A longitudinal evaluation of cognitive deficits in patients with first episode of psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S190-S190
Author(s):  
A. Dardagani ◽  
P. Athanasis ◽  
A. Lagoudis ◽  
A. Ramnalis ◽  
E. Ntouros ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Deficits ◽  
Repeated Measures ◽  
Neuropsychological Test ◽  
First Episode ◽  
Psychotic Episode ◽  
Cognitive Domains ◽  
Mental Flexibility ◽  
Competing Interest ◽  
Over Time

It has been well documented in many studies till now that patients in their first episode of psychosis demonstrate cognitive deficits. However, it is yet to be made clear how these deficits progress. Deterioration, stability or even amelioration in some domains has been noted from researchers. The aim of this study was to examine the longitudinal course of cognitive deficits over time. We administered a comprehensive battery of neuropsychological test to a group of first psychotic episode patients at the acute phase, 6 months and 1 year later. The sample comprised of 25 patients (13 male) in the first episode of psychosis. Specific tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used. The cognitive domains of attention, memory, working memory, visuospatial ability and planning, mental flexibility/shifting were examined. Repeated measures ANOVA was used in order to detect changes in the patients’ performance over time. According to our data, there was an improvement from baseline to 6 months in attention, planning and visual working memory. There was no change in performance in these cognitive domains from 6 months to 1 year from baseline. Memory, mental flexibility/shifting and visuospatial memory remained stable over time. Our data suggest variability concerning neuropsychological performance in specific tests examining different domains. Evaluation of cognitive function in the first episode of psychosis needs more thorough and comprehensive research, in relation to its course over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

No effect of cognitive performance on post-intervention improvement in emotion recognition

2017 ◽  
Vol 41 (S1) ◽  
pp. S190-S190
Author(s):  
V.P. Bozikas ◽  
S. Tsotsi ◽  
A. Dardagani ◽  
E. Dandi ◽  
E.I. Nazlidou ◽  
...  
Keyword(s):  
Emotion Recognition ◽  
Cognitive Performance ◽  
Neuropsychological Test ◽  
Emotion Perception ◽  
First Episode ◽  
Psychotic Episode ◽  
Post Intervention ◽  
Basic Emotions ◽  
The Difference ◽  
Competing Interest

Deficits in emotion perception in patients with first episode of psychosis have been reported by many researchers. Till now, training programs have focused mainly in patients with schizophrenia and not in first psychotic episode (FEP) patients. We used a new intervention for facial affect recognition in a group of 35 FEP patients (26 male). The emotion recognition intervention included coloured pictures of individuals expressing six basic emotions (happiness, sadness, anger, disgust, surprise, fear) and a neutral emotion. The patients were trained to detect changes in facial features, according to the emotion displayed. A comprehensive battery of neuropsychological tests was also administered, measuring attention, memory, working memory, visuospatial ability and executive function by using specific tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). We tried to explore whether cognitive performance can explain the difference noted between the original assessment of emotion recognition and the post-intervention assessment. According to our data, overall cognitive performance did not correlate with post-intervention change in emotion recognition. Specific cognitive domains did not correlate with this change, either. According the above mentioned results, no significant correlation between neuropsychological performance and post-intervention improvement in emotion recognition was noted. This finding may suggest that interventions for emotion recognition may target specific processes that underlie emotion perception and their effect can be independent of general cognitive function.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals T189. FREE THYROXIN CONCENTRATIONS MODERATE THE RESPONSE TO A COGNITIVE REMEDIATION THERAPY IN PEOPLE WITH EARLY PSYCHOSIS: PRELIMINARY FINDINGS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S303-S304
Author(s):  
Francesc Estrada ◽  
Josep Maria Crosas ◽  
Maribel Ahuir ◽  
Sara Pérez ◽  
Wanda Zabala ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Cognitive Remediation ◽  
Early Psychosis ◽  
Cognitive Tasks ◽  
First Episode ◽  
Cognitive Changes ◽  
Cognitive Domains ◽  
Episode Psychosis ◽  
Changes Over Time ◽  
Over Time

