Abstract
BackgroundPatients with first-episode schizophrenia (FES) have consistently showed impaired cognitive functioning compared to healthy controls across a broad array of cognitive domains. After psychosis onset the cognitive performance in FES seems to remain stable or even improve over time. Many earlier studies, however, did not include healthy control groups which made it unclear whether cognitive changes were due to genuine improvements or other arbitrary factors. Thus, the development of individual cognitive domains over time is not yet fully examined.MethodsThe present study has a multi-assessment design, and includes data from eight follow-ups over six years. For the patient group, assessments were conducted yearly, apart from the first year where assessments were conducted every six months. Healthy controls were assessed at baseline, after two years and after six years. A total of 28 FES-patients and 28 healthy controls participated in the study, with 79 % of patients retained at the 6-year follow-up. Cognition was assessed with MATRICS Consensus Cognitive Battery. Data were analyzed with linear multilevel models.ResultsFES-patients scored lower than the control group across all cognitive domains at baseline. Over six years, the cognitive trajectories of visual learning seem to remain stable for both groups, while FES-patients showed slight improvements in attention (β = 1.34, SE = .18, p < .001), verbal learning (β = .65, SE = .29, p < .031), processing speed (β = .69, SE = .35, p < .051), reasoning/ problem solving (β = 1.68, SE = .27 p < .001), working memory (β = .89, SE = .27, p < .002) and social cognition (β = .93, SE = .30, p < .003). Most of these cognitive trajectories start to improve within the first year of illness and continues throughout the six year period. The improvement in processing speed (β = .18, SE = .48, p > .05), verbal learning (β = .56, SE = .59, p > .05) and social cognition (β = .82, SE = .59, p > .05) seem to be larger for FES-patients compared to controls, but these differences were not significant. The patient group’s improvement in reasoning/ problem solving (β = 1.31, SE = .51, p < .05) was significantly larger that the control group, but they showed smaller improvement in working memory (β = -1.03, SE = .51, p < .05).DiscussionOur results show that improvements are already discernable after 6 months following illness outbreak. There are different trajectories for different cognitive domains. Moreover, two cognitive domain trajectories were significantly different between control group and FES-patients. This points to the importance of assessing cognitive development over many years with multiple assessments when exploring cognitive impairments in schizophrenia. From a clinical perspective, this may speak in favor of a targeted rehabilitation of different cognitive domains.
Highlights
Cognitive impairments including deficits in working memory are commonly observed in schizophrenia
40 patients diagnosed with schizophrenia spectrum disorder, 19 patients with anxiety, affective and personality disorders without persecutory delusions, and 28 healthy controls were enrolled in the study
Two cognitive domain trajectories were significantly different between control group and first-episode schizophrenia (FES)-patients
Summary
Cognitive impairments including deficits in working memory are commonly observed in schizophrenia. With respect to longitudinal analyses, we must be careful with their interpretation, since a priori we found a significant group by time interaction (early-onset, late-onset, and non-users) in some domain, when the cannabis use at 3-year follow-up was considered, results did not show any significance, this reveals that cannabis users (early-onset and lateonset) and non-cannabis users did not differ in the degree of change in their cognitive functions, regardless of whether or not the patients had maintained consumption during the first 3-year of disease progression. The aim of our study was to assess the relationship between cognitive biases and psychopathological symptoms (positive, negative, depressive) in a clinical sample of patients with schizophrenia and a population sample of high school students. Our study highlights the importance of identifying and treating cognitive biases with appropriate therapies (e.g. metacognitive training) for improving the outcome of psychoses
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