Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis

Smelror, Runar; Rund, Bjørn Rishovd; Lonning, Vera; Jørgensen, Kjetil Nordbø; Wedervang‐Resell, Kirsten; Andreassen, Ole A.; Ueland, Torill; Myhre, Anne Margrethe; Agartz, Ingrid

doi:10.1007/s00787-020-01479-7

Cited by 8 publications

(11 citation statements)

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“…These findings illustrate a crucial need for increased knowledge of pathological mechanisms associated with EOP. In a previous study from our group including an overlapping EOP sample with the present study, negative and disorganized symptoms were found to mediate the relationship between verbal learning and global functioning (37). However, to the best of our knowledge, the factorial structure of negative symptoms and how specific subdomains of negative symptoms relate with cognition, have not yet been investigated in adolescent patients with EOP.…”

Section: Introductionmentioning

confidence: 43%

Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis

et al. 2022

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Background: Early-onset psychosis (EOP) is among the leading causes of disease burden in adolescents. Negative symptoms and cognitive deficits predicts poorer functional outcome. A better understanding of the association between negative symptoms and cognitive impairment may inform theories on underlying mechanisms and elucidate targets for development of new treatments. Two domains of negative symptoms have been described in adult patients with schizophrenia: apathy and diminished expression, however, the factorial structure of negative symptoms has not been investigated in EOP. We aimed to explore the factorial structure of negative symptoms and investigate associations between cognitive performance and negative symptom domains in adolescents with EOP. We hypothesized that (1) two negative symptom factors would be identifiable, and that (2) diminished expression would be more strongly associated with cognitive performance, similar to adult psychosis patients.Methods: Adolescent patients with non-affective EOP (n = 169) were included from three cohorts: Youth-TOP, Norway (n = 45), Early-Onset Study, Norway (n = 27) and Adolescent Schizophrenia Study, Mexico (n = 97). An exploratory factor analysis was performed to investigate the underlying structure of negative symptoms (measured with the Positive and Negative Syndrome Scale (PANSS)). Factor-models were further assessed using confirmatory factor analyses. Associations between negative symptom domains and six cognitive domains were assessed using multiple linear regression models controlling for age, sex and cohort. The neurocognitive domains from the MATRICS Consensus Cognitive Battery included: speed of processing, attention, working memory, verbal learning, visual learning, and reasoning and problem solving.Results: The exploratory factor analysis of PANSS negative symptoms suggested retaining only a single factor, but a forced two factor solution corroborated previously described factors of apathy and diminished expression in adult-onset schizophrenia. Results from confirmatory factor analysis indicated a better fit for the two-factor model than for the one-factor model. For both negative symptom domains, negative symptom scores were inversely associated with verbal learning scores.Conclusion: The results support the presence of two domains of negative symptoms in EOP; apathy and diminished expression. Future studies on negative symptoms in EOP should examine putative differential effects of these symptom domains. For both domains, negative symptom scores were significantly inversely associated with verbal learning.

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Section: Introductionmentioning

confidence: 43%

Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis

et al. 2022

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“…The patients were recruited from 2005–2007 (Early-Onset Study) and 2013–2018 (Youth-TOP). Cognitive data from the two cohorts have previously been published (Holmen et al, 2010; Juuhl-Langseth et al, 2014; Smelror et al, 2020). The majority of patients in both cohorts were recruited from adolescent psychiatric inpatient units and outpatient clinics in the Oslo region.…”

Section: Methodsmentioning

confidence: 99%

“…Impaired verbal learning in CHR is also one of the strongest cognitive predictors for psychosis development (Carrio ´n et al, 2018;Fusar-Poli et al, 2012;Seidman et al, 2016). In adolescent EOP, specific associations have been reported between verbal learning, negative and disorganized symptoms, and functional outcome (Smelror et al, 2020). Thus, increased knowledge of how cognitive performance in EOP develops after the onset of illness can inform us about psychosis etiology and be beneficial in the development of cognitive remediation strategies, treatment planning and rehabilitation programs, focusing on improving functional outcome in adolescents.…”

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“…Based on previous studies in EOP (e.g., Nieto & Castellanos, 2011), we hypothesized that patient performance would be significantly impaired in all cognitive domains, relative to the age-and sexcorrected standardized scores, and that the speed of processing domain would be particularly compromised. (Holmen et al, 2010;Juuhl-Langseth et al, 2014;Smelror et al, 2020). The majority of patients in both cohorts were recruited from adolescent psychiatric inpatient units and outpatient clinics in the Oslo region.…”

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Cognitive impairment profile in adolescent early-onset psychosis using the MATRICS Battery: Age and sex effects.

Smelror¹,

Johannessen²,

Wedervang‐Resell³

et al. 2021

Neuropsychology

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Objective: To examine cognitive performance, stratified by age and sex, in adolescents with early-onset psychosis (EOP), relative to the healthy adolescent standardized scores for the MATRICS Consensus Cognitive Battery (MCCB). Method: Seventy-one EOP patients (12-18 years) were included in the study. Raw scores of nine MCCB tests were converted into age-and sex-corrected T scores comprising six domains and global cognition (cognitive composite score). Patient performance, relative to the healthy reference group, was examined using one sample t-tests (reference T score mean of 50). Age effects were examined using one-way analyses of variance between three age groups (12-14 years, 15-16 years, 17-18 years). Sex differences were examined using independent samples t tests. Results: The patients performed significantly worse than the healthy reference group in all MCCB domains, with a global deficit of −1.6 SD below the reference. Across the domains, the impairments varied from −1.4 SD in speed of processing to −0.6 SD in visual learning and reasoning and problem-solving. Significant age effects were found in speed of processing, attention/vigilance, reasoning and problem-solving, and global cognition. The oldest age group showed largest impairments relative to the age-and sex-corrected reference. Female patients had a significantly higher mean T score in verbal learning compared to males. Conclusions: This study provides a MCCB performance profile in EOP, stratified by age and sex, relative to adolescent standardized scores. The results can be used to improve cognitive remediation strategies and subsequent functional outcome, in adolescent EOP and related clinical populations. Key PointsQuestion: How do adolescents with early-onset psychosis (EOP) perform on the MATRICS Consensus Cognitive Battery (MCCB) compared to normative cognitive development? Findings: The present findings demonstrate that EOP patients have widespread cognitive deficits with increasing impairment across adolescence, relative to adolescent standardized scores. Importance: The results provide a MCCB profile for adolescent EOP, stratified by age and sex, enabling researchers to compare findings across research sites and cohorts. Next Steps: Longitudinal studies, using the MCCB in large EOP samples are needed to identify cognitive patterns over time. Subsequently, this can expand our understanding about psychosis etiology, treatment planning, and improvement of long-term outcome in children and adolescents.

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“…During adolescence, emerging psychotic and personality disorders, including schizophrenia, bipolar disorder and borderline personality disorder, are major differential diagnoses next to mood and anxiety disorders [5][6][7][8][9][10][11][12]. Recent and very important research has sharpened the understanding of these conditions [13,14], which differentiates them from normal development including puberty. Many of these conditions have their onset in adolescence rather than in adulthood, including subclinical precursors as a prodromal state.…”

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confidence: 99%

What happened to the concept of adolescence crisis?

Waltereit

Uhlmann

Ehrlich

et al. 2020

Eur Child Adolesc Psychiatry

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Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis

Cited by 8 publications

References 77 publications

Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis

Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis

Cognitive impairment profile in adolescent early-onset psychosis using the MATRICS Battery: Age and sex effects.

What happened to the concept of adolescence crisis?

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