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Individual trajectories of cognitive performance in first episode psychosis: a 2-year follow-up study

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Abstract

Individual changes over time in cognition in patients with psychotic disorders have been studied very little, especially in the case of first episode psychosis (FEP). We aimed to establish whether change in individual trajectories in cognition over 2 years of a sample of 159 FEP patients was reliable and clinically significant, using the reliable change index (RCI) and clinically significant change (CSC) methods. We also studied a sample of 151 matched healthy controls. Patients and controls were assessed with a set of neuropsychological tests, as well as premorbid, clinical and functionality measures. We analysed the course of cognitive measures over time, using analysis of variance, and the individual trajectories in the cognitive measures with the regression-based RCI (RCISRB) and the CSC. The RCISRB showed that between 5.4 and 31.2% of the patients showed deterioration patterns, and between 0.6 and 8.8% showed improvement patterns in these tests over time. Patients showing better cognitive profiles according to RCISRB (worsening in zero to two cognitive measures) showed better premorbid, clinical and functional profiles than patients showing deterioration patterns in more than three tests. When combining RCISRB and CSC values, we found that less than 10% of patients showed improvement or deterioration patterns in executive function and attention measures. These results support the view that cognitive impairments are stable over the first 2 years of illness, but also that the analysis of individual trajectories could help to identify a subgroup of patients with particular phenotypes, who may require specific interventions.

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Acknowledgements

All the participants and support staff made this study possible. The authors of the PEPs Group who participated in this manuscript are: Miquel Bioque, Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain. Silvia Amoretti, Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain. Elisa Rodríguez Toscano, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, Madrid, Spain. Ángel del Rey Mejías, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, Madrid, Spain. Anna Alonso, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. Mireia Rabella, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. Itxaso González-Ortega, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; BIOARABA Health Research Institute, OSI Araba, University Hospital, Vitoria, Spain; University of the Basque Country, Vitoria, Spain; School of Psychology, University of the Basque Country, San Sebastian, Spain. Mónica Martínez-Cengotitabengoa, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; BIOARABA Health Research Institute, OSI Araba, University Hospital, Vitoria, Spain; University of the Basque Country, Vitoria, Spain; Universidad Nacional de Educación a Distancia (UNED), Centro asociado de Vitoria, Vitoria, Spain. Julio Arbej, Servicio de Psiquiatría, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain. Pedro Ruiz, Department of Medicine and Psychiatry. University of Zaragoza. Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain; Servicio de Psiquiatría, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain. Julio Sanjuan, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Clinic Hospital (INCLIVA), Valencia, Spain. Eduardo J. Aguilar, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Clinic Hospital (INCLIVA), Valencia, Spain. Anna Mané, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. Iris Cáceres, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. Carla Torrent, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, Catalonia, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona. IDIBAPS. Barcelona, Spain. Brisa Solé, Fundació Clínic, Barcelona, Spain; August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Barcelona, Catalonia, Spain; Department of Psychiatry and Clinical Psychology, University of Barcelona, Catalonia, Spain. Immaculada Baeza, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Barcelona, Catalonia, Spain; Department of Psychiatry and Clinical Psychology, University of Barcelona, Catalonia, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Spain. Josefina Castro-Fornieles, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, Catalonia, Spain; August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Barcelona, Catalonia, Spain; Department of Psychiatry and Clinical Psychology, University of Barcelona, Catalonia, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain. Àuria Albacete, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Psychiatry Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. Jose Manuel Menchón, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Psychiatry Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. Leticia García-Álvarez, Psychiatry Department, University of Oviedo, Oviedo, Spain; Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain. Susana Al-Halabí Díaz, Psychiatry Department, University of Oviedo, Oviedo, Spain; Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain. Miguel Gutiérrrez, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; BIOARABA Health Research Institute, OSI Araba, University Hospital, Vitoria, Spain; University of the Basque Country, Vitoria, Spain. Rafael Segarra, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; BIOCRUCES Health Research Institute, OSI Bizkaia, University Hospital Cruces, Baracaldo, Spain; University of the Basque Country, Spain. Isabel Morales-Muñoz, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain. Roberto Rodriguez-Jimenez, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain. Elena Rubio-Abadal, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Sant Boi de Llobregat Barcelona, Spain; Sant Joan de Déu Research Foundation, Esplugues de Llobregat, Barcelona, Spain; Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Spain. Judith Usall, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Sant Boi de Llobregat Barcelona, Spain; Sant Joan de Déu Research Foundation, Esplugues de Llobregat, Barcelona, Spain; Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Spain. Ramón Landín-Romero, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain. Edith Pomarol-Clotet, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain. Ángela Ibáñez, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain. Jose M. López-Ilundain, Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. Vicente Balanzá-Martínez, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain; Hospital de Bétera. Departament de Medicina. Universitat de València, Valencia, Spain.

