claire Matrunola
Affiliation:
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
Lucy Mitchell
Affiliation:
Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, UK
Ruchika Gajwani
Affiliation:
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
Joachim Gross
Affiliation:
Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, UK Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Muenster, Germany
Andrew I. Gumley
Affiliation:
Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Muenster, Germany
Stephen M. Lawrie
Affiliation:
Department of Psychiatry, University of Edinburgh, Edinburgh, UK
Matthias Schwannauer
Affiliation:
Department of Clinical Psychology, University of Edinburgh, Edinburgh, UK
Frauke Schultze-Lutter
Affiliation:
Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
Peter J. Uhlhaas*
Affiliation:
Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, UK
*
Author for correspondence: Peter J. Uhlhaas, E-mail: peter.uhlhaas@glasgow.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The current study examined the pattern of neurocognitive impairments in a community-recruited sample of clinical high-risk (CHR) participants and established relationships with psychosocial functioning.

Methods

CHR-participants (n = 108), participants who did not fulfil CHR-criteria (CHR-negatives) (n = 42) as well as a group of healthy controls (HCs) (n = 55) were recruited. CHR-status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). The Brief Assessment of Cognition in Schizophrenia Battery (BACS) as well as tests for emotion recognition, working memory and attention were administered. In addition, role and social functioning as well as premorbid adjustment were assessed.

Results

CHR-participants were significantly impaired on the Symbol-Coding and Token-Motor task and showed a reduction in total BACS-scores. Moreover, CHR-participants were characterised by prolonged response times (RTs) in emotion recognition as well as by reductions in both social and role functioning, GAF and premorbid adjustments compared with HCs. Neurocognitive impairments in emotion recognition accuracy, emotion recognition RT, processing speed and motor speed were associated with several aspects of functioning explaining between 4% and 12% of the variance.

Conclusion

The current data obtained from a community sample of CHR-participants highlight the importance of dysfunctions in motor and processing speed and emotion recognition RT. Moreover, these deficits were found to be related to global, social and role functioning, suggesting that neurocognitive impairments are an important aspect of sub-threshold psychotic experiences and a possible target for therapeutic interventions.

Keywords

Clinical high-riskfunctioningneurocognitionpreventionpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 1 , January 2020 , pp. 77 - 85
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Joint First Authors.

