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Correll CU, Arango C, Fagerlund B, Galderisi S, Kas MJ, Leucht S. Identification and treatment of individuals with childhood-onset and early-onset schizophrenia. Eur Neuropsychopharmacol 2024; 82:57-71. [PMID: 38492329 DOI: 10.1016/j.euroneuro.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
Approximately 8 % of patients with schizophrenia are diagnosed before age 18, and 18 % experience their first symptoms before age 18. This narrative review explores the management of patients with early-onset schizophrenia (EOS) and childhood-onset schizophrenia (COS) from diagnosis to their transition to adult care settings. Early diagnosis of schizophrenia in children and adolescents is essential for improving outcomes, but delays are common due to overlapping of symptoms with developmental phenomena and other psychiatric conditions, including substance use, and lack of clinicians' awareness. Once diagnosed, antipsychotic treatment is key, with specific second-generation agents generally being preferred due to better tolerability and their broader efficacy evidence-base in youth. Dosing should be carefully individualized, considering age-related differences in drug metabolism and side effect liability. Clinicians must be vigilant in detecting early non-response and consider switching or dose escalation when appropriate. Since early age of illness onset is a consistent risk factor for treatment-resistant schizophrenia (TRS), clinicians need to be competent in diagnosing TRS and using clozapine. Since COS and EOS are associated with cognitive deficits and impaired functioning, psychosocial interventions should be considered to improve overall functioning and quality of life. Good long-term outcomes depend on continuous treatment engagement, and successful transitioning from pediatric to adult care requires careful planning, early preparation, and collaboration between pediatric and adult clinicians. Targeting functional outcomes and quality of life in addition to symptom remission can improve overall patient well-being. Comprehensive evaluations, age-specific assessments, and targeted interventions are needed to address the unique challenges of EOS and COS.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Birgitte Fagerlund
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences (GELIFES), Neurobiology, University of Groningen, the Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Germany; Department of Psychiatry, Department of Psychosis Studies, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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2
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Herwerth L, Prinz K, Brauner H, Müller K, Fleischhaker C. Psychosen aus dem schizophrenen Formenkreis im Jugendalter: Einflussfaktoren auf Neuropsychologie, Behandlungserfolg und Negativsymptomatik. ZEITSCHRIFT FÜR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 51:196-206. [PMID: 36205021 DOI: 10.1024/1422-4917/a000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Zusammenfassung. Fragestellung: Ziel der vorliegenden Studie war es, Einflussfaktoren auf den Erkrankungsverlauf von Kindern und Jugendlichen mit der Diagnose einer Psychose aus dem schizophrenen Formenkreis in einer stationären Eingliederungsmaßnahme zu untersuchen. Methodik: 33 Patient_innen (Durchschnittsalter 19.4 Jahre, SD = 2.3), davon 12 (36 %) weiblich, nahmen teil. Diese wurden mit klinischen Interviews (IRAOS, SANS/SAPS), neuropsychologischen Tests (WAIS-IV, TMT) und Fragebögen (FBB, BSCL) untersucht. Ergebnis: Korreliert waren das neuropsychologische Funktionsniveau und die prämorbide kognitive Leistungsfähigkeit, ebenso der Behandlungserfolg aus Patientensicht und eine gute Beziehung zum Therapeuten bzw. zur Therapeutin, außerdem eine stärkere Negativsymptomatik mit einer längeren Dauer der unbehandelten Psychose (DUP) und einem längeren ersten Krankenhausaufenthalt. Schlussfolgerung: Mögliche Ansatzpunkte zur besseren Behandlung von Jugendlichen mit Psychosen aus dem schizophrenen Formenkreis stellen eine Verkürzung der DUP und eine gute therapeutische Beziehung dar.
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Affiliation(s)
- Lisette Herwerth
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg, Deutschland
- Geteilte Erstautorenschaft
| | - Katharina Prinz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg, Deutschland
- Geteilte Erstautorenschaft
| | - Heike Brauner
- Psychotherapeutisches Wohnheim für junge Menschen Leppermühle, Buseck bei Gießen, Deutschland
| | - Katarina Müller
- Psychotherapeutisches Wohnheim für junge Menschen Leppermühle, Buseck bei Gießen, Deutschland
| | - Christian Fleischhaker
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg, Deutschland
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3
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The Dutch Bipolar Offspring Study: Cognitive Development and Psychopathology. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1559-1567. [PMID: 30887148 DOI: 10.1007/s10802-019-00532-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Various aspects of the relationship between cognitive impairment and bipolar disorder are not clear yet. This study examines cognitive and educational functioning prospectively in offspring at familial risk for bipolar disorder, in order to improve our understanding of the association between cognitive functioning and psychopathology. Bipolar offspring (N = 92) from the prospective Dutch bipolar offspring study were evaluated at adolescence and adulthood for IQ estimate, educational achievement and development of any psychiatric disorder. The main outcome was IQ estimate after 12 years of follow-up (offspring mean age 28 years). Generalized estimating equation (GEE) analyses showed that any lifetime DSM-IV axis I diagnosis was related to a lower cognitive outcome at adulthood as compared to unaffected bipolar offspring. No specific association was found for type of diagnosis. Early onset psychopathology (diagnosis at or before age 15 years) was significantly related to lower IQ estimate at adulthood, indicating a sensitive period for neurocognitive development.
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Zvereva NV, Koval-Zaitsev AA, Khromov AI. [Psychological diagnosis of cognitive dysontogenesis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:3-11. [PMID: 30141781 DOI: 10.17116/jnevro2018118523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article discusses a systematic clinical and psychological approach to different types of impaired cognitive development in children and adolescents with mental disorders in the context of the concept of cognitive dysontogenesis. The authors describe the types of cognitive dysontogenesis in schizophrenic and autistic spectrum disorders and present two models of its estimation: with complex psychometric and pathopsychological diagnosis and with a support on pathopsychological diagnosis of cognitive development only. Special attention is paid to domestic techniques developed in MHRC, which classify the types of cognitive dysontogenesis in children and adolescents with different disorders of mental development without reliance on psychometric indicators. The developed model of cognitive development profiles allows to make a conclusion about a typical picture of cognitive disorders in different versions of mental pathology.
