Silvia Amoretti1,2,3, Adriane R Rosa4,5,6, Gisela Mezquida1,2,3, Bibiana Cabrera1,2,3, María Ribeiro7,8, Mariola Molina9, Miquel Bioque1,2,3, Antonio Lobo2,10, Ana González-Pinto2,11, David Fraguas2,12, Iluminada Corripio2,13, Eduard Vieta2,3,14, Elena de la Serna2,3,15, Laura Morro16, Marina Garriga2,3,14, Carla Torrent2,3,14, Manuel J Cuesta7,8, Miguel Bernardo1,2,3. 1. Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, Spain. 2. Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain. 3. August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. 4. Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 5. Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 6. Department of Pharmacology and Postgraduate Program: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 7. Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain. 8. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. 9. Instituto de Investigación Sanitaria Gregorio Marañón. School of Psychology, Complutense University, Madrid, Spain. 10. Department of Medicine and Psychiatry. Zaragoza University. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain. 11. Department of Psychiatry, Hospital Universitario de Álava (Sede Santiago), University of the Basque Country (UPV-EHU), Bioaraba Research Institute, Spain. 12. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Institute of Psychiatry and Mental Health, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain. 13. Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. 14. Bipolar and Depressive Disorders Unit, Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain. 15. Child and Adolescent Psychiatry and Psychology Department, 2017SGR881, Institute of Neurosciences, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, Barcelona, Spain. 16. Hospital del Mar, Department of Psychiatry, Barcelona, Spain.
Abstract
BACKGROUND: Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome. METHODS: A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning. RESULTS: At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR. CONCLUSIONS: Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
BACKGROUND: Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome. METHODS: A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning. RESULTS: At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR. CONCLUSIONS: Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.