References

Addington, J, Penn, D, Woods, SW, Addington, D and Perkins, DO (2008 a) Facial affect recognition in individuals at clinical high risk for psychosis. The British Journal of Psychiatry 192, 67–68.Google Scholar
Addington, J, Penn, D, Woods, SW, Addington, D and Perkins, DO (2008 b) Social functioning in individuals at clinical high risk for psychosis. Schizophrenia Research 99, 119–124.Google Scholar
Allott, KA, Schäfer, MR, Thompson, A, Nelson, B, Bendall, S, Bartholomeusz, CF, Yuen, HP, McGorry, PD, Schlögelhofer, M, Bechdolf, A and Amminger, GP (2014) Emotion recognition as a predictor of transition to a psychotic disorder in ultra-high risk participants. Schizophrenia Research 153, 25–31.Google Scholar
Amminger, GP, Schäfer, MR, Klier, CM, Schlögelhofer, M, Mossaheb, N, Thompson, A, Bechdolf, A, Allott, K, McGorry, PD and Nelson, B (2012) Facial and vocal affect perception in people at ultra-high risk of psychosis, first-episode schizophrenia and healthy controls. Early Intervention in Psychiatry 6, 450–454.Google Scholar
Bora, E, Lin, A, Wood, SJ, Yung, AR, McGorry, PD and Pantelis, C (2014) Cognitive deficits in youth with familial and clinical high risk to psychosis: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 130, 1–15.Google Scholar
Bora, E and Murray, RM (2014) Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophr Bull 40, 744–755. https://doi.org/10.1093/schbul/sbt085.Google Scholar
Brewer, WJ, Francey, SM, Wood, SJ, Jackson, HJ, Pantelis, C, Phillips, LJ, Yung, AR, Anderson, VA and McGorry, PD (2005) Memory impairments identified in people at ultra-high risk for psychosis who later develop first-episode psychosis. American Journal of Psychiatry 162, 71–78.Google Scholar
Cannon-Spoor, HE, Potkin, SG and Wyatt, RJ (1982) Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.Google Scholar
Carrión, RE, Goldberg, TE, McLaughlin, D, Auther, AM, Correll, CU and Cornblatt, BA (2011) Impact of neurocognition on social and role functioning in individuals at clinical high risk for psychosis. American Journal of Psychiatry 168, 806–813.Google Scholar
Cornblatt, BA, Auther, AM, Niendam, T, Smith, CW, Zinberg, J, Bearden, CE and Cannon, TD (2007) Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin 33, 688–702.Google Scholar
Dean, DJ and Mittal, VA (2015) Spontaneous parkinsonisms and striatal impairment in neuroleptic free youth at ultrahigh risk for psychosis. NPJ Schizophrenia 1, 14006.Google Scholar
Dean, DJ, Orr, JM, Newberry, RE and Mittal, VA (2016) Motor behavior reflects reduced hemispheric asymmetry in the psychosis risk period. Schizophrenia Research 170, 137–142.Google Scholar
Dickinson, D, Ramsey, ME and Gold, JM (2007) Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry 64, 532–542.Google Scholar
Dickson, H, Laurens, KR, Cullen, AE and Hodgins, S (2012) Meta-analyses of cognitive and motor function in youth aged 16 years and younger who subsequently develop schizophrenia. Psychological Medicine 42, 743–755.Google Scholar
Fett, AKJ, Viechtbauer, W, Penn, DL, van Os, J and Krabbendam, L (2011) The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience & Biobehavioral Reviews 35, 573–588.Google Scholar
Francey, SM, Jackson, HJ, Phillips, LJ, Wood, SJ, Yung, AR and McGorry, PD (2005) Sustained attention in young people at high risk of psychosis does not predict transition to psychosis. Schizophrenia Research 79, 127–136.Google Scholar
Frommann, I, Pukrop, R, Brinkmeyer, J, Bechdolf, A, Ruhrmann, S, Berning, J, Decker, P, Riedel, M, Möller, HJ, Wölwer, W and Gaebel, W (2010) Neuropsychological profiles in different at-risk states of psychosis: executive control impairment in the early – and additional memory dysfunction in the late – prodromal state. Schizophrenia Bulletin 37, 861–873.Google Scholar
Fusar-Poli, P, Deste, G, Smieskova, R, Barlati, S, Yung, AR, Howes, O, Stieglitz, RD, Vita, A, McGuire, P and Borgwardt, S (2012) Cognitive functioning in prodromal psychosis: a meta-analysis. Archives of General Psychiatry 69, 562–571.Google Scholar
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rössler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ and Valmaggia, L (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107–120.Google Scholar
Fusar-Poli, P, Cappucciati, M, Rutigliano, G, Schultze-Lutter, F, Bonoldi, I, Borgwardt, S, Riecher-Rössler, A, Addington, J, Perkins, D, Woods, SW and McGlashan, TH (2015 a) At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction. World Psychiatry 14, 322–332.Google Scholar
Fusar-Poli, P, Schultze-Lutter, F, Cappucciati, M, Rutigliano, G, Bonoldi, I, Stahl, D, Borgwardt, S, Riecher-Rössler, A, Addington, J, Perkins, DO and Woods, SW (2015 b) The dark side of the moon: meta-analytical impact of recruitment strategies on risk enrichment in the clinical high risk state for psychosis. Schizophrenia Bulletin 42, 732–743.Google Scholar
