Objective and subjective cognitive functioning in relation to psychopathology among women with early psychosis

Abstract

Background: Subjective cognitive impairment (SCI) among early psychosis is under-recognized and under-studied. However, SCI is as important as objective impairment to be understood, since it assesses cognitive difficulties in real-life situations from a personal perspective and is therefore an essence of individualized medicine. This study aims to explore the associations between the objective and subjective measures of cognitive impairments and to identify factors contributing to SCI among people with early psychosis.Methods: Participants were 60 females (mean age 24.57 AE 8.28) who had a diagnosis of psychotic-spectrum disorder within 5 years. They completed a battery of neuropsychological tests assessing a range of cognitive functions including verbal learning, memory, attention, and executive functions. The Subjective Cognitive Impairment Scale (SCIS) was used to assess their perceived cognitive decline. Psychotic symptoms and depression were also assessed.Results: SCIS was not correlated with any of the objective cognitive tests results. It was positively correlated with depression and positive symptoms. A hierarchical multiple regression model revealed that positive symptoms and depression together explained 31.9% of the total variance in SCIS and only depression significantly predicted SCI. Performances on the memory tests were correlated with, and predicted by negative symptoms.Conclusions: There was no correlation between SCI and objective cognitive performances in patients with early psychosis. Treatments should not only focus on symptomatic remission and performance of cognitive tests, but also place emphasis on improving moods and subjective cognitive functions of individuals with early psychosis. K E Y W O R D Sdepression, early psychosis, objective cognitive functioning, psychopathology, subjective cognitive impairments

Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over 3 months of treatment

“…43,44 Evidence consistently shows that there is a low correlation between subjective and objective cognitive impairment. [4][5][6][7] It is possible that subjective and objective cognitive assessments capture different, but equally relevant, aspects of cognition in youth mental health. Longitudinal studies that measure both subjective and objective cognitive functioning are needed to understand the trajectory and unique role that subjective and objective cognitive impairments have in relation to symptom expression and psychological and role functioning.…”

“…[1][2][3] Subjective cognitive difficulties are not significantly correlated with objective clinician-administered tests of cognitive performance, [4][5][6][7][8][9] but are significantly associated with a range of individual factors, including levels of stress, chronotype, substance use, sleep quality and mental health symptoms to name a few. 2,5,6,[10][11][12][13] People with depression and anxiety disorders appear especially susceptible to subjective cognitive difficulties; 1-3,9,14,15 these difficulties are associated with severity of affective symptoms [16][17][18][19] and have a negative impact on role functioning and quality of life. 9,16,17,20,21 Younger age is associated with higher levels of subjective cognitive difficulties in people with depression.…”

Psychosis in Women: Time for Personalized Treatment

“…This may depend on greater insight of women compared to men and is confirmed by higher social functioning and less behavioral problems [26], but has the potential negative consequence of underestimating the real needs of female patients and jeopardizing engagement with psychiatric services. It has been noticed that, particularly for female patients with early psychosis, since subjective cognitive impairment seems to be significantly predicted by depression, treatments should not only focus on symptomatic remission and improved performance on cognitive tests, but also concentrate on improving mood and subjective cognitive function [34]. In a sample of adult-onset psychosis (defined as having an age of onset after 18 years of age, but in this particular sample, people whose psychosis emerged after the age of 25 years) the higher levels of correlation observed between female social functioning, negative symptoms and cognition, particularly executive function, suggest that these aspects are more interrelated that in men [33].…”

“…Understanding gender-based specificity at first presentation, development and long-term progress of psychosis might facilitate better treatment orientation or identify patients especially likely to respond to a particular treatment [32]. The suggestion that women's experiences in emotions are different from those of men, particularly but not only in cultures where gender roles and labels are still persistent, is basic for improving the study of gender-related issues and improving care programs that especially look at women's mental health [34]. For example, it could be useful to take into account that women have a unique risk for developing psychosis in the peripartum period and traumatic events such as intimate partner violence, which affects more women than men, and is linked to an increased risk of psychotic experiences [17,40].…”