Impact of Neurocognition on Social and Role Functioning in Individuals at Clinical High Risk for Psychosis

Abstract

Objective Cognitive deficits have been well documented in schizophrenia and have been shown to impair quality of life and to compromise everyday functioning. Recent studies of adolescents and young adults at high risk for developing psychosis show that neurocognitive impairments are detectable before the onset of psychotic symptoms. However, it remains unclear how cognitive impairments affect functioning before the onset of psychosis. The authors assessed cognitive impairment in adolescents at clinical high risk for psychosis and examined its impact on social and role functioning. Method A sample of 127 treatment-seeking patients at clinical high risk for psychosis and a group of 80 healthy comparison subjects were identified and recruited for research in the Recognition and Prevention Program. At baseline, participants were assessed with a comprehensive neurocognitive battery as well as measures of social and role functioning. Results Relative to healthy comparison subjects, clinical high-risk patients showed significant impairments in the domains of processing speed, verbal memory, executive function, working memory, visuospatial processing, motor speed, sustained attention, and language. Clinical high-risk patients also displayed impaired social and role functioning at baseline. Among patients with attenuated positive symptoms, processing speed was related to social and role functioning at baseline. Conclusions These findings demonstrate that cognitive and functional impairments are detectable in patients at clinical high risk for psychosis before the onset of psychotic illness and that processing speed appears to be an important cognitive predictor of poor functioning.

Prediction of vocational participation and global role functioning in help-seeking young adults, from neurocognitive, demographic and clinical variables

“…Studies with psychosis at-risk groups report evidence of both neurocognitive deficits and declines in functioning up to 10 years prior to clinical diagnosis (Bachman et al, 2012;Seidman et al, 2006). Cognitively, this includes reduced processing speed (Carrión et al, 2011;Carrion et al, 2015), impairments in attention (Carrion et al, 2015;Myles-Worsley et al, 2007) and executive function (Carrion et al, 2015). As already noted, some of these deficits were present in our sample.…”

Predicting Risk and the Emergence of Schizophrenia

“…Smith and colleagues 135 have also shown spatial working memory deficits in an American sample of 8 UHR patients. Hawkins and colleagues 136 demonstrated verbal working memory deficits on a letter-number sequencing task in a sample of 36 Canadian and American UHR patients, a finding recently replicated by Carrion and colleagues 137 in a larger sample of UHR patients (n 5 127) also using the letter-number sequencing task.…”

“…Most recently, Carrion and colleagues 137 have also shown in a large sample of American UHR patients that not only were processing speed deficits especially pronounced relative to most other neurocognitive deficits but also processing speed deficits were uniquely predictive of social and role functioning, independent of positive psychotic symptoms. This is interesting given that some researchers have suggested that symbol-coding deficits reflect the core of schizophrenia neurocognitive impairment.…”

“…Pflueger and colleagues, 129 using both the WCST and Tower of Hanoi tasks, also found executive functioning deficits in a sample of 60 UHR patients in Basel, Switzerland. Most recently, in one of the largest studies to date, Carrion and colleagues 137 showed deficits on the WCST in a sample of 127 UHR patients.…”

“…Verbal learning tasks regularly show some of the greatest levels of impairment relative to other neurocognitive domains. [137][138][139][140][141][142] Niendam and colleagues, 142 for example, showed pronounced verbal learning deficits in a sample of 45 12-year-old to 29-year-old UHR patients attending a prodromal clinic in California. Similarly, Jhashan and colleagues 143,144 demonstrated marked deficits in verbal learning in a sample of 48 12-year-old to 30-year-old patients with prodromal syndromes.…”