Abstract Background Cognitive deficits are a common cause of functional disability in people with psychotic disorders. Cognitive remediation produces moderate improvements in cognitive performance in people with schizophrenia, although there is variability in the responses between patients. As previous longitudinal studies suggest that free thyroxin (FT4) levels influence attention cognitive tasks in patients with early psychosis, we aimed to conduct a pilot study to explore whether thyroid hormones might predict the response to cognitive remediation therapy (CRT) in patients with first-episode psychosis. Methods 27 patients (8 women; 19 men) with first-episode psychosis aged between 18 and 35 years old were randomized to receive a computerized CRT for three months (2 sessions/week) (N=14) or treatment as usual (TAU) (N=13). A full cognitive battery (CANTAB Schizophrenia) was administered at baseline and follow-up (3 months later, after the CRT/TAU period). Plasma levels of thyroid-stimulating hormone (TSH) and FT4 were measured. Data were analyzed on an intention-to-treat basis. Correlation analyses were conducted to explore the association between TSH and FT4 levels and cognitive changes over time. An ANOVA for repeated measures was used to compare longitudinal changes over time by the experimental group while adjusting for TSH and FT4 levels. Significance was defined as p<0.05. Results TSH concentrations were not associated with cognitive changes over time. FT4 concentrations were associated with cognitive worsening over time in cognitive tasks dealing with reaction time (simple median movement time [r= 0.60, p= 0.003]; simple median reaction time [r= 0.44, p= 0.039]), sustained attention (signal detection for the rapid visual processing task [r= -0.46, p= 0.028]) and verbal memory (immediate recognition [r= -0.54, p= 0.008]; delayed recognition [r= -0.48, p= 0.019]). The ANOVA for repeated measures did not show time by group effects although a time by FT4 significant effect was found for cognitive tasks dealing with these cognitive domains (p<0.05 for all). Discussion Although a direct effect of the CRT on cognitive improvement was not found, baseline FT4 concentrations appeared to predict the response to CRT in people with early psychosis. Significant associations were found for cognitive domains dealing with attention processes, which are in accordance with previous studies exploring the association between thyroid function and cognitive functioning in early psychotic patients. Our preliminary findings suggest that the determination of thyroid function status might be important for establishing which patients could show cognitive improvements over time. If these results are replicated in larger studies, the determination of thyroid status might help identify those individuals more prone for showing cognitive improvements, and allowing the implementation of a personalized medicine approach in the field of cognitive rehabilitation in psychosis.

The relationship of emotion recognition with neuropsychological performance in patients with first episode psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S190-S190
Author(s):  
A. Dardagani ◽  
E. Dandi ◽  
S. Tsotsi ◽  
M. Nazou ◽  
A. Lagoudis ◽  
...  
Keyword(s):  
Emotion Recognition ◽  
Visual Memory ◽  
Emotion Perception ◽  
First Episode ◽  
Psychotic Episode ◽  
Visuospatial Ability ◽  
Cognitive Domains ◽  
Neuropsychological Dysfunction ◽  
First Psychotic Episode ◽  
The Relationship

The relationship between neuropsychological dysfunction and emotion perception has been frequently noted in various studies. Attention, for example, has been found to play an important role in emotion processing and recognition. Not many studies though, have examined this relationship in first psychotic episode patients. The aim of the present study was to explore the nature of the relation between performance in cognitive tests and a test that measures emotion perception. In a sample of 46 first psychotic episode patients (22 male), we administered a comprehensive battery of neuropsychological non-verbal tests and an emotion recognition test. The cognitive domains of attention, memory, working memory, visuospatial ability and executive function were examined, by using specific tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The emotion recognition assessment comprised a new test that includes 35 coloured pictures of individuals expressing six basic emotions (happiness, sadness, anger, disgust, surprise, fear) and a neutral emotion. We used partial correlation–controlling for the effect of age–and we found a statistically significant relationship between emotion recognition and overall cognitive performance. More specifically, attention, visual memory and visuospatial ability positively correlated with emotion recognition. In regard to specific cognitive domains, attention positively correlated with anger and fear, whereas visual memory correlated with happiness and fear. In conclusion, it seems that the role of underlying visual processes in emotion perception has to be further examined and evaluated in this group of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

