Children with a family history of schizophrenia who have early deficits in “set shifting”—the ability to fluidly move from one cognitive task to another—appear to be at increased risk for psychotic experiences in later childhood compared with children who have similar deficits but no family history of schizophrenia, according to a report in Schizophrenia Bulletin.
Psychotic experiences are subclinical hallucinations and delusions that may occur without a diagnosable psychotic disorder. “Psychotic experiences … are associated with an elevated risk of subsequent psychotic and nonpsychotic disorders,” wrote Christina Bruun Knudsen, M.A., and Nicoline Hemager, Ph.D., both of Aarhus University in Denmark and colleagues.
The researchers assessed neurocognition in 449 children aged 7 years who were participants in the Danish High Risk and Resilience Study—a prospective cohort study of children who have at least one biological parent with a schizophrenia spectrum diagnosis, bipolar disorder, or neither diagnosis. Neurocognitive assessments included tests of verbal and nonverbal intelligence, processing speed, sustained attention, verbal memory, visuospatial memory, working memory and set shifting.
The children were later assessed for psychotic experiences using a structured interview, first with the primary caregiver and then with the child at age 11. The interview inquired about five types of hallucinations and 13 types of delusions. If the children reported hallucinations and/or delusions, they were then asked additional questions, including the frequency and duration of these events.
Across all three groups, poor visuospatial memory and working memory “was associated with a modest, but significant, increased risk of psychotic experiences,” Knudsen, Hemager, and colleagues wrote. Children who had a family history of schizophrenia had an almost twofold increase in psychotic experiences during childhood despite similar neurocognitive performance on several domains compared with children who had a family history of bipolar disorder and children with no family history of either disorder. However, deficits in set shifting tests at age 7 among children with the family history of schizophrenia stood out as a particular risk for later psychotic experiences.
“Set-shifting or cognitive flexibility denotes the mental ability to appropriately and flexibly adjust one’s thinking and behavior in accordance with changes in the environment,” the authors wrote. “Whether such associations during childhood have implications for conversion to psychosis in adolescence and adulthood requires further research.”
For related information, see the Psychiatric News article “Predicting Psychosis: Field Moves From Assessment of Clinical Risk to Search for Biomarkers.”
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