Associations between age and neurocognition in individuals at clinical high risk and first-episode psychosis

Gender differences in cognitive performance among young adults with first-episode schizophrenia in China

Background

Individuals with schizophrenia exhibit distinctive patterns of cognitive impairments, which pose difficulties in patients' everyday functionality and reduce patients' quality of life. Previous research suggests that many demographic variables, such as gender and age, influence the cognitive performance profiles of schizophrenia patients; however, the gender differences in neurocognitive dysfunction among first-episode schizophrenia (FES) patients remain less clear.

Methods

In this cross-sectional study, we compared the cognitive performance of FES patients to that of healthy controls (HC), with a specific focus on gender differences within the Chinese population aged under 35 years. Cognitive performance was assessed using the raw scores from the MATRICS Consensus Cognitive Battery (MCCB).

Results

FES patients show lower overall cognitive impairment across all MCCB domains compared to HCs. Significant sex effects were observed: females outperformed males in aspects of speed of processing and verbal learning in FES, while males outperformed females in parts of working memory and reasoning and problem solving among HC patients. In both FES and HC groups, females exceeded males in visual learning. Moreover, employing a three-way multivariate analysis of variance (MANOVA) displayed interaction effects between gender and clinical diagnosis in areas of speed of processing and verbal learning.

Conclusions

This suggests that schizophrenia and biological sex may jointly influence performance in these domains, emphasizing the need for early intervention and gender-sensitive approaches to address cognitive deficits in schizophrenia.

Cognitive impairments in first-episode psychosis patients with attenuated niacin response

Background

Psychosis is a complex brain disorder with diverse biological subtypes influenced by various pathogenic mechanisms, which can affect treatment efficacy. The ANR(Attenuated Niacin Response) subtype is characterized by pronounced negative symptoms and functional impairments, suggesting a distinct clinical profile. However, research on the cognitive characteristics associated with the ANR subtype in drug-naïve first-episode psychosis(FEP) patients remains limited.

Methods

This observational study involved 54 FEP patients and 52 healthy controls(HC). Clinical psychopathology was assessed using the Positive and Negative Syndrome Scale(PANSS), while cognitive performance was evaluated through the Chinese version of the MATRICS Consensus Cognitive Battery(MCCB). Additionally, niacin response was measured using aqueous methylnicotinate patches, with responses quantified to classify participants into ANR or normal niacin response (NNR) groups.

Results

Among the FEP patients, 25.9 % were classified as having ANR, significantly higher than the 7.7 % in the HC group (χ 2  = 6.247, p = 0.012). The ANR group exhibited more severe negative symptoms and higher total PANSS scores compared to the NNR group, with significant differences in cognitive performance on the Trail Making test and the Brief Visuospatial Memory Test-Revised. Correlation analyses revealed a significant positive relationship between overall symptom severity and niacin response, as well as between cognitive performance and niacin response, particularly for the Trail Making and Symbol coding tests.

Conclusions

This study demonstrates that the ANR subtype in first-episode psychosis is linked to more severe negative symptoms and cognitive impairments. Targeted assessments and interventions for patients with ANR may improve treatment outcomes and enhance understanding of cognitive dysfunction in psychotic disorders.

Neurocognitive resilience as a predictor of psychosis onset and functional outcomes in individuals at high risk

BACKGROUND

Neurocognitive resilience (NCR) refers to the ability of individuals to maintain cognitive function despite the presence of risk factors for psychosis. Investigating NCR is important as it may help predict the onset of psychosis and functional outcomes in individuals at clinical high risk (CHR) for psychosis.

METHODS

This study employed a multi-group prospective design with a 3-year follow-up as part of the ShangHai At Risk for Psychosis-Extended project. Neurocognitive performance was assessed using the Chinese version of the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery. The study focused on two primary outcomes: conversion/non-conversion to psychosis (CHR-C/CHR-NC) and non-remission/remission (CHR-NR/CHR-R). NCR was defined based on the adjusted cognitive variable relative to the healthy control(HC) group's mean, with three categories: NCR (NCR = 0) for scores within one standard deviation, NCR + (NCR = 1) for scores more than one standard deviation above, and NCR - (NCR = - 1) for scores more than one standard deviation below.

