title: The course of neurocognitive functioning in first-episode psychosis and its relation to premorbid adjustment, duration of untreated psychosis, and relapse.
abstract: The aim was to determine the post-onset longitudinal course of cognitive functioning in first-episode psychoses and to examine how premorbid adjustment, duration of untreated psychosis (DUP), and clinical variables such as relapse are associated with that course. Consecutive patients with a DSM-IV diagnosis of non-organic psychosis coming to their first treatment in the health care areas under study were included. Ultimately, 207 patients were assessed neuropsychologically at baseline, 138 were reassessed one year later, and 111 two years later. Five dimensions were identified through principal component analysis of eight neuropsychological (NP) test results: Working Memory (WM), Executive Function (EF), Verbal Learning (VL), Impulsivity (Im), and Motor Speed (MS). No major changes were found in the level of neurocognitive functioning from baseline to the 1-year and 2-year follow-ups. Patients with good initial levels of premorbid academic functioning had consistently better scores on WM at all three time points. No association was found between DUP and the longitudinal course of neurocognitive function. Significant associations occurred between better WM and VL at 1 and 2 years and fewer relapses during the first year, but not the second. Most NP deficits are in place by onset of psychosis and are stable over two years. Milder WM deficits are associated with higher premorbid academic functioning. More severe deficits in WM and VL are associated with more relapses during the first year. It is unclear whether NP deficits cause relapse, relapse causes NP deficits, or both are manifestations of a third deteriorative process.
authors.affiliation: Department of Psychology, University of Oslo, P.O. Box 1094 Blindern, N-0317 Oslo, Norway. b.r.rund@psykologi.uio.no
authors.forename: Bjørn Rishovd
authors.initials: BR
authors.lastname: Rund
authors.forename: Ingrid
authors.initials: I
authors.lastname: Melle
authors.forename: Svein
authors.initials: S
authors.lastname: Friis
authors.forename: Jan Olav
authors.initials: JO
authors.lastname: Johannessen
authors.forename: Tor K
authors.initials: TK
authors.lastname: Larsen
authors.forename: Liv Jaeger
authors.initials: LJ
authors.lastname: Midbøe
authors.forename: Stein
authors.initials: S
authors.lastname: Opjordsmoen
authors.forename: Erik
authors.initials: E
authors.lastname: Simonsen
authors.forename: Per
authors.initials: P
authors.lastname: Vaglum
authors.forename: Thomas
authors.initials: T
authors.lastname: McGlashan
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D012008:Recurrence; D015203:Reproducibility of Results; D012917:Social Adjustment; D014145:Trail Making Test; D014706:Verbal Learning; D014825:Vocabulary