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Affiliation(s)
- N V Zvereva
- Mental Health Research Center, Moscow, Russia, Moscow State Psycho-Pedagogical University, Moscow, Russia
| | - A A Koval-Zaitsev
- Mental Health Research Center, Moscow, Russia, Moscow State Psycho-Pedagogical University, Moscow, Russia
| | - A I Khromov
- Mental Health Research Center, Moscow, Russia, Moscow State Psycho-Pedagogical University, Moscow, Russia
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5
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Werner M, Hofsaess M, Burgbacher A, Müller K, Martin M, Fleischhaker C. [Cross-sectional data of inpatient residents of a rehabilitation center with schizophrenic psychosis diagnosis]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:505-515. [PMID: 29688117 DOI: 10.1024/1422-4917/a000581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cross-sectional data of inpatient residents of a rehabilitation center with schizophrenic psychosis diagnosis Abstract. OBJECTIVE The objective of this study is to evaluate the level of neuropsychological functioning, quality of life, content of treatment, abnormal psychology as well as the level of functioning and medication in children and adolescents who suffer from a schizophrenia spectrum disorder, treated as rehabilitation inpatients. METHODS Forty-two patients could be examined, therefore, the IRAOS, the WAIS-IV, the TMT-A/-B, the FBB-P (patient's version), the ILK-P, the SANS/SAPS, the BPRS, the BSCL, the GAF, the CGAS, and the CGI were used. RESULTS Patients' average age at onset of the disorder was 14.49 years (± 2.90). The total value of IQ was 87.00 (± 15.02), the value of TMT-A was 73.05 (± 14.51), and of the TMT-B 75.62 (± 15.15). The value for the content of treatment in the summary-score of the FBB-P was 3.05 (± 0.49). The value of the total-score in ILK-P was 2.10 (± 0.70). The summary-score of the SANS was 5.00 (± 2.90) and of the SAPS 3.00 (± 2.70). The BPRS-summary-score's value was 30.70 (± 7.80), the BSCL-GSI's value was 0.90 (± 0.50). GAF and CGAS were at 48.30 (± 12.80), respectively 51.00 (± 12.30). Clozapin has been prescribed in 25.0 % of the cases as first or second neuroleptic medication. CONCLUSION We investigated patients with VEOS and EOS living in a rehabilitation center. Usually, the course of their illness is much more severe and chronic than it is seen in a common department for child and adolescent psychiatry. Findings indicate a clear impairment in the level of neuropsychological and global functioning in contrast to rather low to moderate burden of positive/negative deficits. Satisfactory results of treatment and quality of life could be evaluated in spite of the aforementioned impairments. Medication did not conform to current guidelines, especially concerning Clozapin. Findings of the subsequent follow-up will show, if the impairment will improve under inpatient rehabilitation conditions.
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Affiliation(s)
- Micha Werner
- 1 Universitätsklinikum Freiburg, Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Freiburg
| | - Maike Hofsaess
- 1 Universitätsklinikum Freiburg, Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Freiburg
| | | | | | | | - Christian Fleischhaker
- 1 Universitätsklinikum Freiburg, Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Freiburg
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Mollon J, David AS, Zammit S, Lewis G, Reichenberg A. Course of Cognitive Development From Infancy to Early Adulthood in the Psychosis Spectrum. JAMA Psychiatry 2018; 75:270-279. [PMID: 29387877 PMCID: PMC5885954 DOI: 10.1001/jamapsychiatry.2017.4327] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Most patients with psychotic disorders experience severe cognitive impairment, but the onset and course of this impairment remain unclear. Moreover, the course of cognitive functions in other psychiatric conditions remains largely unexamined. Objective To chart the course of general and specific cognitive functions in individuals with psychotic disorders, psychotic experiences, and depression. Design, Setting, and Participants The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective cohort study comprising all live births between April 1, 1991, and December 31, 1992, in Avon, England. The dates of analysis were September 2015 to July 2016. Participants who underwent cognitive testing at ages 18 months and 4, 8, 15, and 20 years and psychiatric assessment at age 18 years were included. Main Outcomes and Measures Individuals with psychotic disorder, psychosis with depression, psychotic experiences, and depression were compared with controls. Outcomes were full-scale, verbal, and nonverbal IQ at ages 18 months and 4, 8, 15, and 20 years, as well as measures of processing speed, working memory, language, visuospatial ability, and attention at ages 8 and 20 years. Results The following numbers of individuals were available for analyses in this longitudinal birth cohort study: 511 (238 male [46.6%]) at age 18 months (mean [SD] age, 1.53 [0.03] years), 483 (229 male [47.4%]) at age 4 years (mean [SD] age, 4.07 [0.03] years), 3930 (1679 male [42.7%]) at age 8 years (mean [SD] age, 8.65 [0.29] years), 3783 (1686 male [44.6%]) at age 15 years (mean [SD] age, 15.45 [0.27] years), and 257 (90 male [35.0%]) at age 20 years (mean [SD] age, 20.06 [0.55] years). Individuals with psychotic disorder showed continually increasing deficits between infancy (18 months) and adulthood (20 years) in full-scale IQ (effect size of change [ESΔ] = -1.09, P = .02) and nonverbal IQ (ESΔ = -0.94, P = .008). The depression group showed a small, increasing deficit in nonverbal IQ (ESΔ = -0.29, P = .04) between infancy and adulthood. Between ages 8 and 20 years, the psychotic disorder group exhibited developmental lags (ie, slower growth) in measures of processing speed (ESΔ = -0.68, P = .001), working memory (ESΔ = -0.59, P = .004), and attention (ESΔ = -0.44, P = .001) and large, static deficits in measures of language (ES = -0.87, P = .005) and visuospatial ability (ES = -0.90, P = .001). There was only weak evidence for cognitive deficits in the psychosis with depression group and the psychotic experiences group. Conclusions and Relevance The findings herein suggest that the origins of psychotic disorder involve dynamic developmental processes, affecting both verbal and nonverbal abilities throughout the first 2 decades of life and leading to increasing dysfunction. These developmental processes do not manifest in other psychiatric disorders, such as psychosis with depression and depression.
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Affiliation(s)
- Josephine Mollon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England.,currently with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England
| | - Stanley Zammit
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, Wales.,Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England
| | - Abraham Reichenberg
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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7
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Neuroimaging findings from childhood onset schizophrenia patients and their non-psychotic siblings. Schizophr Res 2016; 173:124-131. [PMID: 25819937 PMCID: PMC4583796 DOI: 10.1016/j.schres.2015.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 12/14/2022]
Abstract
Childhood onset schizophrenia (COS), with onset of psychosis before age 13, is a rare form of schizophrenia that represents a more severe and chronic form of the adult onset illness. In this review we examine structural and functional magnetic resonance imaging (MRI) studies of COS and non-psychotic siblings of COS patients in the context of studies of schizophrenia as a whole. Studies of COS to date reveal progressive loss of gray matter volume and cortical thinning, ventricular enlargement, progressive decline in cerebellar volume and a significant but fixed deficit in hippocampal volume. COS is also associated with a slower rate of white matter growth and disrupted local connectivity strength. Sibling studies indicate that non-psychotic siblings of COS patients share many of these brain abnormalities, including decreased cortical thickness and disrupted white matter growth, yet these abnormalities normalize with age. Cross-sectional and longitudinal neuroimaging studies remain some of the few methods for assessing human brain function and play a pivotal role in the quest for understanding the neurobiology of schizophrenia as well as other psychiatric disorders. Parallel studies in non-psychotic siblings provide a unique opportunity to understand both risk and resilience in schizophrenia.
