BACKGROUND: Cognitive predictors of relapse have been extensively explored only in few long term longitudinal studies of first-episode schizophrenia. METHOD: This study prospectively followed 93 patients with first-episode schizophrenia, schizophreniform disorder, and schizoaffective disorder for 3 years after their first-episode illness. Cognitive domains including verbal intelligence, verbal and visual memory, verbal fluency, and Wisconsin Card Sorting Test performance were investigated as potential predictors of relapse. RESULTS: We found that by the first year 21% patients had relapsed, by the second year 33% had relapsed, and by the third year 40% had relapsed. There was a significant difference in the relapse rate between patients with good adherence and patients with poor adherence to medication regimes. A multiple logistic regression analysis revealed that after controlling for medication adherence, perseverative error in the Wisconsin Card Sorting Test was the only cognitive function that significantly predict relapse with an odds ratio of 2.4. CONCLUSIONS: Cognitive flexibility in set shifting is related to tendency towards relapse in first-episode schizophrenic patients. Other cognitive factors appear not to be related to relapse. Possible mechanisms included the link between prefrontal dysfunction and sub-cortical dopamine system stability, as well as the effects of executive dysfunction on insight impairment and adherence behavior.
BACKGROUND: Cognitive predictors of relapse have been extensively explored only in few long term longitudinal studies of first-episode schizophrenia. METHOD: This study prospectively followed 93 patients with first-episode schizophrenia, schizophreniform disorder, and schizoaffective disorder for 3 years after their first-episode illness. Cognitive domains including verbal intelligence, verbal and visual memory, verbal fluency, and Wisconsin Card Sorting Test performance were investigated as potential predictors of relapse. RESULTS: We found that by the first year 21% patients had relapsed, by the second year 33% had relapsed, and by the third year 40% had relapsed. There was a significant difference in the relapse rate between patients with good adherence and patients with poor adherence to medication regimes. A multiple logistic regression analysis revealed that after controlling for medication adherence, perseverative error in the Wisconsin Card Sorting Test was the only cognitive function that significantly predict relapse with an odds ratio of 2.4. CONCLUSIONS: Cognitive flexibility in set shifting is related to tendency towards relapse in first-episode schizophrenicpatients. Other cognitive factors appear not to be related to relapse. Possible mechanisms included the link between prefrontal dysfunction and sub-cortical dopamine system stability, as well as the effects of executive dysfunction on insight impairment and adherence behavior.
Authors: Leslie Marino; Ilana Nossel; Jean C Choi; Keith Nuechterlein; Yuanjia Wang; Susan Essock; Melanie Bennett; Karen McNamara; Sapna Mendon; Lisa Dixon Journal: J Nerv Ment Dis Date: 2015-05 Impact factor: 2.254
Authors: Yu-Tao Xiang; Chuan-Yue Wang; Yong-Zhen Weng; Qi-Jing Bo; Helen F K Chiu; Sandra S M Chan; Edwin H M Lee; Gabor S Ungvari Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2010-11-03 Impact factor: 4.328
Authors: Kenneth L Subotnik; Keith H Nuechterlein; Joseph Ventura; Michael J Gitlin; Stephen Marder; Jim Mintz; Gerhard S Hellemann; Leslie A Thornton; Indira R Singh Journal: Am J Psychiatry Date: 2011-01-04 Impact factor: 18.112
Authors: Margaret M McClure; Fiona Graff; Joseph Triebwasser; Mercedes Perez-Rodriguez; Daniel R Rosell; Harold Koenigsberg; Erin A Hazlett; Larry J Siever; Philip D Harvey; Antonia S New Journal: Am J Psychiatry Date: 2019-01-18 Impact factor: 18.112