From ADHD to psychosis… executive functions and time

2016 ◽  
Vol 33 (S1) ◽  
pp. S353-S353
Author(s):  
C.D.M. Isabel
Keyword(s):  
Executive Functions ◽  
Psychotic Disorders ◽  
Stressful Life Event ◽  
Auditory Hallucination ◽  
First Episode ◽  
Psychotic Episode ◽  
Positive Symptoms ◽  
Memory Work ◽  
First Psychotic Episode ◽  
Competing Interest

IntroductionCognitive impairment is present from the early stages of psychotic disorders. Alterations are found mainly in areas of attention, memory work and executive functions. During adolescence, ADHD patients often suffer from secondary disorders to lack of efficient procurement processes information by the poor development of executive functions.ObjectiveEvaluation of a patient whose diagnosis of ADD evolve to acute psychotic episode.MethodReview by clinical and psychometric tests developments in executive functions disorders.ResultsTwelve years old patient who comes to the hospital since 2012, was initially diagnosed with literacy difficulties and low academic performance, after MFF-20 speaks of Learning Disabilities. It presents lack of motivation, apathy, difficulty in scheduling and organization and adherence to schedules, so they diagnosed ADD. It is given treatment with methylphenidate and atomoxetine, presenting erratic path.After a year without treatment and the presence of a major stressful life event, at 17, has a first episode, consisting in mutiste attitude, phenomena of self-referenciality, experiences of control, enforcement and dissemination of ideas and auditory hallucination imperative type.ConclusionsThe presence of emocional dysregulation and alterations in the executive functions atribuyen to ADD, in this case, were premorbid symtomatology of a first psychotic episode. The presence of positive symptoms allows to clarify the diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S271-S272
Author(s):  
S. Malta Vacas ◽  
R. Carvalho ◽  
M.J. Heitor
Keyword(s):  
Great Majority ◽  
First Episode ◽  
Psychotic Episode ◽  
Term Care ◽  
First Psychotic Episode ◽  
Effective Interventions ◽  
Episode Psychosis ◽  
Competing Interest

IntroductionMuch research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.ObjectivesThis study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.MethodsRetrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.ResultsBetween 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.ConclusionsThe evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals M232. COORDINATED SPECIALTY CARE FOR FIRST EPISODE PSYCHOSIS IN MINNESOTA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S225-S225
Author(s):  
Jamie Fischer ◽  
Joshua Mervis ◽  
Erin Begnel ◽  
Piper Meyer-Kalos
Keyword(s):  
Substance Use ◽  
Repeated Measures ◽  
Integrated Treatment ◽  
Self Report ◽  
First Episode ◽  
Future Research ◽  
Illness Management ◽  
Global Functioning ◽  
Significant Difference ◽  
Over Time

