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Cognitive performance during the first year of treatment in first-episode schizophrenia: a case–control study

Published online by Cambridge University Press:  22 May 2015

M. R. Olivier ,
S. Killian ,
B. Chiliza ,
L. Asmal ,
R. Schoeman ,
P. P. Oosthuizen ,
M. Kidd  and
R. Emsley
M. R. Olivier
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
S. Killian
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
B. Chiliza
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
L. Asmal
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
R. Schoeman
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
P. P. Oosthuizen
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
M. Kidd
Affiliation:
Centre for Statistical Consultation, Stellenbosch University, South Africa
R. Emsley*
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
*
*Address for correspondence: R. Emsley, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg Campus, Cape Town 7505, South Africa. (Email: [email protected])
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Abstract

Background

Several questions remain unanswered regarding the magnitude and time course of cognitive improvement in response to antipsychotic treatment. The purpose of this study was to assess changes in cognitive performance in antipsychotic-naive or minimally medicated patients with first-episode schizophrenia during the first 12 months of treatment, in a case–control design. Patients were treated with flupenthixol decanoate depot injection, according to a standard algorithm. The primary outcome measure was change in MATRICS Cognitive Consensus Battery (MCCB) composite score over 12 months.

Method

The sample comprised 92 patients and 100 healthy controls matched for age, sex, ethnicity and educational status. Cognitive function was assessed by means of the MCCB.

Results

A mixed-effects model identified a significant group × time effect (p ≤ 0.0001) for the MCCB composite score, with patients showing a greater degree of change than the controls. For the other MCCB domains there were significant group × time effects at adjusted significance level for attention and vigilance (p ≤ 0.0001), visual learning (p ≤ 0.0001), verbal learning (p = 0.005) and working memory (p ≤ 0.0001), but not for reasoning and problem solving (p = 0.04), speed of processing (p = 0.03) and social cognition (p = 0.06). There were moderate correlations between change in MCCB composite score and change in symptomatology as assessed by Positive and Negative Syndrome Scale factor analysis-derived domains.

Conclusions

Substantial improvements in cognitive function were observed over and above a practice effect, and were significantly correlated with improvements in psychopathology and functionality.

Keywords

Flupenthixol decanoateneurocognitionoutcomepsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 13 , October 2015 , pp. 2873 - 2883
Copyright
Copyright © Cambridge University Press 2015 

