Psychotic symptoms, cognition and affect as predictors of psychosocial problems and functional change in first-episode psychosis

Luyken H Stouten; Wim Veling; Winfried Laan; Mischa van der Helm; Mark van der Gaag

doi:10.1016/j.schres.2014.06.023

Psychotic symptoms, cognition and affect as predictors of psychosocial problems and functional change in first-episode psychosis

Schizophr Res. 2014 Sep;158(1-3):113-9. doi: 10.1016/j.schres.2014.06.023. Epub 2014 Jul 5.

Authors

Luyken H Stouten¹, Wim Veling², Winfried Laan³, Mischa van der Helm³, Mark van der Gaag⁴

Affiliations

¹ Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands. Electronic address: l.stouten@parnassia.nl.
² Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
³ Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands.
⁴ Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.

PMID: 25008791
DOI: 10.1016/j.schres.2014.06.023

Abstract

Objective: To enable further understanding of how cognitive deficits and psychopathology impact psychosocial functioning in first-episode psychosis patients, we investigated how psychopathology and cognitive deficits are associated with psychosocial problems at baseline, and how these predict psychosocial functioning at 12 months follow-up. Also, we tested whether the effect of baseline psychopathology on psychosocial functioning decreases between baseline and 12 months and the effect of baseline cognition increases.

Methods: Eight neurocognitive and four social cognitive subdomains and psychopathology (positive and negative symptoms, depression and anxiety) were assessed at baseline in 153 non-affective first-episode psychosis (FEP) patients. Psychosocial functioning (work/study, relationships, self-care, disturbing behavior and general psychosocial functioning) was assessed at baseline and 12 months. Spearman correlations were examined and backward regression models were computed to test our hypotheses.

Results: At baseline, psychosocial functioning was associated strongest with positive and negative symptoms of all assessed clinical domains, followed by neurocognition and social cognition. In contrast, psychosocial functioning at 12 months was not predicted by psychotic symptoms, but rather by neurocognition, social cognition and depression. Change in social functioning in the first 12 months after baseline was predicted by positive and negative symptoms, but to a similar degree by neurocognition and social cognition.

Conclusions: Whereas psychotic symptoms show marked impact on psychosocial functioning at illness onset, cognitive deficits appear to be more accurate longitudinal predictors of psychosocial problems and functional recovery in the early course of psychosis.

Keywords: Affect; First-episode psychosis; Neurocognition; Psychosocial functioning; Social cognition.

MeSH terms

Adult
Affect*
Anxiety
Cognition*
Depression
Female
Follow-Up Studies
Humans
Longitudinal Studies
Male
Neuropsychological Tests
Prognosis
Prospective Studies
Psychiatric Status Rating Scales
Psychotic Disorders / diagnosis*
Psychotic Disorders / psychology*
Regression Analysis