RESULTS

The study included 771 individuals at CHR (346 males, mean age 18.8 years) and 764 HCs (359 males, mean age 22.5 years). Among the CHR participants, 540 (70.0%) completed the 3-year follow-up, with 106 (19.6%) converting to psychosis (CHR-C) and 277 (51.3%) classified as non-remission (CHR-NR). Significant negative correlations were found between the total NCR score and various clinical symptoms. Comparing CHR-C and non-converters (CHR-NC), there were notable differences in NCR distributions across four cognitive measures, with a higher proportion of CHR-C individuals categorized as NCR - . For CHR-NR versus remission (CHR-R), CHR-NR individuals were more likely to be classified as NCR - across nearly all cognitive domains. The receiver operating characteristic (ROC) curve for predicting conversion to psychosis yielded an area under the curve (AUC) of 0.621 (95% CI (0.561-0.681), p = 0.0001), while the ROC for predicting non-remission demonstrated a higher AUC of 0.826 (95% CI (0.790-0.861), p < 0.0001).

CONCLUSIONS

NCR was associated with both conversion to psychosis and non-remission outcomes in CHR individuals, showing notable predictive accuracy, particularly for non-remission.

Advancements and Future Directions in Prevention Based on Evaluation for Individuals With Clinical High Risk of Psychosis: Insights From the SHARP Study

BACKGROUND AND HYPOTHESIS

This review examines the evolution and future prospects of prevention based on evaluation (PBE) for individuals at clinical high risk (CHR) of psychosis, drawing insights from the SHARP (Shanghai At Risk for Psychosis) study. It aims to assess the effectiveness of non-pharmacological interventions in preventing psychosis onset among CHR individuals.

STUDY DESIGN

The review provides an overview of the developmental history of the SHARP study and its contributions to understanding the needs of CHR individuals. It explores the limitations of traditional antipsychotic approaches and introduces PBE as a promising framework for intervention.

STUDY RESULTS

Three key interventions implemented by the SHARP team are discussed: nutritional supplementation based on niacin skin response blunting, precision transcranial magnetic stimulation targeting cognitive and brain functional abnormalities, and cognitive behavioral therapy for psychotic symptoms addressing symptomatology and impaired insight characteristics. Each intervention is evaluated within the context of PBE, emphasizing the potential for tailored approaches to CHR individuals.

CONCLUSIONS

The review highlights the strengths and clinical applications of the discussed interventions, underscoring their potential to revolutionize preventive care for CHR individuals. It also provides insights into future directions for PBE in CHR populations, including efforts to expand evaluation techniques and enhance precision in interventions.

Two-Month Cognitive Changes Enhance Prediction of Nonremission in Clinical High-Risk Individuals

BACKGROUND

Longitudinal changes in cognitive function may be crucial in predicting clinical outcomes in clinical high-risk (CHR) individuals. In this study, we aimed to investigate the predictive value of baseline cognitive impairment and short-term cognitive changes for nonremission and conversion to psychosis in individuals at CHR for psychosis compared with healthy control individuals (HCs).

METHODS

This study used a multiple-group prospective design with a 3-year follow-up. CHR individuals and HCs were assessed at baseline and at a 2-month follow-up. Neuropsychological performance was evaluated using the Chinese version of the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery.

RESULTS

The study included 310 CHR individuals and 93 HCs. Significant improvements in predicting nonremission in CHR individuals were observed when incorporating cognitive changes over 2 months (area under the receiver operating characteristic curve [AUC] for baseline cognition, 0.690; AUC for changes, 0.819; z = 3.365, p < .001). Key predictors included the Hopkins Verbal Learning Test-Revised (β = 0.083, p = .003), Wechsler Memory Scale-III spatial span (β = 0.330, p < .001), and Brief Visuospatial Memory Test-Revised (β = 0.127, p < .001). Conversely, predicting conversion to psychosis showed no significant difference between baseline and 2-month cognitive changes (AUC for baseline cognition, 0.667; AUC for changes, 0.666; z = 0.021, p = .242).

CONCLUSIONS

The findings underscore the importance of dynamic cognitive monitoring in CHR individuals. Short-term cognitive changes significantly enhanced the prediction of nonremission but did not add predictive value for conversion to psychosis beyond baseline assessments. Specific cognitive domains, such as verbal learning and working memory, were particularly valuable for predicting clinical outcomes.

