Lawrence H Yang1, Bernalyn Ruiz2, Amar D Mandavia3, Margaux M Grivel4, Liang Y Wong5, Michael R Phillips6, Matcheri S Keshavan7, Huijun Li8, Jeffrey A Lieberman9, Ezra Susser10, Larry J Seidman7, William S Stone7. 1. New York University, School of Global Public Health, 715 Broadway, New York, NY 10003, United States; Columbia University, Department of Epidemiology, Mailman School of Public Health, 622 West 168th Street, New York, NY 10032, United States. Electronic address: Lawrence.yang@nyu.edu. 2. University of Massachusetts Boston, Department of Counseling and School Psychology, 100 Morrisey Blvd, Boston, MA 02125, United States. 3. Teachers College, Columbia University, Department of Counseling and Clinical Psychology, 525 West 120th St, New York, NY 10027, United States. 4. New York University, School of Global Public Health, 715 Broadway, New York, NY 10003, United States. 5. City College, City University of New York, Department of Clinical Psychology, 160 Convent Ave., New York, NY 10031, United States. 6. Columbia University, Department of Epidemiology, Mailman School of Public Health, 622 West 168th Street, New York, NY 10032, United States; Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Center, 3210 Humin Road, Shanghai 201108, China; New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States. 7. Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, United States. 8. Florida A&M University, Department of Psychology, 501 Orr Dr., 203 B Gore Education Complex (GEC), Tallahassee, FL 32307, United States. 9. Columbia University, Department of Psychiatry, 1051 Riverside Dr, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States. 10. Columbia University, Department of Epidemiology, Mailman School of Public Health, 622 West 168th Street, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States.
Abstract
BACKGROUND: Comparing the course of antipsychotic-naïve psychosis in low- and middle-income countries (LMIC) may help to illuminate core pathophysiologies associated with this condition. Previous reviews-primarily from high-income countries (HIC)-identified cognitive deficits in antipsychotic-naïve, first-episode psychosis, but did not examine whether individuals with psychosis with longer duration of untreated psychosis (DUP > 5 years) were included, nor whether LMIC were broadly represented. METHOD: A comprehensive search of PUBMED from January 2002-August 2018 identified 36 studies that compared cognitive functioning in antipsychotic-naïve individuals with psychosis (IWP) and healthy controls, 20 from HIC and 16 from LMIC. RESULTS: A key gap was identified in that LMIC study samples were primarily shorter DUP (<5 years) and were primarily conducted in urban China. Most studies matched cases and controls for age and gender but only 9 (24%) had sufficient statistical power for cognitive comparisons. Compared with healthy controls, performance of antipsychotic-naïve IWP was significantly worse in 81.3% (230/283) of different tests of cognitive domains assessed (90.1% in LMIC [118/131] and 73.7% [112/152] in HIC). CONCLUSIONS: Most LMIC studies of cognition in antipsychotic-naïve IWP adopted standardized procedures and, like HIC studies, found broad-based impairments in cognitive functioning. However, these LMIC studies were often underpowered and primarily included samples typical of HIC: primarily male, young-adult, high-school educated IWP, in their first episode of illness with relatively short DUP (<5 years). To enhance understanding of the long-term natural course of cognitive impairments in untreated psychosis, future studies from LMIC should recruit community-dwelling IWP from rural areas where DUP may be longer.
BACKGROUND: Comparing the course of antipsychotic-naïve psychosis in low- and middle-income countries (LMIC) may help to illuminate core pathophysiologies associated with this condition. Previous reviews-primarily from high-income countries (HIC)-identified cognitive deficits in antipsychotic-naïve, first-episode psychosis, but did not examine whether individuals with psychosis with longer duration of untreated psychosis (DUP > 5 years) were included, nor whether LMIC were broadly represented. METHOD: A comprehensive search of PUBMED from January 2002-August 2018 identified 36 studies that compared cognitive functioning in antipsychotic-naïve individuals with psychosis (IWP) and healthy controls, 20 from HIC and 16 from LMIC. RESULTS: A key gap was identified in that LMIC study samples were primarily shorter DUP (<5 years) and were primarily conducted in urban China. Most studies matched cases and controls for age and gender but only 9 (24%) had sufficient statistical power for cognitive comparisons. Compared with healthy controls, performance of antipsychotic-naïve IWP was significantly worse in 81.3% (230/283) of different tests of cognitive domains assessed (90.1% in LMIC [118/131] and 73.7% [112/152] in HIC). CONCLUSIONS: Most LMIC studies of cognition in antipsychotic-naïve IWP adopted standardized procedures and, like HIC studies, found broad-based impairments in cognitive functioning. However, these LMIC studies were often underpowered and primarily included samples typical of HIC: primarily male, young-adult, high-school educated IWP, in their first episode of illness with relatively short DUP (<5 years). To enhance understanding of the long-term natural course of cognitive impairments in untreated psychosis, future studies from LMIC should recruit community-dwelling IWP from rural areas where DUP may be longer.
Authors: R Andersen; B Fagerlund; H Rasmussen; B H Ebdrup; B Aggernaes; A Gade; B Oranje; B Glenthoj Journal: Eur Psychiatry Date: 2012-09-19 Impact factor: 5.361
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