Abstract Background People who are experiencing a First Episode of Psychosis (FEP) often have limited recovery from non-integrated treatment approaches in usual settings. Treatment of FEP typically entails high rates of non-adherence, disengaging from treatment, and increased rates of relapse (Mueser et al., 2015; Kane et al., 2016). NAVIGATE is an evidence-based approach implemented in the Recovery After an Initial Schizophrenia Episode treatment project. Methods The present study is a review of archival data with NAVIGATE model teams in Minnesota. Clinical information from 118 people with FEP was reviewed from the first 6-months of treatment, with a subset analyzed for the first 12-months. Individuals were assessed with clinician ratings of current needs, illness management, and global functioning. Self-report assessments addressed symptoms and illness management from the client’s perspective. Data was analyzed using repeated measures analysis of variance with post-hoc honest significant difference testing. Additional data analysis utilized McNemar’s test, a repeated measures test using counts and a chi-square distribution. Results Total current needs did not change significantly across time. All other domains assessed showed significant differences between intake and 6-months. All other domains except total needs showed significant differences between intake and 12-months. No domains showed significant differences between 6-months and 12-months. Substance use was not reduced over time. Antipsychotic medication use was not reduced over time. Hospitalizations were substantially reduced from intake to 6-months. Discussion Almost all symptoms improved from intake to 6-months. No additional treatment gains were observed from 6-months to 12-months. Improvements from intake were stable from 6-months to 12-months. Most symptoms improved from intake to 6-months but not beyond. The NAVIGATE model was a successful intervention as implemented in Minnesota. Overall, symptom reduction gains were durable at 12-months, hospitalizations were reduced from intake to 6-months, but the intervention did not improve substance use. Substance use, continued improvement of symptoms beyond the 6-month mark, and further improvements in symptoms or reduced hospitalizations are areas for future research and treatment development.

scholarly journals Demographic Effects on Longitudinal Semantic Processing, Working Memory, and Cognitive Speed

2020 ◽  
Vol 75 (9) ◽  
pp. 1850-1862 ◽  
Author(s):  
Jet M J Vonk ◽  
Eve Higby ◽  
Alexandre Nikolaev ◽  
Dalia Cahana-Amitay ◽  
Avron Spiro ◽  
...  
Keyword(s):  
Working Memory ◽  
Factor Analysis ◽  
Semantic Memory ◽  
Cognitive Domains ◽  
Memory Efficiency ◽  
Age Related ◽  
Cognitive Speed ◽  
Language And Cognition ◽  
Rate Of Decline ◽  
Over Time

Abstract Objectives To better understand and compare effects of aging and education across domains of language and cognition, we investigated whether (a) these domains show different associations with age and education, (b) these domains show similar patterns of age-related change over time, and (c) education moderates the rate of decline in these domains. Method We analyzed data from 306 older adults aged 55–85 at baseline of whom 116 returned for follow-up 4–8 years later. An exploratory factor analysis identified domains of language and cognition across a range of tasks. A confirmatory factor analysis analyzed cross-sectional associations of age and education with these domains. Subsequently, mixed linear models analyzed longitudinal change as a function of age and moderation by education. Results We identified 2 language domains, that is, semantic control and semantic memory efficiency, and 2 cognitive domains, that is, working memory and cognitive speed. Older age negatively affected all domains except semantic memory efficiency, and higher education positively affected all domains except cognitive speed at baseline. In language domains, a steeper age-related decline was observed after age 73–74 compared to younger ages, while cognition declined linearly with age. Greater educational attainment did not protect the rate of decline over time in any domain. Discussion Separate domains show varying effects of age and education at baseline, language versus cognitive domains show dissimilar patterns of age-related change over time, and education does not moderate the rate of decline in these domains. These findings broaden our understanding of age effects on cognitive and language abilities by placing observed age differences in context.

Insight and Social Cognition in First Episode of Psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S272-S272
Author(s):  
L. Martínez ◽  
A. Mané ◽  
R. Cortizo ◽  
I. Cáceres ◽  
D. Treen ◽  
...  
Keyword(s):  
Social Cognition ◽  
Pearson Correlation ◽  
Treatment Compliance ◽  
First Episode ◽  
Psychotic Episode ◽  
Emotional Perception ◽  
Linear Correlation Analysis ◽  
Competing Interest ◽  
Underlying Mechanisms ◽  
Insight Into