Age-related differences in borderline personality disorder traits and childhood maltreatment: a cross-sectional study

Introduction

This study investigates age-related differences in Borderline Personality Disorder (BPD) traits and childhood maltreatment (CM) experiences among adolescents, young adults, and older adults within a clinical sample.

Methods

A cross-sectional design was employed, involving 2029 outpatients aged 15-50 years from the Shanghai Mental Health Center. BPD traits were assessed using the Personality Diagnostic Questionnaire 4th Edition Plus (PDQ-4+), and CM experiences were evaluated using the Child Trauma Questionnaire Short Form (CTQ-SF). Participants were categorized into three age groups: adolescents (15-21 years), young adults (22-30 years), and older adults (31-50 years).

Results

Adolescents reported significantly higher frequencies of BPD traits and diagnoses compared to young adults and older adults (p=0.036). Specifically, identity disturbance and impulsivity were more pronounced in adolescents (p<0.001). Additionally, adolescents reported higher levels of emotional (F=15.987, p<0.001) and physical abuse (F=12.942, p=0.002), while older adults reported higher levels of emotional and physical neglect. Logistic regression analysis identified key BPD criteria and CM subtypes that differentiated adolescents from adults.

Discussion

The findings underscore the importance of age-specific interventions in treating BPD and addressing childhood maltreatment. Adolescents exhibit distinct patterns of BPD traits and CM experiences, necessitating tailored therapeutic approaches.

Associations between cytokine levels and cognitive function among individuals at clinical high risk for psychosis

OBJECTIVE

To explore the intricate interplay among cytokines, cognitive functioning, and conversion to psychosis in individuals at clinical high-risk (CHR) for psychosis.

METHOD

We initially enrolled 385 individuals at CHR and 95 healthy controls (HCs). Subsequently, 102 participants at CHR completed the 1-year follow-up assessments, and 47 participants transitioned to psychosis. We assessed the levels of interleukins (IL-1β, IL-2, IL-6, IL-8, IL-10), tumor necrosis factor-α (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF), and vascular endothelial growth factor (VEGF). We comprehensively evaluated cognitive performance across six domains, including speed of processing (SP), attention/vigilance (AV), working memory (WM), verbal learning (VeL), visual learning (ViL), and reasoning and problem-solving (RPS).

RESULTS

Higher baseline cognitive domain scores were associated with elevated GM-CSF and reduced VEGF levels. In the follow-up analysis, significant time effects were observed for IL-1β and IL-2. We also observed significant interaction effects between specific cognitive domains (AV, WM, VeL, and OCS) and levels of cytokine (GM-CSF, IL-1β, IL-6, and TNF-α). Changes in WM were negatively correlated with changes in TNF-α levels and positively correlated with changes in VEGF levels. Variations in VeL were inversely correlated with changes in GM-CSF and IL-10 levels, whereas changes in RPS were positively associated with changes in GM-CSF and IL-8 levels.

CONCLUSIONS

Our results revealed intricate associations among cytokine levels, cognitive performance, and psychosis progression.

Timeframe for Conversion to Psychosis From Individuals at Clinical High-Risk: A Quantile Regression

BACKGROUND AND HYPOTHESIS

The time taken for an individual who is at the clinical high-risk (CHR) stage to transition to full-blown psychosis may vary from months to years. This temporal aspect, known as the timeframe for conversion to psychosis (TCP), is a crucial but relatively underexplored dimension of psychosis development.

STUDY DESIGN

The sample consisted of 145 individuals with CHR who completed a 5-year follow-up with a confirmed transition to psychosis within this period. Clinical variables along with functional variables such as the Global Assessment of Function (GAF) score at baseline (GAF baseline) and GAF-drop from the highest score in the past year. The TCP was defined as the duration from CHR identification to psychosis conversion. Participants were categorized into 3 groups based on TCP: "short" (≤6 months, ≤33.3%), "median" (7-17 months, 33.3%-66.6%), and "long" (≥18 months, ≥66.6%). The quantile regression analysis was applied.

