Abstract
Robust deficits in cognitive functioning are present in people with psychosis and are evident in the early stages of the disorder. Impairments in verbal memory and verbal fluency are reliably seen in individuals at clinical high-risk for psychosis (CHR) compared to healthy populations. As previous studies have shown a relationship between cognition and longer-term outcomes in schizophrenia, the aim of this paper was to explore whether verbal memory and verbal fluency performance predicted outcomes in a large CHR sample recruited as part of the EU-GEI High Risk Study. Participants included 316 CHR individuals, 90.8% of whom were not currently on antipsychotic medication, and 60 healthy controls. Verbal memory and verbal fluency performance were measured at baseline. At two-year follow-up, CHR individuals were assessed by three different outcome measures, those who did and did not (1) transition to psychosis, (2) experience burdening impairment or disabilities, or (3) remit clinically from CHR status. Individuals with CHR displayed significant verbal memory and verbal fluency deficits at baseline compared to healthy controls (Hedges' g effect size = 0.24 to 0.66). There were no significant differences in cognitive performance of those who did and did not transition to psychosis. However, impaired immediate verbal recall predicted both functional disability and non-remission from the CHR state. Results remained significant when analyses were restricted to only include antipsychotic-free CHR participants. These findings may inform the development of early interventions designed to improve cognitive deficits in the early stages of psychosis.
Highlights
Cognitive impairment is a core feature of schizophrenia (Sheffield et al, 2018) and is an important predictor of poor functional outcome (Bowie and Harvey, 2005, Green et al, 2004)
Our first main finding was that clinical high-risk for psychosis (CHR) individuals displayed deficits in verbal memory and verbal fluency compared to HC
Our second major finding was that, within the CHR sample, impairments in immediate verbal recall at baseline were associated with both nonremission and functional disability at two-year follow-up
Summary
Cognitive impairment is a core feature of schizophrenia (Sheffield et al, 2018) and is an important predictor of poor functional outcome (Bowie and Harvey, 2005, Green et al, 2004). Cognitive impairment in CHR is less pronounced than individuals with first-episode psychosis relative to healthy individuals (HC), certain domains, and memory, may be impaired to a comparable degree as first-episode psychosis (Becker et al, 2010, Sheffield et al, 2018). In such instance, verbal memory and verbal fluency performance may be useful in predicting psychosis and functional outcome, as well as targeting early interventions to improve performance (Catalan et al, 2021, Hauser et al, 2017). Long-term functional difficulties are highly prevalent within CHR individuals, irrespective of transition, and they are not addressed by psychological interventions (van der Gaag et al, 2019) so represent an important target for prevention (Carrión et al, 2013)
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