Executive Impairment Predicts Schizophrenia Diagnosis and Treatment Status in Mid-Term Follow-Up of Early-Onset Psychosis

Abstract

Objectives: Early-onset psychoses (EOP) vary considerably with regard to diagnostic stability and functional outcome. The aim of this study was the assessment of executive dysfunction as a predictor of outcome in EOP. Method: This was a retrospective cohort study. Twenty-five hospitalized patients with non-affective EOP were assessed with the Wisconsin Card Sorting Test (WCST) during the index admission. Associations with current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed in 6 years of follow-up. Results: The mean age at the index admission and the follow-up was 16.1 ± 1.35 and 22.0 ± 2.1 years, respectively. After discharge, almost all subjects (96%) at least briefly continued psychiatric treatment, and the majority of them (76%) were readmitted. Worse baseline WCST results were associated with a follow-up schizophrenia diagnosis, being a psychiatric in- or outpatient at the moment of follow-up assessment and receiving psychotropic medication. A low number of completed categories correlated with receiving a disability pension at the follow-up. Conclusion: In patients with EOP, baseline executive function impairment was associated with schizophrenia diagnosis and psychiatric treatment at the follow-up. The association between baseline results and psychiatric treatment may explain the limited effect of baseline impairment on follow-up occupational and relationship status.

Cognitive Biases and Socio-Occupational Functioning Mediate the Relationship between Executive Functions and the Severity of Psychopathology among Young Adults with Psychotic-like Experiences: 1-Year Follow-Up Study

“…For instance, the study of Albert et al [ 29 ] revealed that worse childhood executive functions (EFs) are predictive of greater prodromal symptoms of psychosis in young adulthood. Also, in the retrospective cohort study of Rembark et al [ 30 ], baseline executive function impairment was associated with a schizophrenia diagnosis and psychiatric treatment at follow-up. At the same time, in another study [ 17 ], executive functions show the largest impairments in different “at-risk” groups, although they do not predict a later transition to psychosis.…”

Dopaminergic lesions of the anterior cingulate cortex of rats increase vulnerability to salient distractors

“…Specifically, a hypofunction of the dopamine system in the ACC (Abi‐Dargham & Moore, 2003; Chen et al, 2016; MacKenzie et al, 2018; McCutcheon et al, 2020). The increased susceptibility to distraction has been linked to poor psychosocial measures, and a generally impaired quality of life (Fehnel et al, 2016; Friedman et al, 2018; Michl et al, 2013; Remberk et al, 2014). As current pharmacotherapies for ADHD (Bioulac et al, 2020; Pitzianti et al, 2020) and major depression (Mallet et al, 2019) typically increase dopamine levels in the brain but fail to alleviate distractibility, more research is needed to understand the specific contributions of the ACC to distractibility.…”