Visual working memory deterioration preceding relapse in psychosis.
Relapse is distressingly common after the first episode of psychosis, yet it is poorly understood and difficult to predict. Investigating changes in cognitive function preceding relapse may provide new insights into the underlying mechanism of relapse in psychosis. We hypothesized that relapse in fully remitted first-episode psychosis patients was preceded by working memory deterioration.



Visual memory and verbal working memory were monitored prospectively in a 1-year randomized controlled trial of remitted first-episode psychosis patients assigned to medication continuation (quetiapine 400 mg/day) or discontinuation (placebo). Relapse (recurrence of positive symptoms of psychosis), visual (Visual Patterns Test) and verbal (Letter-Number span test) working memory and stressful life events were assessed monthly.



Remitted first-episode patients (n = 102) participated in the study. Relapsers (n = 53) and non-relapsers (n = 49) had similar baseline demographic and clinical profiles. Logistic regression analyses indicated relapse was associated with visual working memory deterioration 2 months before relapse [odds ratio (OR) 3.07, 95% confidence interval (CI) 1.19-7.92, P = 0.02], more stressful life events 1 month before relapse (OR 2.11, 95% CI 1.20-3.72, P = 0.01) and medication discontinuation (OR 5.52, 95% CI 2.08-14.62, P = 0.001).



Visual working memory deterioration beginning 2 months before relapse in remitted first-episode psychosis patients (not baseline predictor) may reflect early brain dysfunction that heralds a psychotic relapse. The deterioration was found to be unrelated to a worsening of psychotic symptoms preceding relapse. Testable predictors offer insight into the brain processes underlying relapse in psychosis.
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
C L M
CL
Hui
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
Y K
YK
Li
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
A W Y
AW
Li
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
E H M
EH
Lee
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
W C
WC
Chang
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
S K W
SK
Chan
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
S Y
SY
Lam
Department of Psychology,Simon Fraser University,Burnaby,BC,Canada.
A E
AE
Thornton
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
P
P
Sham
Department of Psychiatry,University of British Columbia,Vancouver,BC,Canada.
W G
WG
Honer
Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China.
E Y H
EY
Chen
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D060825:Cognitive Dysfunction / Q000503:physiopathology*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology*; D011379:Prognosis; D011618:Psychotic Disorders / Q000188:drug therapy / Q000503:physiopathology*; D000069348:Quetiapine Fumarate / Q000008:administration & dosage / Q000494:pharmacology; D012008:Recurrence; D012074:Remission Induction; D013315:Stress, Psychological / Q000503:physiopathology*; D013997:Time Factors; D055815:Young Adult
D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate
Early psychosis; predictors; relapse; schizophrenia; working memory