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8
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Rabanea-Souza T, Akiba HT, Berberian AA, Bressan RA, Dias ÁM, Lacerda ALT. Neuropsychological correlates of remission in chronic schizophrenia subjects: The role of general and task-specific executive processes. SCHIZOPHRENIA RESEARCH-COGNITION 2016; 3:39-46. [PMID: 28740806 PMCID: PMC5506725 DOI: 10.1016/j.scog.2015.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/30/2015] [Accepted: 12/23/2015] [Indexed: 01/30/2023]
Abstract
Background Although cognitive deficits have consistently been characterized as core features of schizophrenia, they have not been incorporated into definitions of remission. Furthermore, just a few studies have examined the relationship between cognitive deficits and symptomatic remission. The main aim of the present study is to evaluate the executive functioning of nonremitted schizophrenia patients. Methods 72 remitted and 42 nonremitted schizophrenia patients, and 119 healthy controls were examined. Subjects were tested with a comprehensive battery of cognitive tests, including a measure to assess the general components of executive functioning and individual tasks to tap the three specific executive dimensions assessed in the present study, namely updating, shifting and inhibition. Results Schizophrenia subjects performed poorly on general executive functioning and shifting tasks in comparison to healthy controls. Remitted subjects performed better than nonremitted on inhibition and updating tasks. Whereas being a male and showing decreases in updating increase the chances of being in the nonremitted schizophrenia subjects group, increases in shifting and updating enhance the odds of being in the healthy control group. Conclusion The present findings suggest that executive function deficits are present in chronic schizophrenic patients. In addition, specific executive processes might be associated to symptom remission. Future studies examining prospectively first-episode, drug naive patients diagnosed with schizophrenia may be especially elucidative.
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Affiliation(s)
- Thais Rabanea-Souza
- Laboratory of Interdisciplinary Clinical Neurosciences, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Henrique T Akiba
- Experimental Psychology Program, University of Sao Paulo, Sao Paulo, Brazil
| | - Arthur A Berberian
- Laboratory of Interdisciplinary Clinical Neurosciences, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo A Bressan
- Laboratory of Interdisciplinary Clinical Neurosciences, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Álvaro M Dias
- Laboratory of Interdisciplinary Clinical Neurosciences, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Acioly L T Lacerda
- Laboratory of Interdisciplinary Clinical Neurosciences, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
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9
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Zvereva NV, Strogova SE, Koval-Zaytsev AA, Simashkova NV, Khromov AI, Vlasenkova IN. [On the problem of psychological (psychometric) diagnosis of intelligence in children with developmental disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:21-27. [PMID: 26356276 DOI: 10.17116/jnevro20151155221-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A review includes the following sections corresponded with methods of investigation and groups of patients: Wechsler test for atypical autism and schizophrenia; Psycho Educational Profile (PEP) in endogenous mental pathology, the Kaufman Test of Educational Achievement in children schizophrenia, Edinburgh Picture Test in mental dysontogenesis. The results of the studies in these fields are presented.
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Affiliation(s)
- N V Zvereva
- Mental Health Research Centre Russian Academy of Sciences, Moscow; Moscow State University of Psychology and Education, Moscow
| | - S E Strogova
- Mental Health Research Centre Russian Academy of Sciences, Moscow
| | - A A Koval-Zaytsev
- Mental Health Research Centre Russian Academy of Sciences, Moscow; Moscow State University of Psychology and Education, Moscow
| | - N V Simashkova
- Mental Health Research Centre Russian Academy of Sciences, Moscow
| | - A I Khromov
- Mental Health Research Centre Russian Academy of Sciences, Moscow; Moscow State University of Psychology and Education, Moscow
| | - I N Vlasenkova
- Moscow State University of Psychology and Education, Moscow
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10
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Meier MH, Caspi A, Reichenberg A, Keefe RS, Fisher H, Harrington H, Houts R, Poulton R, Moffitt T. Neuropsychological decline in schizophrenia from the premorbid to the postonset period: evidence from a population-representative longitudinal study. Am J Psychiatry 2014; 171:91-101. [PMID: 24030246 PMCID: PMC3947263 DOI: 10.1176/appi.ajp.2013.12111438] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Despite the widespread belief that neuropsychological decline is a cardinal feature of the progression from the premorbid stage to the chronic form of schizophrenia, few longitudinal studies have examined change in neuropsychological functioning from before to after illness onset. The authors examined whether neuropsychological decline is unique to schizophrenia, whether it is generalized or confined to particular mental functions, and whether individuals with schizophrenia also have cognitive problems in everyday life. METHOD Participants were members of a representative cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed prospectively to age 38, with 95% retention. Assessment of IQ and specific neuropsychological functions was conducted at ages 7, 9, 11, and 13, and again at age 38. Informants also reported on any cognitive problems at age 38. RESULTS Individuals with schizophrenia exhibited declines in IQ and in a range of mental functions, particularly those tapping processing speed, learning, executive function, and motor function. There was little evidence of decline in verbal abilities or delayed memory, however, and the developmental progression of deficits in schizophrenia differed across mental functions. Processing speed deficits increased gradually from childhood to beyond the early teen years, whereas verbal deficits emerged early but remained static thereafter. Neuropsychological decline was specific to schizophrenia, as no evidence of decline was apparent among individuals with persistent depression, children with mild cognitive impairment, individuals matched on childhood risk factors for schizophrenia, and psychiatrically healthy individuals. Informants also noticed more cognitive problems in individuals with schizophrenia. CONCLUSIONS There is substantial neuropsychological decline in schizophrenia from the premorbid to the postonset period, but the extent and developmental progression of decline varies across mental functions. Findings suggest that different pathophysiological mechanisms may underlie deficits in different mental functions.
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Affiliation(s)
- Madeline H. Meier
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
,Duke Transdisciplinary Prevention Research Center, Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
,Duke Transdisciplinary Prevention Research Center, Center for Child and Family Policy, Duke University, Durham, NC, USA
,Institute for Genome Sciences × Policy, Duke University, Durham, NC, USA
,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, UK
| | - Abraham Reichenberg
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, UK
| | - Richard S.E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Helen Fisher
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, UK
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
,Institute for Genome Sciences × Policy, Duke University, Durham, NC, USA
,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
,Institute for Genome Sciences × Policy, Duke University, Durham, NC, USA
,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Preventive and Social Medicine, School of Medicine, University of Otago, Dunedin, New Zealand
| | - Terrie Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
,Duke Transdisciplinary Prevention Research Center, Center for Child and Family Policy, Duke University, Durham, NC, USA
,Institute for Genome Sciences × Policy, Duke University, Durham, NC, USA
,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, UK
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11
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Abstract
Cognitive impairment is recognized as a central feature of schizophrenia. Early-onset schizophrenia (EOS) represents a more severe variant of the disorder associated with onset in childhood or adolescence. Examination of the cognitive abnormalities of EOS offers the opportunity to explore how disease-related mechanisms may affect facets of cognitive development. This article summarizes and synthesizes available data with regards to the profile of cognitive impairments in EOS, their severity, and their evolution over the course of the disorder.
