Cognition in Individuals With Psychotic Disorders Declined Over 20 Years, Study Finds

In a 20-year study, most cognitive functions in 445 individuals with psychotic disorders declined, according to a report published in JAMA Psychiatry.

“Compared with a matched control group, year-20 cognitive outcomes were poor in [participants with] psychotic disorders, especially for older participants,” wrote Anne-Kathrin J. Fett, Ph.D., of the University of London and colleagues. “These results provide the first comprehensive picture of long-term cognitive changes and associated clinical and functional outcomes in psychotic disorders.”

The participants were part of the Suffolk County Mental Health Project, a longitudinal study of patients with psychotic disorders recruited between 1989 and 1995 from 12 psychiatric inpatient units in Suffolk County, N.Y. To be included in the study, patients had to have had their first admission for a psychotic disorder within six months of recruitment and be between the ages of 15 and 60 years. Diagnoses included schizophrenia, schizoaffective disorder, psychotic bipolar disorder, major depressive disorder, and other psychoses.

The participants were evaluated two years after their initial hospitalization and again 20 years later. Researchers measured six cognitive domains: verbal knowledge, verbal declarative memory, visual declarative memory, attention and processing speed, abstraction-execution function, and verbal fluency.

Verbal fluency performance did not change over the 18 years, but verbal knowledge significantly increased. Performance declined significantly on all other tests, however. At both years two and 20, participants with schizophrenia spectrum disorders performed worse than those with other psychotic disorders.

“Older age at first cognitive assessment was associated with worse performance on the cognitive tests, except verbal knowledge and fluency,” the authors wrote. “These changes were similar in magnitude across all psychotic disorders. They were associated with worsening of negative symptoms and loss of gainful employment.”

If the results are successfully replicated, the authors concluded, “they will highlight the importance of studying cognitive and neural functioning in later phases of psychotic illness to develop further strategies for prevention of progressive deterioration.”

For related information, see the Psychiatric News article “Handgrip Linked to Cognition In Mood Disorders, Schizophrenia.”

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Early Decline in Social Functioning Said to Predict Long-term Outcome in Psychosis

Social functioning appears to be a useful indicator of long-term outcome in people with psychotic disorders and may be an important treatment target that could lead to improvements in other areas of functioning, according to a study in AJP in Advance.

Eva Velthorst, Ph.D., of the Icahn School of Medicine at Mount Sinai and colleagues analyzed data from the Suffolk County Mental Health Project, a 20-year prospective study of first-admission patients with psychotic disorders. They looked at social functioning and long-term outcome in 485 individuals with schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, or schizophreniform disorder), major depressive disorder with psychosis, and bipolar disorder with psychosis, as well as a control group of individuals who had never experienced psychosis.

Using statistical analysis, the researchers identified four distinct trajectories over the 20-year period among the individuals with psychosis: preserved functioning (n=82), moderately impaired functioning (n=148), severely impaired functioning (n=181), and profoundly impaired functioning (n=74).

The trajectories of profoundly and severely impaired social functioning were associated with worse 20-year real-life functional outcomes in a variety of domains, such as not having obtained a high school diploma, being unemployed, not living independently, and using public assistance.

The researchers also found that differences in the level of social functioning were already evident in childhood. The years between early adolescence and first hospitalization appear to be a period in which a substantial number of individuals who later developed a psychotic disorder displayed a steep decline in social functioning.

The researchers stated, “[O]ur findings are consistent with recent programs of research focused on adolescence as the critical intervention window and support current early intervention strategies for high-risk individuals and those that offer intensive treatment to first-admission patients aimed to prevent social withdrawal in severe psychotic illnesses.”

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