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References

Aas, M, Dazzan, P, Mondelli, V, Melle, I, Murray, RM, Pariante, CM (2014). A systematic review of cognitive function in first-episode psychosis, including a discussion on childhood trauma, stress, and inflammation. Frontiers in Psychiatry 4, 182.Google Scholar
Addington, D, Addington, J (1993). Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry 22 (Suppl.), 39–44.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Barder, HE, Sundet, K, Rund, BR, Evensen, J, Haahr, U, Ten Velden, HW, Joa, I, Johannessen, JO, Langeveld, H, Larsen, TK, Melle, I, Opjordsmoen, S, Rossberg, JI, Simonsen, E, Vaglum, P, McGlashan, T, Friis, S (2013). Neurocognitive development in first episode psychosis 5 years follow-up: associations between illness severity and cognitive course. Schizophrenia Research 149, 63–69.Google Scholar
Bilder, RM, Goldman, RS, Robinson, D, Reiter, G, Bell, L, Bates, JA, Pappadopulos, E, Willson, DF, Alvir, JM, Woerner, MG, Geisler, S, Kane, JM, Lieberman, JA (2000). Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. American Journal of Psychiatry 157, 549–559.Google Scholar
Birchwood, M, Smith, J, Drury, V, Healy, J, Macmillan, F, Slade, M (1994). A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica 89, 62–67.CrossRefGoogle ScholarPubMed
Bowie, CR, Leung, WW, Reichenberg, A, McClure, MM, Patterson, TL, Heaton, RK, Harvey, PD (2008). Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biological Psychiatry 63, 505–511.Google Scholar
Bozikas, VP, Andreou, C (2011). Longitudinal studies of cognition in first episode psychosis: a systematic review of the literature. Australian and New Zealand Journal of Psychiatry 45, 93–108.Google Scholar
Buchanan, RW, Keefe, RS, Umbricht, D, Green, MF, Laughren, T, Marder, SR (2011). The FDA-NIMH-MATRICS guidelines for clinical trial design of cognitive-enhancing drugs: what do we know 5 years later? Schizophrenia Bulletin 37, 1209–1217.Google Scholar
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.Google Scholar
Chen, EY, Hui, CL, Dunn, EL, Miao, MY, Yeung, WS, Wong, CK, Chan, WF, Tang, WN (2005). A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients. Schizophrenia Research 77, 99–104.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioural Sciences. Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Davidson, M, Galderisi, S, Weiser, M, Werbeloff, N, Fleischhacker, WW, Keefe, RS, Boter, H, Keet, IP, Prelipceanu, D, Rybakowski, JK, Libiger, J, Hummer, M, Dollfus, S, Lopez-Ibor, JJ, Hranov, LG, Gaebel, W, Peuskens, J, Lindefors, N, Riecher-Rossler, A, Kahn, RS (2009). Cognitive effects of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: a randomized, open-label clinical trial (EUFEST). American Journal of Psychiatry 166, 675–682.Google Scholar
de Wit, H (2010). Flupenthixol. In Encyclopedia of Psychopharmacology: Springer Reference (ed. Stolerman, I. and Rice, L.), pp. 538–539. Springer-Verlag: Berlin Heidelberg.Google Scholar
Desamericq, G, Schurhoff, F, Meary, A, Szoke, A, Macquin-Mavier, I, Bachoud-Levi, AC, Maison, P (2014). Long-term neurocognitive effects of antipsychotics in schizophrenia: a network meta-analysis. European Journal of Clinical Pharmacology 70, 127–134.CrossRefGoogle ScholarPubMed
Dickinson, D, Ragland, JD, Gold, JM, Gur, RC (2008). General and specific cognitive deficits in schizophrenia: Goliath defeats David? Biological Psychiatry 64, 823–827.Google Scholar
Ekerholm, M, Firus, WS, Fagerberg, T, Soderman, E, Terenius, L, Agartz, I, Jonsson, EG, Nyman, H (2012). Neurocognitive function in long-term treated schizophrenia: a five-year follow-up study. Psychiatry Research 200, 144–152.CrossRefGoogle ScholarPubMed
Emsley, R, Rabinowitz, J, Torreman, M (2003). The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophrenia Research 61, 47–57.Google Scholar
First, MB, Spitzer, RLGM, Williams, LBW (1994). Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-P). New York State Psychiatric Institute, Biometrics Research: New York.Google Scholar
Goldberg, TE, Goldman, RS, Burdick, KE, Malhotra, AK, Lencz, T, Patel, RC, Woerner, MG, Schooler, NR, Kane, JM, Robinson, DG (2007). Cognitive improvement after treatment with second-generation antipsychotic medications in first-episode schizophrenia: is it a practice effect? Archive of General Psychiatry 64, 1115–1122.Google Scholar
Goldberg, TE, Keefe, RS, Goldman, RS, Robinson, DG, Harvey, PD (2010). Circumstances under which practice does not make perfect: a review of the practice effect literature in schizophrenia and its relevance to clinical treatment studies. Neuropsychopharmacology 35, 1053–1062.CrossRefGoogle Scholar
Harvey, PD, Rabinowitz, J, Eerdekens, M, Davidson, M (2005). Treatment of cognitive impairment in early psychosis: a comparison of risperidone and haloperidol in a large long-term trial. American Journal of Psychiatry 162, 1888–1895.CrossRefGoogle Scholar
International Conference on Harmonization (1996). ICH Harmonized Tripartite Guidelines for Good Clinical Practice. Brookwood Medical Publications Ltd: Richmond, Surrey.Google Scholar
Kahn, RS, Keefe, RS (2013). Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry 70, 1107–1112.Google Scholar