STUDY RESULTS

The overall sample had a median TCP of 11 months. Significant differences among the three TCP groups were observed, particularly in GAF-drop (χ2 = 8.806, P = .012), disorganized symptoms (χ2 = 7.071, P = .029), and general symptoms (χ2 = 6.586, P = .037). Greater disorganized symptoms (odds ratio [OR] = 0.824, P = .009) and GAF-drop (OR = 0.867, P = .011) were significantly associated with a shorter TCP, whereas greater general symptoms (OR = 1.198, P = .012) predicted a longer TCP. Quantile regression analysis demonstrated a positive association between TCP and GAF baseline above the 0.7 quantile and a negative association between TCP rank and GAF drop below the 0.5 quantile.

CONCLUSIONS

This study underscores the pivotal role of functional characteristics in shaping TCP among individuals with CHR, emphasizing the necessity for a comprehensive consideration of temporal aspects in early prevention efforts.

Association between serum cytokines and timeframe for conversion from clinical high-risk to psychosis

AIM

Although many studies have explored the link between inflammatory markers and psychosis, there is a paucity of research investigating the temporal progression in individuals at clinical high-risk (CHR) who eventually develop full psychosis. To address this gap, we investigated the correlation between serum cytokine levels and Timeframe for Conversion to Psychosis (TCP) in individuals with CHR.

METHODS

We enrolled 53 individuals with CHR who completed a 5-year follow-up with a confirmed conversion to psychosis. Granulocyte macrophage-colony stimulating factor (GM-CSF), interleukin (IL)-1β, 2, 6, 8, 10, tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF) levels were measured at baseline and 1-year. Correlation and quantile regression analyses were performed.

RESULTS

The median TCP duration was 14 months. A significantly shorter TCP was associated with higher levels of TNF-α (P = 0.022) and VEGF (P = 0.016). A negative correlation was observed between TCP and TNF-α level (P = 0.006) and VEGF level (P = 0.04). Quantile regression indicated negative associations between TCP and GM-CSF levels below the 0.5 quantile, IL-10 levels below the 0.3 quantile, IL-2 levels below the 0.25 quantile, IL-6 levels between the 0.65 and 0.75 quantiles, TNF-α levels below the 0.8 quantile, and VEGF levels below the 0.7 quantile. A mixed linear effects model identified significant time effects for IL-10 and IL-2, and significant group effects for changes in IL-2 and TNF-α.

CONCLUSIONS

Our findings underscore that a more pronounced baseline inflammatory state is associated with faster progression of psychosis in individuals with CHR. This highlights the importance of considering individual inflammatory profiles during early intervention and of tailoring preventive measures for risk profiles.

Childhood maltreatment and personality disorders in adolescents and adults with psychotic or non-psychotic disorders

Introduction

While the attention to personality disorders (PD) and childhood maltreatment (CM) has grown in recent years, there remains limited understanding of the prevalence and distinctions of PD and CM in clinical populations of Chinese adolescents in comparison to adults.

Methods

A total of 1,417 participants were consecutively sampled from patients diagnosed with either psychotic or non-psychotic disorders in the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. The participants were categorized into two groups based on their age: adolescents (aged 15-21 years) and adults (aged 22-35 years). PDs were evaluated using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were assessed using the Chinese version of the Child Trauma Questionnaire Short Form.

Results

When comparing self-reported PD traits and CM between adolescents and adults, differences emerge. Adolescents, particularly in the psychotic disorder group, exhibit more pronounced schizotypal PD traits (p=0.029), and this pattern extends to non-psychotic disorders (p<0.001). Adolescents in the non-psychotic disorder group also report higher levels of emotional abuse (p=0.014), with a notable trend in physical abuse experiences compared to adults (p=0.057). Furthermore, the most prevalent PDs in the clinical sample are avoidant, borderline, and obsessive-compulsive PDs. Among patients with psychotic disorders, adolescents exhibit higher rates of schizoid, schizotypal, and obsessive-compulsive PDs compared to adults. Logistic regression analyses highlight distinct predictors for psychotic and non-psychotic disorders in adolescents and adults.

Discussion

The findings emphasize distinct differences in PDs and CMs between adolescent and adult groups, shedding light on their potential roles in psychotic and non-psychotic disorders.