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12
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Zaytseva Y, Korsakova N, Agius M, Gurovich I. Neurocognitive functioning in schizophrenia and during the early phases of psychosis: targeting cognitive remediation interventions. BIOMED RESEARCH INTERNATIONAL 2013; 2013:819587. [PMID: 24089689 PMCID: PMC3780553 DOI: 10.1155/2013/819587] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/17/2013] [Accepted: 08/05/2013] [Indexed: 02/02/2023]
Abstract
Recent interest in the early course of schizophrenia accentuated altered cognition prior to the onset. Ultrahigh risk (UHR) individuals with attenuated positive symptoms and transient psychotic episodes demonstrate neurocognitive deficits across multiple domains such as memory, executive functioning, and processing speed which are consistent with similar disturbances identified in patients with a first episode of schizophrenia. Cognitive remediation (CR) approaches representing a broad set of activities are aimed to restore or improve cognitive functioning. CR proved to be effective in modulating the cognitive dysfunction in schizophrenia but is rarely used in ultrahigh risk individuals. From the clinical prospective, a better understanding of cognitive functioning in at-risk states is essential for the development of optimal early intervention models. In the review, we highlight the intervention targets, notably the specific cognitive deficits in at risk individuals which preceed the transition to psychosis and emphasize the need of the additional studies using CR approaches in UHR group aiming to enhance cognition and therefore mediate functional improvement.
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Affiliation(s)
- Yulia Zaytseva
- Department of Outpatient Psychiatry and Organization of Psychiatric Care, Moscow Research Institute of Psychiatry, Poteshnaya Street 3, Moscow 107076, Russia
| | - Natalya Korsakova
- Lomonosov Moscow State University, Mokhovaya Street 11-9, Moscow 125009, Russia
| | - Mark Agius
- Department of Psychiatry, Clare College, University of Cambridge and South Essex Partnership University Foundation Trust, Weller Wing Bedford Hospital, Kempston Road, Bedford MK42 9DJ, UK
| | - Isaac Gurovich
- Department of Outpatient Psychiatry and Organization of Psychiatric Care, Moscow Research Institute of Psychiatry, Poteshnaya Street 3, Moscow 107076, Russia
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McClellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry 2013; 52:976-90. [PMID: 23972700 DOI: 10.1016/j.jaac.2013.02.008] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/21/2013] [Indexed: 01/16/2023]
Abstract
This Practice Parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Early-onset schizophrenia is diagnosed using the same criteria as in adults and appears to be continuous with the adult form of the disorder. Clinical standards suggest that effective treatment includes antipsychotic medications combined with psychoeducational, psychotherapeutic, and educational interventions. Since this Practice Parameter was last published in 2001, several controlled trials of atypical antipsychotic agents for early-onset schizophrenia have been conducted. However, studies suggest that many youth with early-onset schizophrenia do not respond adequately to available agents and are vulnerable to adverse events, particularly metabolic side effects. Further research is needed to develop more effective and safer treatments.
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Jepsen JRM, Fagerlund B, Pagsberg AK, Christensen AMR, Nordentoft M, Mortensen EL. Profile of cognitive deficits and associations with depressive symptoms and intelligence in chronic early-onset schizophrenia patients. Scand J Psychol 2013; 54:363-70. [DOI: 10.1111/sjop.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Birgitte Fagerlund
- Lundbeck Foundation Centre for Clinical Intervention and Neuropsychiatric Schizophrenia; Research and Center for Neuropsychiatric Schizophrenia Research; Psychiatric Centre Glostrup; Copenhagen University Hospital Glostrup; Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Psychiatric Center Bispebjerg; Copenhagen University Hospital Bispebjerg; Denmark
| | | | - Merete Nordentoft
- Psychiatric Center Copenhagen; Copenhagen University Hospital Bispebjerg; Denmark
| | - Erik Lykke Mortensen
- Institute of Public Health and Center for Healthy Aging; University of Copenhagen; Denmark
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Hedman AM, van Haren NEM, van Baal GCM, Brans RGH, Hijman R, Kahn RS, Hulshoff Pol HE. Is there change in intelligence quotient in chronically ill schizophrenia patients? A longitudinal study in twins discordant for schizophrenia. Psychol Med 2012; 42:2535-2541. [PMID: 22717138 DOI: 10.1017/s0033291712000694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intellectual deficits are commonly found in schizophrenia patients. These intellectual deficits have been found to be heritable. However, whether the intellectual deficits change over time and, if so, whether the change is related with an increased genetic risk for the disease are not known. METHOD We investigated change of intelligence quotient (IQ) in a twin sample of chronically ill schizophrenia patients, the discordant co-twins and healthy controls during a follow-up period of 5 years. A total of 52 twins completed two IQ assessments: nine patients [three monozygotic (MZ) and six dizygotic (DZ)], 10 unaffected co-twins (three MZ and seven DZ) and 33 healthy control twins (21 MZ and 12 DZ). RESULTS A significant interaction effect over time was found between IQ measurement and illness (F=4.22, df=1, p<0.05), indicating that change in IQ over time is significantly different between the groups. A stable course in IQ over time was found in the patients with schizophrenia (mean IQ from 109.78 at baseline to 108.44 at follow-up) relative to both the healthy control twins who showed a small increase (from 114.61 at baseline to 119.18 at follow-up) (t=2.06, p<0.05) and the unaffected co-twins (from 111.60 to 117.60, t=-2.32, p<0.05). IQ change in the unaffected co-twins of schizophrenia patients was comparable with that in healthy control twins (t=-0.49, p=0.63). CONCLUSIONS Patients with schizophrenia in the chronic phase of the disease, but not the discordant co-twins, show a lack of increase in IQ, which is probably due to environmental (non-genetic) factors related to the disease.
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Affiliation(s)
- A M Hedman
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands.
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16
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Abstract
BACKGROUND The current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies in 1980. METHODS A systematic search of articles published in the English-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS) or both EOS and other psychotic disorders (MIX). The authors of the current review scored the outcome as either "good," "moderate," or "poor." The mean age of onset in these studies was <18 years. RESULTS In general, the outcome in studies with EOS is worse than the outcome in MIX studies. Only 15.4% of the patients in EOS studies versus 19.6% of the patients in MIX studies experienced a "good" outcome. In contrast, 24.5% of the patients in EOS studies versus 33.6% in MIX studies experienced a "moderate" outcome, and 60.1% in EOS studies versus 46.8% in MIX studies experienced a "poor" outcome. The authors identified various significant effects on outcome. In EOS, the findings were significantly affected by sample attrition, indicating that in studies with a high dropout rate, fewer patients experienced a "moderate" outcome, and more patients experienced a "poor" outcome; however, the effect sizes were small. Furthermore, the effects were also small and more favourable for specific functioning measures, as opposed to more global measures, small to moderate in terms of worse outcomes for follow-up periods >10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970. CONCLUSIONS In contrast to the adult manifestation, the early manifestation of schizophrenia in childhood and adolescence still carries a particularly poor prognosis. According to these aggregated data analyses, longer follow-up periods, male sex, and patients having been diagnosed before 1970 contribute predominantly to the rather poor course of EOS.