Gee, DG, Karlsgodt, KH, van Erp, TG, Bearden, CE, Lieberman, MD, Belger, A, Perkins, DO, Olvet, DM, Cornblatt, BA, Constable, T and Woods, SW (2012) Altered age-related trajectories of amygdala-prefrontal circuitry in adolescents at clinical high risk for psychosis: a preliminary study. Schizophrenia Research 134, 1–9.Google Scholar
Giuliano, AJ, Li, H, Mesholam-Gately, RI, Sorenson, SM, Woodberry, KA and Seidman, LJ (2012) Neurocognition in the psychosis risk syndrome: a quantitative and qualitative review. Current Pharmaceutical Design 18, 399–415.Google Scholar
Glenthøj, LB, Jepsen, JRM, Hjorthøj, C, Bak, N, Kristensen, TD, Wenneberg, C, Krakauer, K, Nordentoft, M and Fagerlund, B (2017) Negative symptoms mediate the relationship between neurocognition and function in individuals at ultrahigh risk for psychosis. Acta Psychiatrica Scandinavica 135, 250–258.Google Scholar
Green, MF, Kern, RS, Braff, DL and Mintz, J (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119–136.Google Scholar
Green, MF, Nuechterlein, KH, Gold, JM, Barch, DM, Cohen, J, Essock, S, Fenton, WS, Frese, F, Goldberg, TE, Heaton, RK and Keefe, RS (2004) Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria. Biological Psychiatry 56, 301–307.Google Scholar
Green, MF, Horan, WP and Lee, J (2015) Social cognition in schizophrenia. Nature Reviews Neuroscience 16, 620.Google Scholar
Heinrichs, RW and Zakzanis, KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426.Google Scholar
Hooker, C and Park, S (2002) Emotion processing and its relationship to social functioning in schizophrenia patients. Psychiatry Research 112, 41–50.Google Scholar
Ising, HK, Veling, W, Loewy, RL, Rietveld, MW, Rietdijk, J, Dragt, S, Klaassen, RM, Nieman, DH, Wunderink, L, Linszen, DH and van der Gaag, M (2012) The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population. Schizophrenia Bulletin 38, 1288–1296.Google Scholar
Jahshan, C, Heaton, RK, Golshan, S and Cadenhead, KS (2010) Course of neurocognitive deficits in the prodrome and first episode of schizophrenia. Neuropsychology 24, 109.Google Scholar
Keefe, RS, Goldberg, TE, Harvey, PD, Gold, JM, Poe, MP and Coughenour, L (2004) The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research 68, 283–297.Google Scholar
Keefe, RS, Harvey, PD, Goldberg, TE, Gold, JM, Walker, TM, Kennel, C and Hawkins, K (2008) Norms and standardization of the Brief Assessment of Cognition in Schizophrenia (BACS). Schizophrenia Research 102, 108–115.Google Scholar
Kindler, J, Schultze-Lutter, F, Michel, C, Martz-Irngartinger, A, Linder, C, Schmidt, SJ, Stegmayer, K, Schimmelmann, BG and Walther, S (2016) Abnormal involuntary movements are linked to psychosis-risk in children and adolescents: results of a population-based study. Schizophrenia Research 174, 58–64.Google Scholar
Klosterkötter, J, Hellmich, M, Steinmeyer, EM and Schultze-Lutter, F (2001) Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry 58, 158–164.Google Scholar
Lam, M, Lee, J, Rapisarda, A, See, YM, Yang, Z, Lee, SA, Abdul-Rashid, NA, Kraus, M, Subramaniam, M, Chong, SA and Keefe, RS (2018) Longitudinal cognitive changes in young individuals at ultrahigh risk for psychosis. JAMA Psychiatry 75, 929–939.Google Scholar
Lencz, T, Smith, CW, McLaughlin, D, Auther, A, Nakayama, E, Hovey, L and Cornblatt, BA (2006) Generalized and specific neurocognitive deficits in prodromal schizophrenia. Biological Psychiatry 59, 863–871.Google Scholar
Lin, A, Wood, SJ, Nelson, B, Brewer, WJ, Spiliotacopoulos, D, Bruxner, A, Broussard, C, Pantelis, C and Yung, AR (2011) Neurocognitive predictors of functional outcome two to 13 years after identification as ultra-high risk for psychosis. Schizophrenia Research 132, 1–7.Google Scholar
McDonald, M, Christoforidou, E, Van Rijsbergen, N, Gajwani, R, Gross, J, Gumley, AI, Lawrie, SM, Schwannauer, M, Schultze-Lutter, F and Uhlhaas, PJ (2018) Using online screening in the general population to detect participants at clinical high-risk for psychosis. Schizophrenia Bulletin. doi: 10.1093/schbul/sby069.Google Scholar
Mesholam-Gately, RI, Giuliano, AJ, Goff, KP, Faraone, SV and Seidman, LJ (2009) Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 23, 315.Google Scholar
Meyer, EC, Carrión, RE, Cornblatt, BA, Addington, J, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF and Woods, SW (2014) The relationship of neurocognition and negative symptoms to social and role functioning over time in individuals at clinical high risk in the first phase of the North American Prodrome Longitudinal Study. Schizophrenia Bulletin 40, 1452–1461.Google Scholar
Michel, C, Ruhrmann, S, Schimmelmann, BG, Klosterkötter, J and Schultze-Lutter, F (2014) A stratified model for psychosis prediction in clinical practice. Schizophrenia Bulletin 40, 1533–1542.Google Scholar
Miller, TJ, McGlashan, TH, Rosen, JL, Cadenhead, K, Ventura, J, McFarlane, W, Perkins, DO, Pearlson, GD and Woods, SW (2003) Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703–715.Google Scholar