IntroductionImpairment of insight in psychotic disorder is associated with adverse impact in treatment compliance, outcome and social functioning although its underlying mechanisms are still unknown. Social cognition and more specifically Theory of mind have been proposed to be correlated to insight. However, the relationship between both factors is still not well defined.AimsTo study the association between social cognition and insight into mental illness in individuals with early psychosis included in the first episode of psychosis program of Hospital del Mar.MethodsFrom the 94 patients included in the first psychotic episode program between January 2011 and January 2016, thirty-eight patients were evaluated six months after the episode. The three initial items of SUMD (Scale Unawareness of Mental Disorder) were used to measure insight and MSCEIT (Mayer-Salovey-Caruso Emotional Intelligence Test) was used to assess social cognition. Linear correlation analysis by Pearson correlation was conducted.ResultsInsight results of SUMD six months after the first episode of psychosis were significantly associated with several subsections of MSCEIT, such as experiential area total punctuation (r = –0.574; P = 0.025), emotional facilitation section (r = –0.633; P = 0.011) and the facial emotion perception task (r = –0.572; P = 0.026).ConclusionsResults suggest an association between insight and emotional perception and facilitation performance in first episode patients, which may suggest a role of social cognition in psychosis insight impairment. Further research to better define the participation of social cognition in insight into psychosis alteration is mandatory to understand the etiology of insight, define treatment targets and consequently improve the disorder prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clozapine induced diarrhea

2017 ◽  
Vol 41 (S1) ◽  
pp. s502-s502
Author(s):  
S. Ramos-Perdigues ◽  
M.J. Gordillo ◽  
C. Caballero ◽  
S. Latorre ◽  
S.V. Boned ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Differential Diagnosis ◽  
Therapeutic Option ◽  
Disease Diagnosis ◽  
First Episode ◽  
Psychotic Episode ◽  
Histological Findings ◽  
Anticholinergic Effects ◽  
Severe Diarrhea ◽  
Competing Interest

IntroductionClozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.ObjectivesWe describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.AimsDiscuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.MethodsWe present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.ResultsAt the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)ConclusionsDiarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Olanzapine or chlorpromazine plus lithium in first episode psychotic mania: An 8-week randomised controlled trial

2015 ◽  
Vol 30 (8) ◽  
pp. 975-982 ◽  
Author(s):  
P. Conus ◽  
M. Berk ◽  
S.M. Cotton ◽  
L. Kader ◽  
C. Macneil ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Safety Profile ◽  
Repeated Measures ◽  
Controlled Trial ◽  
Vital Signs ◽  
Treatment Strategies ◽  
First Episode ◽  
Safety And Efficacy ◽  
Randomised Controlled ◽  
Over Time

AbstractBackgroundTreatment strategies for mental disorders may vary according to illness stage. However no data currently exist to guide treatment in first episode psychotic mania. The aim of this study was to compare the safety and efficacy profile of chlorpromazine and olanzapine, as add-on to lithium, in patients with a first episode of psychotic mania, expecting better safety profile and adherence to olanzapine but similar efficacy for both treatments.MethodsData from 83 patients were collected in an 8-week randomised controlled trial on clinical variables, side effects, vital signs, and weight. Analyses of treatment differences over time were based on intent-to-treat principles. Kaplan-Meier estimated survival curves were used to analyse time-to-event data and mixed effects models repeated measures analysis of variance were used to determine treatment group differences over time on safety and efficacy measures.ResultsEthics committee approval to delay informed consent procedure until recovery from the acute episode allowed the inclusion of 83 patients highly representative of those treated in the public sector. Contrary to our hypotheses, safety profile of both medications was similar. A signal for higher rate (P=.032) and earlier occurrence (P= .043) of mania remission was observed in the olanzapine group which did not survive correction for multiple comparisons.ConclusionsOlanzapine and chlorpromazine have a similar safety profile in a uniquely representative cohort of patients with first episode psychotic mania. The possibility for a greater impact of olanzapine on manic symptoms leading to earlier remission of the episode needs exploration in a large sample.

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