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Seese RR, O’Neill J, Hudkins M, Siddarth P, Levitt J, Tseng B, Wu KN, Caplan R. Proton magnetic resonance spectroscopy and thought disorder in childhood schizophrenia. Schizophr Res 2011; 133:82-90. [PMID: 21872444 PMCID: PMC3229835 DOI: 10.1016/j.schres.2011.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 07/05/2011] [Accepted: 07/09/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although magnetic resonance spectroscopy has identified metabolic abnormalities in adult and childhood schizophrenia, no prior studies have investigated the relationship between neurometabolites and thought disorder. This study examined this association in language-related brain regions using proton magnetic resonance spectroscopic imaging ((1)H MRSI). METHOD MRSI was acquired bilaterally from 28 youth with childhood-onset schizophrenia and 34 healthy control subjects in inferior frontal, middle frontal, and superior temporal gyri at 1.5T and short echo time (TR/TE = 1500/30 ms). CSF-corrected "total NAA" (tNAA; N-acetyl-aspartate + N-acetyl-aspartyl-glutamate), glutamate + glutamine (Glx), creatine + phosphocreatine (Cr + PCr), choline compounds (Cho), and myo-inositol (mI) were assayed in manually drawn regions-of-interest partitioned into gray matter, white matter, and CSF and then coregistered with MRSI. Speech samples of all subjects were coded for thought disorder. RESULTS In the schizophrenia group, the severity of formal thought disorder correlated significantly with tNAA in the left inferior frontal and superior temporal gyri and with Cr + PCr in left superior temporal gyrus. CONCLUSIONS Neurometabolite concentrations in language-related brain regions are associated with thought disorder in childhood-onset schizophrenia.
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Affiliation(s)
- Ronald R. Seese
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Joseph O’Neill
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Matthew Hudkins
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Prabha Siddarth
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Jennifer Levitt
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Ben Tseng
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Keng Nei Wu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Rochelle Caplan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
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Gogtay N, Vyas NS, Testa R, Wood SJ, Pantelis C. Age of onset of schizophrenia: perspectives from structural neuroimaging studies. Schizophr Bull 2011; 37:504-13. [PMID: 21505117 PMCID: PMC3080674 DOI: 10.1093/schbul/sbr030] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many of the major neuropsychiatric illnesses, including schizophrenia, have a typical age of onset in late adolescence. Late adolescence may reflect a critical period in brain development making it particularly vulnerable for the onset of psychopathology. Neuroimaging studies that focus on this age range may provide unique insights into the onset and course of psychosis. In this review, we examine the evidence from 2 unique longitudinal cohorts that span the ages from early childhood through young adulthood; a study of childhood-onset schizophrenia where patients and siblings are followed from ages 6 through to their early twenties, and an ultra-high risk study where subjects (mean age of 19 years) are studied before and after the onset of psychosis. From the available evidence, we make an argument that subtle, regionally specific, and genetically influenced alterations during developmental age windows influence the course of psychosis and the resultant brain phenotype. The importance of examining trajectories of development and the need for future combined approaches, using multimodal imaging together with molecular studies is discussed.
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Affiliation(s)
- Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Nora S. Vyas
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Renee Testa
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia
| | - Stephen J. Wood
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia
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19
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Abstract
AIM Early-onset schizophrenia (onset before adulthood) is a rare and severe form of the disorder that shows phenotypic and neurobiological continuity with adult-onset schizophrenia. Here, we provide a synthesis of keynote findings in this enriched population to understand better the neurobiology and pathophysiology of early-onset schizophrenia. METHODS A synthetic and integrative approach is applied to review studies stemming from epidemiology, phenomenology, cognition, genetics and neuroimaging data. We provide conclusions and future directions of research on early-onset schizophrenia. RESULTS Childhood and adolescent-onset schizophrenia is associated with severe clinical course, greater rates of premorbid abnormalities, poor psychosocial functioning and increased severity of brain abnormalities. Early-onset cases show similar neurobiological correlates and phenotypic deficits to adult-onset schizophrenia, but show worse long-term psychopathological outcome. Emerging technological advances have provided important insights into the genomic architecture of early-onset schizophrenia, suggesting that some genetic variations may occur more frequently and at a higher rate in young-onset than adult-onset cases. CONCLUSIONS Clinical, cognitive, genetic and imaging data suggest increased severity in early-onset schizophrenia. Studying younger-onset cases can provide useful insights into the neurobiological mechanisms of schizophrenia and the complexity of gene-environment interactions leading to the emergence of this debilitating disorder.
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Affiliation(s)
- Nora S Vyas
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, Maryland, USA.
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20
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Vyas NS, Kumra S, Puri BK. What insights can we gain from studying early-onset schizophrenia? The neurodevelopmental pathway and beyond. Expert Rev Neurother 2010; 10:1243-7. [PMID: 20662747 DOI: 10.1586/ern.10.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Nora S Vyas
- Department of Imaging, Imperial College Healthcare Trust, London, W12 OHS, UK
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21
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Freedman D, Brown AS. The developmental course of executive functioning in schizophrenia. Int J Dev Neurosci 2010; 29:237-43. [PMID: 21111039 DOI: 10.1016/j.ijdevneu.2010.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 11/15/2010] [Accepted: 11/15/2010] [Indexed: 11/18/2022] Open
Abstract
Executive dysfunction is a core feature of schizophrenia, but our understanding of the developmental course of this neuropsychological domain in the disease remains largely unexplored. A review of the research evidence points to a number of persistent debates about the course of executive functioning and its relation to illness course. A better understanding of the neurocognitive trajectories of executive functioning in schizophrenia could help identify the risk and modifying factors that influence the onset, severity and course of disease, and the chance to re-direct or re-shape that course and improve outcomes. To accomplish this requires assessment of the diverse and integrated nature of those abilities, and the changes over time in those abilities requires multiple instruments and techniques in order to improve the research methods and understanding of an important area of impairment in schizophrenia.
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Affiliation(s)
- David Freedman
- Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY 10032, USA.
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22
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Jepsen JRM, Fagerlund B, Pagsberg AK, Christensen AMR, Nordentoft M, Mortensen EL. Deficient maturation of aspects of attention and executive functions in early onset schizophrenia. Eur Child Adolesc Psychiatry 2010; 19:773-86. [PMID: 20680364 DOI: 10.1007/s00787-010-0126-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 07/12/2010] [Indexed: 11/24/2022]
Abstract
The few existing long-term, neuropsychological follow-up studies of early onset schizophrenia (EOS) patients have reported relative stability in some cognitive functions but abnormal developmental trajectories in verbal memory, set shifting, aspects of attention, and speed of information processing throughout late adolescence into early adulthood. The current 5-year follow-up study compared the development of specific cognitive functions in EOS patients (N = 17) from the time of first-episode to chronic phase with that of healthy controls (N = 38) and secondarily to patients with other early onset, non-organic, non-affective psychoses (EOP) (N = 11). Speed of processing of executive functions, set shifting, and attention improved significantly in the healthy controls and reflected continuous functional maturation during late adolescence and early adulthood. The developmental progression of attention and set shifting but not speed of processing of executive functions was significantly subnormal in EOS patients. Other specific cognitive functions that had attained functional maturity in the healthy controls before or around the time of the baseline assessment showed normal development in EOS patients during the follow-up period, indicating stable cognitive deficits. These results suggest post-onset developmental deficits in two out of the three aspects of attention and executive functions that have protracted maturational trajectories and that overlap the age of onset of EOS. No significant difference in the development of any specific cognitive function was found between the EOS and EOP group.