Mills, JG, Fusar-Poli, P, Morgan, C, Azis, M and McGuire, P (2017) People meeting ultra high risk for psychosis criteria in the community. World Psychiatry 16, 322–323.Google Scholar
Moore, TM, Reise, SP, Gur, RE, Hakonarson, H and Gur, RC (2015) Psychometric properties of the Penn computerized neurocognitive battery. Neuropsychology 29, 235.Google Scholar
Morrens, M, Hulstijn, W and Sabbe, B (2006) Psychomotor slowing in schizophrenia. Schizophrenia Bulletin 33, 1038–1053.Google Scholar
Niendam, TA, Bearden, CE, Johnson, JK, McKinley, M, Loewy, R, O'Brien, M, Nuechterlein, KH, Green, MF and Cannon, TD (2006) Neurocognitive performance and functional disability in the psychosis prodrome. Schizophrenia Research 84, 100–111.Google Scholar
Niendam, TA, Bearden, CE, Zinberg, J, Johnson, JK, O'brien, M and Cannon, TD (2007) The course of neurocognition and social functioning in individuals at ultra high risk for psychosis. Schizophrenia Bulletin 33, 772–781.Google Scholar
Pinkham, AE, Penn, DL, Perkins, DO, Graham, KA and Siegel, M (2007) Emotion perception and social skill over the course of psychosis: a comparison of individuals ‘at-risk’ for psychosis and individuals with early and chronic schizophrenia spectrum illness. Cognitive Neuropsychiatry 12, 198–212.Google Scholar
Pukrop, R and Klosterkötter, J (2010) Neurocognitive indicators of clinical high-risk states for psychosis: a critical review of the evidence. Neurotoxicity Research 18, 272–286.Google Scholar
Rajji, TK, Ismail, Z and Mulsant, BH (2009) Age at onset and cognition in schizophrenia: meta-analysis. The British Journal of Psychiatry 195, 286–293.Google Scholar
Schultze-Lutter, F, Addington, J, Ruhrmann, S and Klosterkötter, J (2007) Schizophrenia proneness instrument, adult version (SPI-A). Rome: Giovanni Fioriti.Google Scholar
Schultze-Lutter, F, Ruhrmann, S, Berning, J, Maier, W and Klosterkötter, J (2008) Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state. Schizophrenia Bulletin 36, 182–191.Google Scholar
Schultze-Lutter, F, Klosterkötter, J and Ruhrmann, S (2014) Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms. Schizophrenia Research 154, 100–106.Google Scholar
Schultze-Lutter, F, Michel, C, Ruhrmann, S and Schimmelmann, BG (2018) Prevalence and clinical relevance of interview-assessed psychosis-risk symptoms in the young adult community. Psychological Medicine 48, 1167–1178.Google Scholar
Seidman, LJ, Giuliano, AJ, Meyer, EC, Addington, J, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF and Woods, SW (2010) Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis. Archives of General Psychiatry 67, 578–588.Google Scholar
Seidman, LJ, Shapiro, DI, Stone, WS, Woodberry, KA, Ronzio, A, Cornblatt, BA, Addington, J, Bearden, CE, Cadenhead, KS, Cannon, TD and Mathalon, DH (2016) Association of neurocognition with transition to psychosis: baseline functioning in the second phase of the North American prodrome longitudinal study. JAMA Psychiatry 73, 1239–1248.Google Scholar
Seiferth, NY, Pauly, K, Habel, U, Kellermann, T, Shah, NJ, Ruhrmann, S, Klosterkötter, J, Schneider, F and Kircher, T (2008) Increased neural response related to neutral faces in individuals at risk for psychosis. Neuroimage 40, 289–297.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R and Dunbar, GC (1998) The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry 59, 22.Google Scholar
Simon, AE, Dvorsky, DN, Boesch, J, Roth, B, Isler, E, Schueler, P, Petralli, C and Umbricht, D (2006) Defining subjects at risk for psychosis: a comparison of two approaches. Schizophrenia Research 81, 83–90.Google Scholar
Thompson, AD, Bartholomeusz, C and Yung, AR (2011) Social cognition deficits and the ‘ultra high risk’ for psychosis population: a review of literature. Early Intervention in Psychiatry 5, 192–202.Google Scholar
Uhlhaas, PJ, Gajwani, R, Gross, J, Gumley, AI, Lawrie, SM and Schwannauer, M (2017) The youth mental health risk and resilience study (YouR-Study). BMC Psychiatry 17, 43.Google Scholar
Van Rijn, S, Aleman, A, de Sonneville, L, Sprong, M, Ziermans, T, Schothorst, P, Van Engeland, H and Swaab, H (2011) Misattribution of facial expressions of emotion in adolescents at increased risk of psychosis: the role of inhibitory control. Psychological Medicine 41, 499–508.Google Scholar
Velthorst, E, Nieman, DH, Linszen, D, Becker, H, de Haan, L, Dingemans, PM, Birchwood, M, Patterson, P, Salokangas, RK, Heinimaa, M and Heinz, A (2010) Disability in people clinically at high risk of psychosis. The British Journal of Psychiatry 197, 278–284.Google Scholar
Yung, AR, Yung, AR, Pan Yuen, H, Mcgorry, PD, Phillips, LJ, Kelly, D, Dell'olio, M, Francey, SM, Cosgrave, EM, Killackey, E and Stanford, C (2005) Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry 39, 964–971.Google Scholar
Supplementary material: File

Haining et al. supplementary material

Haining et al. supplementary material
Download Haining et al. supplementary material(File)
File 115 KB