Significant and widespread cognitive problems appear to exist in schizophrenia in its earliest phase, making it very hard for people with the disorder to work, study or be social, according to a new study published by the American Psychological Association.
Understanding the early and central role of cognitive problems may help clinicians to more accurately diagnose incipient schizophrenia by telling it apart from other neuropsychiatric disorders that also have cognitive problems, such as attention-deficit hyperactivity disorder (ADHD).
It could also allow them to provide more appropriate treatment. Combining schizophrenia's cognitive warning signs with family history and signs of worsening daily functioning may also aid early diagnosis. Should improved early treatments become available, early diagnosis could make it possible to ease or even prevent these problems.
These were among the conclusions of a meta-analysis conducted by researchers at Harvard Medical School and SUNY Upstate Medical University in Syracuse, N.Y. The researchers examined 47 previously published, peer-reviewed studies of first-episode schizophrenia that involved 43 separate samples comprising 2,204 patients and 2,775 largely age- and gender-matched control participants. Results of this new analysis appear in the May issue of Neuropsychology, which is published by the American Psychological Association.
The psychologists sorted the studies' collective findings into10 areas of neurocognition, including general cognitive ability, attention, memory, and various verbal, motor and visuospatial skills. Among their main findings:
„XIn the very first episode of schizophrenia, cognitive problems were already broad and serious. Early impairment approached or matched the severity of problems seen in patients who had been sick for a while.
„XPeople experiencing their first episode of schizophrenia had significantly worse performance on all cognitive measures than healthy controls who were largely matched for gender and age.
„XPatients struggled the most with processing speed and with verbal learning and memory, especially when encoding information. Although many psychiatric and neurological illnesses, such as bipolar disorder, affect processing speed, schizophrenia seems to disrupt it more profoundly.
„XMeasured IQ and other cognitive abilities dropped the most between the high-risk period just before symptoms appear and the first acute phases. After that, these cognitive abilities were stable. This cognitive pattern, when combined with other signs such as clinical symptoms and family history, could suggest a diagnosis of schizophrenia.
The first episode of schizophrenia, which is typically in the late teens or early 20s, brings "a sense of tremendous terror, trauma and shock, along with prominent cognitive disorganization, increasingly compelling unusual and/or paranoid thoughts, altered perceptions, and loss of insight," according to lead co-authors Raquelle Mesholam-Gately, PhD, and Anthony Giuliano, PhD. Popular images of schizophrenia focus on its auditory and visual hallucinations, and strange or distressing behaviors.
However, as the authors noted, people with schizophrenia have experienced a high-risk period for a few months to two years before illness sets in, showing increased problems with daily living that foreshadow full-blown illness. Early intervention for cognitive problems might lessen their intensity and duration, allowing for a better prognosis, lower relapse rates, and better preservation of cognitive and social skills, and of family and social supports, according to the authors. The high-risk, or "prodromal," period is now a focal point for prevention, diagnosis and treatment.
Cognitive testing could also be useful for older children who have a family history of schizophrenia and emerging clinical symptoms. Doctors viewing cognitive impairments in a vacuum might think of something like ADHD, but the researchers said the new findings play up the importance of family history (schizophrenia has a genetic component) and better characterization of clinical or behavioral symptoms, especially around the age of peak risk.
At this time, there are no effective treatments for cognitive problems in schizophrenia. In the United States, the National Institute of Mental Health recently sponsored two nationwide initiatives to develop assessment standards for cognition in schizophrenia and to evaluate medicines that may potentially treat its cognitive problems. They are called Measurement and Treatment Research to Improve Cognition in Schizophrenia, or MATRICS, and Treatment Units for Research on Neurocognition and Schizophrenia, or TURNS.
Article: "Neurocognition in First-Episode Schizophrenia: A Meta-Analytic Review," Raquelle I. Mesholam-Gately, PhD, and Anthony J. Giuliano, PhD; Kirsten P. Goff, PhD, Harvard Medical School and Private Practice, Kentfield, California; Stephen V. Faraone, PhD, SUNY Upstate Medical University; Larry J. Seidman, PhD, Harvard Medical School; Neuropsychology, Vol. 23, No. 3.
(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/neu233315.pdf)
Raquelle Mesholam-Gately can be reached at firstname.lastname@example.org or by phone at (617) 626-9409 or (617) 998-5042. Anthony Giuliano can be reached at email@example.com or by phone at (617) 998-5018.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
Public Affairs | EurekAlert!
Further reports about: > ADHD > Cancer treatment > Cognition > Medical Wellness > Neurocognition > Neuropsychology > attention-deficit hyperactivity disorder > cognitive abilities > cognitive problems > effective treatment > psychiatric disorder > schizophrenia > schizophrenia's cognitive warning signs
Innovative genetic tests for children with developmental disorders and epilepsy
11.07.2018 | Christian-Albrechts-Universität zu Kiel
Oxygen loss in the coastal Baltic Sea is “unprecedentedly severe”
05.07.2018 | European Geosciences Union
For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.
To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...
For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.
Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...
Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.
A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...
Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.
"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....
Ultra-short, high-intensity X-ray flashes open the door to the foundations of chemical reactions. Free-electron lasers generate these kinds of pulses, but there is a catch: the pulses vary in duration and energy. An international research team has now presented a solution: Using a ring of 16 detectors and a circularly polarized laser beam, they can determine both factors with attosecond accuracy.
Free-electron lasers (FELs) generate extremely short and intense X-ray flashes. Researchers can use these flashes to resolve structures with diameters on the...
13.07.2018 | Event News
12.07.2018 | Event News
03.07.2018 | Event News
13.07.2018 | Event News
13.07.2018 | Materials Sciences
13.07.2018 | Life Sciences