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Affiliation(s)
- Jens Richardt M Jepsen
- Child and Adolescent Psychiatric Centre Bispebjerg, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
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23
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Borofsky LA, McNealy K, Siddarth P, Wu KN, Dapretto M, Caplan R. Semantic Processing and Thought Disorder in Childhood-Onset Schizophrenia: Insights from fMRI. JOURNAL OF NEUROLINGUISTICS 2010; 23:204-222. [PMID: 22147958 PMCID: PMC3229826 DOI: 10.1016/j.jneuroling.2009.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Impairments in language processing and thought disorder are core symptoms of schizophrenia. Here we used fMRI to investigate functional abnormalities in the neural networks subserving sentence-level language processing in childhood-onset schizophrenia (COS). Fourteen children with COS (mean age: 13.34; IQ: 95) and 14 healthy controls (HC; mean age: 12.37; IQ: 104) underwent fMRI while performing a semantic judgment task previously shown to differentially engage semantic and syntactic processes. We report four main results. First, different patterns of functional specialization for semantic and syntactic processing were observed within each group, despite similar level of task performance. Second, after regressing out IQ, significant between-group differences were observed in the neural correlates of semantic and, to a lesser extent, syntactic processing, with HC children showing overall greater activity than COS children. Third, while these group differences were not related to effects of medications, a significant negative correlation was observed in the COS group between neuroleptic dosage and activity in the left inferior frontal gyrus for the semantic condition. Finally, COS children's level of thought disorder was significantly correlated with task-related activity in language-relevant networks. Taken together, these findings suggest that children with COS exhibit aberrant patterns of neural activity during semantic, and to a lesser extent syntactic, processing and that these functional abnormalities in language-relevant networks are significantly related to severity of thought disorder.
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Affiliation(s)
- L A Borofsky
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, California, 90095, USA
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Jepsen JRM, Fagerlund B, Pagsberg AK, Christensen AMR, Hilker RW, Nordentoft M, Mortensen EL. Course of intelligence deficits in early onset, first episode schizophrenia: a controlled, 5-year longitudinal study. Eur Child Adolesc Psychiatry 2010; 19:341-51. [PMID: 19763665 DOI: 10.1007/s00787-009-0053-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 08/20/2009] [Indexed: 11/25/2022]
Abstract
Only few prospective longitudinal studies have assessed the course of intelligence deficits in early onset schizophrenia (EOS), and these have used different age appropriate versions of Wechsler Intelligence Scales and age appropriate norms. The post-psychotic development of intelligence in EOS has predominantly been characterized as relatively stable in these studies. However, comparisons of IQs from different test versions based on the different norms may not permit unequivocal interpretations. The objective of the current study was to compare the development of intelligence in EOS patients (N = 10) from their first psychotic episode to 5 years of post onset with that of healthy controls (N = 35) and patients who at baseline had been diagnosed with other non-affective psychoses (N = 8). The same version of a Wechsler Intelligence Scale was administered at both baseline and follow-up assessments, and the same norms were used to derive IQs at baseline and follow-up. Significantly smaller change in mean full scale intelligence quotient (FSIQ) was found in diagnostically stable EOS patients compared with healthy controls during the follow-up period. However, no statistically significant difference in mean FSIQ change was observed between patients with EOS and patients with other non-affective psychoses, although this result must be interpreted with caution due to the small sample sizes. The results suggest abnormally slow acquisition of new intellectual information and skills in EOS patients during the first 5 years after full clinical presentation.
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Jahshan C, Heaton RK, Golshan S, Cadenhead KS. Course of neurocognitive deficits in the prodrome and first episode of schizophrenia. Neuropsychology 2010; 24:109-120. [PMID: 20063952 DOI: 10.1037/a0016791] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Understanding the trajectory of cognitive changes in the development of schizophrenia may shed light on the neurodevelopmental processes in the beginning stage of illness. Subjects at risk for psychosis (AR, n = 48), patients in their first episode of schizophrenia (FE, n = 20), and normal comparison subjects (n = 29) were assessed on a neurocognitive battery at baseline and at a 6-month follow-up. There were significant group differences across all cognitive domains as well as a significant group by time interaction in the verbal learning domain. After statistically controlling for practice effects and regression to the mean, a high proportion of FE subjects showed an improvement in verbal learning, and a significant number of AR subjects improved in general intelligence. Moreover, a higher than expected percentage of FE subjects, as well as AR subjects who later converted to psychosis, showed a deterioration in working memory and processing speed. These inconsistent trajectories suggest that some domains may improve with stabilization in the early stages of psychosis, whereas others may decline with progression of the illness, indicating possible targets for cognitive remediation strategies and candidate vulnerability markers for future psychosis.
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Affiliation(s)
- Carol Jahshan
- Joint Doctoral Program in Clinical Psychology, San Diego State University
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26
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Frangou S. Cognitive function in early onset schizophrenia: a selective review. Front Hum Neurosci 2010; 3:79. [PMID: 20140271 PMCID: PMC2816177 DOI: 10.3389/neuro.09.079.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 12/29/2009] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia is widely regarded as the clinical outcome of aberrant neurodevelopment caused by a combination of genetic and non-genetic factors. Early Onset Schizophrenia (EOS) manifests in childhood or adolescence and represents a more severe variant of the Adult Onset form of the disorder (AOS). EOS offers a unique opportunity of exploring the impact of disease related mechanisms on the developmental trajectory of cognitive function. The present review focused on the domains of general intellectual ability (IQ), attention, executive function and memory. Significant methodological variability was noted across the different studies that examined these aspects of cognition in EOS patients. Despite this, a consistent pattern emergent from the data suggesting that (a) EOS patients compared to healthy children and adolescents show impairments of medium to large effect size in IQ, attention, memory and executive function (b) despite increased clinical severity, the cognitive profile of EOS patients is comparable to that of AOS patients (c) healthy adolescents show age-related improvement in their ability to perform tests of attention, memory and executive function; this is not present in EOS patients thus resulting in increased age-related deviance in patients’ performance. This apparent decline is mostly attributable to patients’ failure to acquire new information and to use more sophisticated cognitive strategies.
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Affiliation(s)
- Sophia Frangou
- Section of Neurobiology of Psychosis, Institute of Psychiatry, King's College London London, UK
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27
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Psychiatric disorders and intellectual functioning throughout development in velocardiofacial (22q11.2 deletion) syndrome. J Am Acad Child Adolesc Psychiatry 2009; 48:1060-1068. [PMID: 19797984 DOI: 10.1097/chi.0b013e3181b76683] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Velocardiofacial syndrome (VCFS) is associated with cognitive deficits and high rates of schizophrenia and other neuropsychiatric disorders. We report the data from two large cohorts of individuals with VCFS from Israel and Western Europe to characterize the neuropsychiatric phenotype from childhood to adulthood in a large sample. METHOD Individuals with VCFS (n = 172) aged 5 to 54 years were evaluated with structured clinical interviews for psychiatric disorders and age-appropriate versions of the Wechsler intelligence tests. RESULTS The frequency of psychiatric disorders was high and remarkably similar between samples. Psychotic disorders and depression were uncommon during childhood but increased in rates during adulthood (depressive disorders: 40.7% in young adults [aged 18-24 years]; psychotic disorders: 32.1% in adults [age >24 years]). Cognitive scores were inversely associated with age in subjects with VCFS, including patients without psychosis. Specifically, Verbal IQ (VIQ) scores negatively correlated with age, and the subjects with VCFS and psychotic disorders had significantly lower VIQ scores than nonpsychotic VCFS subjects. CONCLUSIONS Neuropsychiatric deficits in individuals with VCFS seem to follow a developmental pattern. The VIQ scores are negatively associated with age and rates of mood, and psychotic disorders increase dramatically during young adulthood. The data presented here support careful monitoring of psychiatric symptoms during adolescence and young adulthood in VCFS. Prospective longitudinal studies are needed to examine the nature of age-related cognitive changes and their association with psychiatric morbidity in VCFS.
