Abstract
There is a scarcity of evidence on subjectively reported cognitive difficulties in individuals at ultra-high risk (UHR) for psychosis and whether these self-perceived cognitive difficulties may relate to objective cognitive deficits, psychopathology, functioning, and adherence to cognitive remediation (CR). Secondary, exploratory analyses to a randomized, clinical trial were conducted with 52 UHR individuals receiving a CR intervention. Participants completed the Measure of Insight into Cognition—Self Report (MIC-SR), a measure of daily life cognitive difficulties within the domains of attention, memory, and executive functions along with measures of neuropsychological test performance, psychopathology, functioning, and quality of life. Our study found participants with and without objectively defined cognitive deficits reported self-perceived cognitive deficits of the same magnitude. No significant relationship was revealed between self-perceived and objectively measured neurocognitive deficits. Self-perceived cognitive deficits associated with attenuated psychotic symptoms, overall functioning, and quality of life, but not with adherence to, or neurocognitive benefits from, a CR intervention. Our findings indicate that UHR individuals may overestimate their cognitive difficulties, and higher levels of self-perceived cognitive deficits may relate to poor functioning. If replicated, this warrants a need for both subjective and objective cognitive assessment in at-risk populations as this may guide psychoeducational approaches and pro-functional interventions. Self-perceived cognitive impairments do not seem to directly influence CR adherence and outcome in UHR states. Further studies are needed on potential mediator between self-perceived cognitive deficits and functioning and quality of life.
Highlights
Individuals at ultra-high risk (UHR) for psychosis are characterized by persistent cognitive deficits within both global and specific cognitive domains[1,2,3,4,5,6]
Brief Assessment of Cognition in Schizophrenia (BACS) composite change scores rho = 0.002 p = 0.988 rho = −0.029 p = 0.842 rho = 0.177 p = 0.215 rho = −0.010 p = 0.949 subjective cognitive deficits being unrelated to estimated IQ, while objective cognitive deficits (BACS composite score) were significantly related
Our study found UHR individuals to report self-perceived cognitive deficits of a magnitude exceeding that of patients with established psychosis[12,14]
Summary
Individuals at ultra-high risk (UHR) for psychosis are characterized by persistent cognitive deficits within both global and specific cognitive domains[1,2,3,4,5,6]. Meta-analytical evidence has revealed moderate overall impairments in neurocognition in UHR compared to healthy controls (Hedges’ g = −0.344)[7]. The severity of neurocognitive impairments are found to be intermediate between that of patients with schizophrenia and healthy controls[3,7]. Neurocognitive deficits in UHR have been implicated in psychosis development[4,8] and poor functional outcome[9,10]. As performance-based cognitive testing is the preferred assessment measure employed in psychosis research, few studies have elucidated on patient’s self-perceived cognitive impairments: in general, the studies do not find an association between objective and subjective neurocognitive deficits in patients with established psychosis[11,12,13,14]. To the best of our knowledge, no previous study has, investigated whether this discrepancy between objective and subjective cognitive deficits apply to the UHR state of psychosis
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