Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort.
The natural history of neurocognitive impairments in schizophrenia is unclear. We aimed to characterise this in an epidemiological first-episode cohort and relate it to long-term outcome. All but 1 of 112 first-episode psychosis cases ascertained from a geographical catchment area were traced at 10-12 years. Neurocognitive and multi-dimensional outcome assessments were made at interview in 49 cases with schizophrenia and related disorders. Twenty-four of these had completed the same neurocognitive battery at index admission. Comparisons with normative data showed impaired executive function in a proportion of the first episode (FE) sample at baseline. Significant deterioration was seen over the follow-up period in three of nine sub-tests: object assembly, picture completion and memory for designs. Neurocognitive impairments at outcome, but not baseline, correlated with clinical outcome. Poor outcome was associated with a decline in performance on visuo-spatial tasks and a failure to improve on frontal-temporal tasks during the follow-up period. Executive deficits may be present in the FE, but do not progress over 10-12 years. Visuo-spatial function is spared in the FE but may deteriorate over time. Changes in both these patterned deficits are predictive of clinical outcome.
Stirling
John
J
Department of Psychology and Speech Pathology, Manchester Metropolitan University, Hathersage Road, Manchester M13 0JA, UK. j.stirling@mmu.ac.uk
White
Colin
C
Lewis
Shon
S
Hopkins
Richard
R
Tantam
Digby
D
Huddy
Alice
A
Montague
Linda
L
D000293:Adolescent; D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications*; D012720:Severity of Illness Index; D014888:Wechsler Scales