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Kumra S, Asarnow R, Grace A, Keshavan M, McClellan J, Sikich L, Wagner A. From bench to bedside: translating new research from genetics and neuroimaging into treatment development for early-onset schizophrenia. Early Interv Psychiatry 2009; 3:243-58. [PMID: 22642727 DOI: 10.1111/j.1751-7893.2009.00142.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Children and adolescents with schizophrenia share a similar pattern of phenomenological, genetic and cognitive abnormalities to adults with schizophrenia. However, an early-onset of schizophrenia (EOS) (prior to 18 years of age) is associated with a higher frequency of risk indicators associated with schizophrenia (e.g. developmental delays and familial spectrum disorders) and a worse long-term outcome. This overview examines recent research on the neurobiological alterations, possible causes, developmental trajectory and treatment of EOS and attempts to identify gaps in the field. METHOD The authors provide a selective review of major findings from genetics, neuroimaging and treatment studies of pediatric schizophrenia that were presented at a workshop sponsored by the National Institute of Mental Health. These data are synthesized in conjunction with preclinical studies into a model of the pathophysiology of EOS. RESULTS EOS is associated with a high frequency of cytogenetic abnormalities (e.g. velocardiofacial syndrome, sex chromosome anomalies) and other rare denovo chromosomal aberrations. Brain imaging research in adolescents with EOS has revealed a progressive loss of cortical grey matter post-onset of psychosis and subtle abnormalities in white matter microstructure. Although EOS patients are more likely to be treatment-refractory than their adult counterparts, there are substantial data that this subgroup is particularly responsive to clozapine. CONCLUSIONS Genetic or environmental factors operating during adolescence that reduce frontal capacity might contribute to an EOS in susceptible individuals. Additional longitudinal studies of adolescents with schizophrenia are needed to better understand the relationship between structural changes in fronto-limbic regions, stress responsivity, and cognitive and neurochemical development.
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Affiliation(s)
- Sanjiv Kumra
- Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota 55454, USA.
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29
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Olié JP, Mouaffak F, Krebs MO, Lôo H. [Schizophrenia, a neurodevelopmental illness]. ANNALES PHARMACEUTIQUES FRANÇAISES 2009; 67:251-5. [PMID: 19596098 DOI: 10.1016/j.pharma.2009.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 02/12/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY Developmental anomalies have been identified as risk factors for a future schizophrenic illness: low weight at birth, congenital malformations, delayed motor and social learning. Cognitive deficits and neurological soft signs belong to the indices of the schizophrenic spectrum. Neuroimaging has visualized various structural abnormalities present from the very beginning of schizophrenia. These structural changes may represent an exacerbation of normal neurodevelopmental processes. Moreover, vulnerability genes for schizophrenia are involved at different stages of neurodevelopment: the best studied associations are dysfunctional variants of DISC-1 and neuroregulin-1 genes, the role of other genes (dysbindin, BDNF, reelin...) remaining more widely debated. Lastly, the observation of structural chromosomal anomalies in 15% of patients suffering from schizophrenia (versus 5% of controls), more frequent in early onset schizophrenia (32% of cases) suggests a neurodevelopmental cause. Such a dynamic understanding of schizophrenia is consistent with what we know about cerebral plasticity along the life span. This does not preclude the search for cues of degenerative mechanisms. The issue now is a better characterization of the vulnerable phenotype for screening procedures to be implemented prior to disease onset.
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Affiliation(s)
- J-P Olié
- Inserm U894, Center of Psychiatry and Neurosciences, Paris, France.
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Wozniak JR, Block EE, White T, Jensen JB, Schulz SC. Clinical and neurocognitive course in early-onset psychosis: a longitudinal study of adolescents with schizophrenia-spectrum disorders. Early Interv Psychiatry 2008; 2:169-77. [PMID: 21352150 PMCID: PMC5674519 DOI: 10.1111/j.1751-7893.2008.00075.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Adolescents with psychotic disorders show deficits in IQ, attention, learning and memory, executive functioning, and processing speed that are related to important clinical variables including negative symptoms, adaptive functioning and academics. Previous studies have reported relatively consistent deficits with varying relationships to illness status and symptoms. The goals of this study were to examine these relationships in a larger sample at baseline, and also to examine the longitudinal course of these deficits in a smaller subset of adolescents. METHOD Thirty-six subjects, aged 10 to 17 years, were included at baseline. All had Diagnostic and Statistical Manual-Fourth Edition diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder and psychosis - not otherwise specified, as determined by Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children structured interviews. Patients were administered a neuropsychological battery, and Positive and Negative Syndrome Scale ratings were completed at baseline and again at 1 year (n = 14). Most participants were inpatients at baseline, and 13 of 14 were on atypical antipsychotic medication during both sessions. RESULTS At baseline, the patients demonstrated impairments in working memory, processing speed, executive function and verbal learning. No significant cognitive change was detected at 1-year follow-up. In contrast, clinical symptoms were variable across 1 year, with an improvement in positive symptoms at 1 year. No relationships between clinical and cognitive symptoms were observed, with the exception of baseline IQ predicting negative symptoms at 1 year. CONCLUSIONS Young patients with schizophrenia-spectrum disorders displayed neurocognitive impairments at baseline. Despite measurable fluctuations in clinical symptoms over the year, no significant changes were measured in cognition. Lower IQ at baseline was predictive of more negative symptoms at 1 year.
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Affiliation(s)
- Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota Medical Center-Twin Cities, Minneapolis, Minnesota 55454, USA.
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Frangou S, Hadjulis M, Vourdas A. The Maudsley early onset schizophrenia study: cognitive function over a 4-year follow-up period. Schizophr Bull 2008; 34:52-9. [PMID: 18024468 PMCID: PMC2632369 DOI: 10.1093/schbul/sbm124] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Generalized cognitive deficits have been consistently reported in adolescents with early onset schizophrenia (EOS; defined as onset before the age of 17 years). The impact on cognition of potential interactions between disease pathology and brain maturation remains unclear. We therefore compared cognitive function between 20 EOS patients and 20 healthy controls matched on age, gender, and parental socioeconomic status at 2 time points, when aged 15.58 (2.27) and after a mean interval of 4 +/- 1.08 years when aged 19.46 (2.21) years. Repeated measures analyses revealed no differences between patients and controls in the degree of change over this time period in general intellectual function and planning ability as measured by the Tower of London. There was deterioration in the verbal memory and attentional control index scores from the Wechsler Memory Scale-Revised but relative improvement in Part A of the Trail Making Test. Patients' level of symptomatology as well as the type and dose of medication were comparable at both time points. We conclude that most aspects of cognitive function remain relatively stable in EOS patients during adolescence; there is evidence for deterioration in immediate verbal memory and attention while speed of information processing may show improvement.
