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      Neuropsychological function at first episode in treatment-resistant psychosis: findings from the ÆSOP-10 study

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          Abstract

          Background

          Neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis.

          Methods

          We report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up.

          Results

          Compared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning ( p values⩽0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample ( t = −2.32; p = 0.022) and in the schizophrenia diagnostic subgroup ( t = −2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance ( p values<0.01–0.001) and those born outside the UK ( p values<0.05).

          Conclusions

          Verbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable – at a group level – at the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.

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          Most cited references40

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          VALIDITY OF THE TRAIL MAKING TEST AS AN INDICATOR OF ORGANIC BRAIN DAMAGE

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            Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology.

            Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines.
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              Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia.

              Impaired Wisconsin Card Sorting Test (WCST) performance has been one critical piece of evidence suggesting frontal lobe dysfunction in schizophrenia. However, the specific cognitive processes underlying impaired performance have not been identified. Impaired WCST performance in schizophrenia might in part reflect a fundamental working memory deficit. We examined the performance of 30 normal subjects and 36 patients with schizophrenia on a neuropsychological battery including a novel measure of working memory-letter-number (LN) span. Patients with schizophrenia were impaired on LN span performance, which was also highly correlated with WCST performance (r = 0.74). Between-group WCST differences were eliminated when we covaried LN span. Regression analyses suggested that LN span performance predicted the WCST category achieved score, whereas measures of set shifting, verbal fluency, and attention were predictive of perseveration. Working memory may be a critical determinant of one aspect of WCST performance in schizophrenia.
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                Author and article information

                Journal
                Psychol Med
                Psychol Med
                PSM
                Psychological Medicine
                Cambridge University Press (Cambridge, UK )
                0033-2917
                1469-8978
                September 2019
                23 October 2018
                : 49
                : 12
                : 2100-2110
                Affiliations
                [1 ]Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London , 16 De Crespigny Park, London SE5 8AF, England, UK
                [2 ]Academic Rheumatology Department, School of Immunology & Microbial Sciences, King's College London , Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, England, UK
                [3 ]Environmental Medicine and Public Health Department, Icahn School of Medicine at Mount Sinai , 1 Gustave L. Levy Place, New York NY 10029-5674, USA
                [4 ]Department of Psychology, University of Westminster , 115 New Cavendish Street, London W1W 2UW, England, UK
                [5 ]Department of Psychiatry, St. Patricks University Hospital and Trinity College, University of Dublin , James St., Dublin 8, Ireland
                [6 ]Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London , 16 De Crespigny Park, London SE5 8AF, England, UK
                [7 ]Division of Psychiatry and Applied Psychology, Queen's Medical Centre, University of Nottingham , Nottingham NG7 2UH, England, UK
                [8 ]Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London , 16 De Crespigny Park, London SE5 8AF, England, UK
                [9 ]Department of Psychiatry, University of Cambridge , Herchel Smith Building, Cambridge CB2 0SZ, England, UK
                [10 ]Koç University, School of Medicine , Rumelifeneri Yolu 34450 Sarıyer, Istanbul, Turkey
                [11 ]UNSW Research Unit for Schizophrenia, School of Psychiatry, The University of New South Wales , Sydney NSW 2052, Australia
                Author notes
                Author for correspondence: Eugenia Kravariti, E-mail: eugenia.kravariti@ 123456kcl.ac.uk
                [*]

                These authors contributed equally to this work (Joint Last Authors).

                Article
                S0033291718002957 00295
                10.1017/S0033291718002957
                6712950
                30348234
                2a847590-0d9c-4d4e-8a41-49cdf10b7821
                © Cambridge University Press 2018

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 March 2018
                : 10 September 2018
                : 20 September 2018
                Page count
                Figures: 1, Tables: 4, References: 62, Pages: 11
                Categories
                Original Articles

                Clinical Psychology & Psychiatry
                cohort study,first episode,neuropsychological,population-based,psychosis,schizophrenia,treatment resistant

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