ABSTRACT
Studies of cognitive functioning in patients with first episode schizophrenia spectrum disorders can be particularly informative. Through the use of electronic- and bibliography-based searches, the authors identified studies examining the course of cognitive functioning in first episode patients. The results of this review indicated that first episode patients at presentation for treatment often show compromised cognitive functioning, particularly in the domains of verbal learning and memory, psychomotor speed and attention. However, in comparison with patients with a longer illness history, first episode patients demonstrate significantly superior performance. In longitudinal studies of first episode patients, cognitive functioning generally remained static, suggesting limited change in performance over the first several years of the illness. The implications of these findings for future research are discussed.
Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/physiopathology , Cognition , Memory , Psychomotor Performance , Schizophrenia/diagnosis , Schizophrenia/physiopathology , Clinical Trials as Topic , Cognition Disorders/etiology , Disease Progression , Humans , Schizophrenia/complications , Severity of Illness IndexABSTRACT
The course of cognitive functioning over a 1-year period was examined among a community cohort of individuals presenting with first episode schizophrenia spectrum psychosis. Data were obtained for 83 outpatients at entry to an early intervention program and 12 months later on the National Adult Reading Test, Wechsler Adult Intelligence Scales-Third Edition, Wechsler Memory Scales-Third Edition, Paced Auditory Serial Addition Task, Wisconsin Card Sorting Test, Stroop Colour and Word Test, Trail Making Test, Continuous Performance Task and Thurstone Word Fluency Test. Paired sample t-tests indicated significant and positive changes in verbal and non-verbal intelligence, auditory and visual memory, working memory and some aspects of executive functioning. Processing speed also improved though remained an area of relative weakness for this sample. Findings indicated generally average performance at both assessment periods. Neither gender nor duration of untreated psychosis were related to the degree of change in cognitive functioning for this sample. The implications of these findings and the impact of early intervention with this population are discussed.
Subject(s)
Antipsychotic Agents/therapeutic use , Cognition Disorders/etiology , Cognition Disorders/therapy , Cognitive Behavioral Therapy/methods , Schizophrenia/complications , Adult , Cognition Disorders/diagnosis , Female , Humans , Male , Neuropsychological Tests , Severity of Illness Index , Time FactorsABSTRACT
OBJECTIVE: A phase-specific intervention provided soon after the onset of a first episode of psychosis is likely to engender a more hopeful outlook. This article describes a community-oriented treatment program of phase-specific medical and psychosocial treatments integrated within an intensive case management model for patients with first-episode psychosis in a geographically defined population. One-year status is reported for a consecutive sample of patients with nonaffective mostly schizophrenic first-episode psychosis who were receiving treatment in this program. METHODS: Patients were assessed at baseline and at one year with a modified version of the Interview for Retrospective Assessment of Onset of Schizophrenia, the Structured Clinical Assessment for DSM-IV, the Scale for Assessment of Positive Symptoms, and the Scale for Assessment of Negative Symptoms to ascertain baseline patient characteristics, remission rates, hospital readmission rates, and change in the severity of symptoms. RESULTS: Data at 13 months for 53 patients indicated a complete remission rate of 70 percent, a hospital readmission rate of 20 percent, a highly significant improvement in all dimensions of psychopathology, higher rates of remission among patients who entered treatment within six months of the onset of psychosis (82 percent compared with 60 percent), and a longer median duration of untreated psychosis among patients who did not experience complete remission (10.5 compared with 6.5 months). Nearly half the patients received initial treatment as outpatients without adverse consequences for their subsequent use of hospitalization. CONCLUSIONS: An epidemiologically representative sample of patients experiencing a first episode of psychosis, when treated optimally with low dosages of novel antipsychotics and phase-specific psychological interventions, showed a high rate of clinical recovery and were able to remain in the community most of the time.
