Abstract
BackgroundThe majority of patients with psychotic disorders experience severe neuropsychological impairment. The onset and course of this impairment, however, is debated. Moreover, the course of neuropsychological functioning in other psychiatric conditions remains largely unexamined. This study used longitudinal data from infancy to early adulthood to chart the course of general and specific neuropsychological functions in individuals with psychotic disorders, psychotic experiences and depression.MethodsData were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort study comprising all live births between 1991 and 1992 in Avon, UK. All participants who underwent cognitive testing at 18 months, 4, 8, 15 and 20 years, and psychiatric assessment at age 18 were included. Individuals with non-affective psychotic disorder, affective psychotic disorder, subclinical psychotic experiences and depression were compared to controls on full-scale, verbal and non-verbal IQ, and measures of processing speed, working memory, language, visuospatial ability and attention.ResultsIndividuals with non-affective psychosis showed continually increasing deficits between infancy (18 months) and adulthood (20 years) in full-scale IQ (effect size of change (ESΔ) =−1.09, p=.02), and non-verbal IQ (ESΔ=−0.94, p=.008). The depression group showed a small, increasing deficit in non-verbal IQ (ESΔ=−0.29, p=.04) between infancy and adulthood. Between ages 8 and 20, the non-affective psychosis group exhibited developmental lags (i.e. slower growth) on measures of processing speed, working memory and attention (ESΔ=−0.68, p=.001; ESΔ=−0.59, p=.004; ESΔ=−0.44, p=.001), and large, static deficits on measures of language and visuospatial ability (ES=−0.87, p=.005; ES=−0.90, p=.001). There was only weak evidence for neuropsychological deficits in individuals with affective psychosis, depression, and subclinical psychotic experiences.DiscussionThese findings suggest that the origins of non-affective psychotic disorder involve dynamic neurodevelopmental processes, which effect both verbal and non-verbal abilities throughout the first two decades of life. These neurodevelopmental processes do not manifest in other psychiatric disorders, such as affective psychotic disorder and depression.
Highlights
The majority of patients with psychotic disorders experience severe neuropsychological impairment
Dr Mollon will present new data examining the origin of cognitive impairment across the psychosis spectrum using a populationbased cohort followed prospectively from birth
Dr Fett will present recent research on cognitive functioning in a large sample of patients at first hospitalization for a psychotic disorder who have been followed 20-years into the illness. Her findings indicate that cognitive functioning in psychotic disorders continues to decline after illness onset, that this decline is not specific to schizophrenia but present across psychotic disorders, and that, relative to never-psychotic individuals, impairments on some key-cognitive domains worsen with age
Summary
This symposium will draw together state of the art findings on the lifelong cognitive trajectories, on key-predictors of cognitive functioning and the functional consequences of cognitive impairments in schizophrenia and related psychotic disorders from developmental epidemiological, prodromal, and clinical research. Dr Mollon will present new data examining the origin of cognitive impairment across the psychosis spectrum using a populationbased cohort followed prospectively from birth Her findings demonstrate that while individuals with affective psychosis, subthreshold psychotic experiences and even depression experience some degree of cognitive impairment across the first two decades of life, only those who go on to develop non-affective psychosis exhibit large, widespread and increasing deficits. Dr Fett will present recent research on cognitive functioning in a large sample of patients at first hospitalization for a psychotic disorder who have been followed 20-years into the illness Her findings indicate that cognitive functioning in psychotic disorders continues to decline after illness onset, that this decline is not specific to schizophrenia but present across psychotic disorders, and that, relative to never-psychotic individuals, impairments on some key-cognitive domains worsen with age. Josephine Mollon*,1, Anthony David, Stanley Zammit, Glyn Lewis, Abraham Reichenberg5 1Yale University; 2Institute of Psychiatry, King’s College London; 3Cardiff University; 4University College London; 5Icahn School of Medicine at Mount Sinai
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