Kay, SR, Fizbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophrenia Bulletin 13, 261–267.Google Scholar
Keefe, RS, Bilder, RM, Davis, SM, Harvey, PD, Palmer, BW, Gold, JM, Meltzer, HY, Green, MF, Capuano, G, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Davis, CE, Hsiao, JK, Lieberman, JA (2007a). Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE Trial. Archives of General Psychiatry 64, 633–647.Google Scholar
Keefe, RS, Buchanan, RW, Marder, SR, Schooler, NR, Dugar, A, Zivkov, M, Stewart, M (2013). Clinical trials of potential cognitive-enhancing drugs in schizophrenia: what have we learned so far? Schizophrenia Bulletin 39, 417–435.CrossRefGoogle ScholarPubMed
Keefe, RS, Seidman, LJ, Christensen, BK, Hamer, RM, Sharma, T, Sitskoorn, MM, Lewine, RR, Yurgelun-Todd, DA, Gur, RC, Tohen, M, Tollefson, GD, Sanger, TM, Lieberman, JA (2004). Comparative effect of atypical and conventional antipsychotic drugs on neurocognition in first-episode psychosis: a randomized, double-blind trial of olanzapine versus low doses of haloperidol. American Journal of Psychiatry 161, 985–995.Google Scholar
Keefe, RS, Seidman, LJ, Christensen, BK, Hamer, RM, Sharma, T, Sitskoorn, MM, Rock, SL, Woolson, S, Tohen, M, Tollefson, GD, Sanger, TM, Lieberman, JA (2006). Long-term neurocognitive effects of olanzapine or low-dose haloperidol in first-episode psychosis. Biological Psychiatry 59, 97–105.Google Scholar
Keefe, RS, Silva, SG, Perkins, DO, Lieberman, JA (1999). The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia: a review and meta-analysis. Schizophrenia Bulletin 25, 201–222.Google Scholar
Keefe, RS, Sweeney, JA, Gu, H, Hamer, RM, Perkins, DO, McEvoy, JP, Lieberman, JA (2007b). Effects of olanzapine, quetiapine, and risperidone on neurocognitive function in early psychosis: a randomized, double-blind 52-week comparison. American Journal of Psychiatry 164, 1061–1071.CrossRefGoogle ScholarPubMed
Lieberman, JA, Perkins, DO, Jarskog, LF (2007). Neuroprotection: a therapeutic strategy to prevent deterioration associated with schizophrenia. CNS Spectrums 12, 1–13.CrossRefGoogle ScholarPubMed
Mishara, AL, Goldberg, TE (2004). A meta-analysis and critical review of the effects of conventional neuroleptic treatment on cognition in schizophrenia: opening a closed book. Biological Psychiatry 55, 1013–1022.Google Scholar
Nielsen, RE (2011). Cognition in schizophrenia – a systematic review. Drug Discovery Today: Therapeutic Strategies 8, 43–48.Google Scholar
Nuechterlein, KH, Green, MF (2006). MATRICS Consensus Battery Manual. MATRICS Assessment Inc.: Los Angeles.Google Scholar
Nuechterlein, KH, Green, MF, Kern, RS, Baade, LE, Barch, DM, Cohen, JD, Essock, S, Fenton, WS, Frese III, FJ, Gold, JM, Goldberg, T, Heaton, RK, Keefe, RS, Kraemer, H, Mesholam-Gately, R, Seidman, LJ, Stover, E, Weinberger, DR, Young, AS, Zalcman, S, Marder, SR (2008). The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity. American Journal of Psychiatry 165, 203–213.Google Scholar
Nuechterlein, KH, Subotnik, KL, Green, MF, Ventura, J, Asarnow, RF, Gitlin, MJ, Yee, CM, Gretchen-Doorly, D, Mintz, J (2011). Neurocognitive predictors of work outcome in recent-onset schizophrenia. Schizophrenia Bulletin 37 (Suppl. 2), S33–S40.Google Scholar
Porter, RJ, Bowie, CR, Jordan, J, Malhi, GS (2013). Cognitive remediation as a treatment for major depression: a rationale, review of evidence and recommendations for future research. Australian and New Zealand Journal of Psychiatry 47, 1165–1175.Google Scholar
Rajji, TK, Voineskos, AN, Butters, MA, Miranda, D, Arenovich, T, Menon, M, Ismail, Z, Kern, RS, Mulsant, BH (2013). Cognitive performance of individuals with schizophrenia across seven decades: a study using the MATRICS Consensus Cognitive Battery. American Journal of Geriatric Psychiatry 21, 108–118.Google Scholar
Shen, X, Xia, J, Adams, CE (2012). Flupenthixol versus placebo for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD009777. DOI: 10.1002/14651858.CD009777.pub2.CrossRefGoogle ScholarPubMed
Stern, R, White, T (2003). Neuropsychological Assessment Battery: Mazes. Psychological Assessment Resources, Incorporated: Lutz, FL.Google Scholar
Stip, E, Chouinard, S, Boulay, LJ (2005). On the trail of a cognitive enhancer for the treatment of schizophrenia. Progress in Neuropsychopharmacology and Biological Psychiatry 29, 219–232.Google Scholar
Tandon, R, Nasrallah, HA, Keshavan, MS (2009). Schizophrenia, “just the facts” 4. Clinical features and conceptualization. Schizophrenia Research 110, 1–23.Google Scholar
Woodberry, KA, McFarlane, WR, Giuliano, AJ, Verdi, MB, Cook, WL, Faraone, SV, Seidman, LJ (2013). Change in neuropsychological functioning over one year in youth at clinical high risk for psychosis. Schizophrenia Research 146, 87–94.Google Scholar
Woodward, ND, Purdon, SE, Meltzer, HY, Zald, DH (2007). A meta-analysis of cognitive change with haloperidol in clinical trials of atypical antipsychotics: dose effects and comparison to practice effects. Schizophrenia Research 89, 211–224.Google Scholar
World Health Organization (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychological Medicine 28, 551–558.Google Scholar
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