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Affiliation(s)
- Sophia Frangou
- Section of neurobiology of Psychosis, London, SE5 8AF, UK.
| | - Michael Hadjulis
- Section of Neurobiology of Psychosis, Institute of Psychiatry (PO66), Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Apostolos Vourdas
- Section of Neurobiology of Psychosis, Institute of Psychiatry (PO66), Kings College London, De Crespigny Park, London SE5 8AF, UK
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Abstract
Early onset schizophrenia (with onset before adulthood) represents a rarer and possibly more severe form of the disorder which has received particular attention in the last two decades. Current evidence strongly suggest continuity with adult onset schizophrenia, with phenomenological, cognitive, genetic and neuroimaging data pointing towards similar neurobiological correlates and clinical deficits but worse long term outcome. Future research in early onset cases is likely to increase further our insight into the neurodevelopmental origins of schizophrenia and the complex gene-environment interactions affecting its emergence.
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Affiliation(s)
- Marinos Kyriakopoulos
- Section of Neurobiology of Psychosis, Institute of Psychiatry, De Crespigny Park, King's College, London, UK
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Cervellione KL, Burdick KE, Cottone JG, Rhinewine JP, Kumra S. Neurocognitive deficits in adolescents with schizophrenia: longitudinal stability and predictive utility for short-term functional outcome. J Am Acad Child Adolesc Psychiatry 2007; 46:867-78. [PMID: 17581451 DOI: 10.1097/chi.0b013e318054678d] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous cross-sectional studies in adolescents with early-onset schizophrenia (EOS; onset of psychotic symptoms by 18 years of age) have reported patterns of generalized neurocognitive deficits as compared to healthy comparison subjects (HCSs). Here, the authors examined the longitudinal stability of neuropsychological deficits in adolescents with EOS relative to HCS and the associations of these deficits with short-term functional outcome in patients. METHOD Fifty-two subjects (26 EOS, 26 HCS) were evaluated using a comprehensive neuropsychological test battery a median of 13 months after baseline examination. The stability of scores and the relationship between baseline test performance and functional outcome in patients was explored. RESULTS Adolescents with EOS were impaired across neurocognitive domains at baseline and follow-up compared to HCSs; these deficits remained relatively stable over time. Follow-up social/communication, personal living, and community living skills were significantly related to attention/vigilance, working memory and verbal memory at baseline; individual cognitive domains were more strongly related to functional outcome than a global measure of intelligence. CONCLUSIONS Neuropsychological impairment in patients with EOS appears to remain relatively stable over time regardless of changes in clinical state. In addition, this report offers preliminary support for a longitudinal relationship between neurocognitive performance in specific domains and functional outcome.
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Affiliation(s)
- Kelly L Cervellione
- Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
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Greenstein D, Lerch J, Shaw P, Clasen L, Giedd J, Gochman P, Rapoport J, Gogtay N. Childhood onset schizophrenia: cortical brain abnormalities as young adults. J Child Psychol Psychiatry 2006; 47:1003-12. [PMID: 17073979 DOI: 10.1111/j.1469-7610.2006.01658.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood onset schizophrenia (COS) is a rare but severe form of the adult onset disorder. While structural brain imaging studies show robust, widespread, and progressive gray matter loss in COS during adolescence, there have been no longitudinal studies of sufficient duration to examine comparability with the more common adult onset illness. METHODS Neuro-anatomic magnetic resonance scans were obtained prospectively from ages 7 through 26 in 70 children diagnosed with COS and age and sex matched healthy controls. Cortical thickness was measured at 40,962 points across the cerebral hemispheres using a novel, fully automated, validated method. Patterns of patient-control differences in cortical development were compared over a 19-year period. RESULTS Throughout the age range, the COS group had significantly smaller mean cortical thickness compared to controls. However, the COS brain developmental trajectory appeared to normalize in posterior (parietal) regions, and remained divergent in the anterior regions (frontal and temporal) regions, and the pattern of loss became more like that seen in adults. CONCLUSIONS Cortical thickness loss in COS appears to localize with age to prefrontal and temporal regions that are seen for both medication naïve and medicated adult onset patients.
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Thaden E, Rhinewine JP, Lencz T, Kester H, Cervellione KL, Henderson I, Roofeh D, Burdick KE, Napolitano B, Cornblatt BA, Kumra S. Early-onset schizophrenia is associated with impaired adolescent development of attentional capacity using the identical pairs continuous performance test. Schizophr Res 2006; 81:157-66. [PMID: 16309895 DOI: 10.1016/j.schres.2005.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 09/19/2005] [Accepted: 09/21/2005] [Indexed: 11/20/2022]
Abstract
The authors examined performance on the Continuous Performance Test-Identical Pairs "numbers" task in adolescents with schizophrenia (n=59) and healthy controls (n=55). Adjusting for an estimate of premorbid intelligence and socioeconomic status, patients performed worse than normal controls on all three d' conditions (2-digit, 3-digit, 4-digit). However, there was a significant group-by-age-by-condition interaction (F[4,100]=4.69, p<.01) indicating an interaction between development and disease state. At the simplest level of the task (2-digit) the difference between patients with schizophrenia and controls was evident at all ages; while for the more difficult levels of the task (3-digit, 4-digit), differences between groups gradually increased across the tested age span (10 to 20 years of age). Premorbid social isolation was associated with worse attentional performance in patients, suggesting a relationship and continuity with negative symptoms. These data suggest that attentional differences in adolescents with schizophrenia are better captured by different tasks at different ages. The discrepant findings of attentional impairments reported in the literature for adolescents with schizophrenia could reflect the underlying etiological complexity of the disorder that may have a variable impact on involved brain regions and neurocognitive functioning.
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Affiliation(s)
- Emily Thaden
- The Zucker-Hillside Hospital, Department of Psychiatry Research 75-59 263rd Street, Glen Oaks, NY 11004, USA.
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Fu EJ, Cadenhead KS. Progress in the Prospective Study of the Schizophrenia Prodrome. CURRENT PSYCHOSIS & THERAPEUTICS REPORTS 2005; 3:169-174. [PMID: 21691454 PMCID: PMC3117596 DOI: 10.1007/bf02629450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Further understanding of the schizophrenia spectrum has helped to define the prodrome of the illness, leading to hopes of earlier identification and intervention in susceptible, at-risk individuals. Given the heterogeneity and comorbidity observed in the clinically and demographically identified prodromal sample, it is essential that neurobiological markers that are more closely linked to brain function, and perhaps the ability to predict evolution of psychosis, be identified. Ultimately, it may be possible to identify an algorithm of risk factors that will combine clinical and demographic risk factors with vulnerability markers associated with later development of schizophrenia to better target at-risk individuals or preventative treatment.
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Affiliation(s)
| | - Kristin S. Cadenhead
- Department of Psychiatry, 0810, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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