Funding

This work was supported by the Carlos III Health Institute (European Regional Development Funds-ERDF) of the Spanish Ministry of Economic Affairs and Competitiveness (08/1026, 11/02831, 14/01621) and the Health Department of the Government of Navarra (87/2014).

Author information

Authors and Affiliations

  1. Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 3, 31008, Pamplona, Spain

    A. M. Sánchez-Torres, L. Moreno-Izco, R. Lorente-Omeñaca, M. Ribeiro & M. J. Cuesta

  2. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    A. M. Sánchez-Torres, L. Moreno-Izco, R. Lorente-Omeñaca, M. Ribeiro & M. J. Cuesta

  3. Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain

    B. Cabrera, G. Mezquida & M. Bernardo

  4. Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain

    B. Cabrera, A. M. González-Pinto, J. Merchán-Naranjo, I. Corripio, E. Vieta, E. de la Serna, A. Butjosa, F. Contreras, S. Sarró & M. Bernardo

  5. Department of Medicine and Psychiatry, Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Saragossa, Spain

    A. Lobo

  6. BIOARABA Health Research Institute, OSI Araba University Hospital, Vitoria, Spain

    A. M. González-Pinto

  7. University of the Basque Country, Vitoria, Spain

    A. M. González-Pinto

  8. Child and Adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, IISGM, Universidad Complutense, Madrid, Spain

    J. Merchán-Naranjo

  9. Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    I. Corripio

  10. Department of Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, Catalonia, Spain

    E. Vieta

  11. August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Catalonia, Barcelona, Spain

    E. Vieta

  12. Department of Psychiatry and Clinical Psychology, University of Barcelona, Catalonia, Spain

    E. Vieta

  13. Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain

    E. de la Serna

  14. Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Sant Boi de Llobregat, Barcelona, Spain

    A. Butjosa

  15. Sant Joan de Déu Research Foundation. Esplugues de Llobregat, Barcelona, Spain

    A. Butjosa

  16. Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Barcelona, Spain

    A. Butjosa

  17. Psychiatry Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, Spain

    F. Contreras

  18. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain

    F. Contreras

  19. FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain

    S. Sarró

  20. Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain

    E. Vieta & M. Bernardo

Authors
  1. A. M. Sánchez-Torres
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  2. L. Moreno-Izco
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  3. R. Lorente-Omeñaca
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  4. B. Cabrera
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  5. A. Lobo
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  6. A. M. González-Pinto
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  7. J. Merchán-Naranjo
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  8. I. Corripio
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  9. E. Vieta
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  10. E. de la Serna
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  11. A. Butjosa
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  12. F. Contreras
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  13. S. Sarró
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  14. G. Mezquida
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  15. M. Ribeiro
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  16. M. Bernardo
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  17. M. J. Cuesta
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Consortia

PEPs group

  • Miquel Bioque
  • , Silvia Amoretti
  • , Elisa Rodríguez Toscano
  • , Ángel del Rey Mejías
  • , Anna Alonso
  • , Mireia Rabella
  • , Itxaso González-Ortega
  • , Mónica Martínez-Cengotitabengoa
  • , Julio Arbej
  • , Pedro Ruiz
  • , Julio Sanjuan
  • , Eduardo J. Aguilar
  • , Anna Mané
  • , Iris Cáceres
  • , Carla Torrent
  • , Brisa Solé
  • , Immaculada Baeza
  • , Josefina Castro-Fornieles
  • , Àuria Albacete
  • , Jose Manuel Menchón
  • , Leticia García-Álvarez
  • , Susana Al-Halabí Díaz
  • , Miguel Gutiérrrez
  • , Rafael Segarra
  • , Isabel Morales-Muñoz
  • , Roberto Rodriguez-Jimenez
  • , Elena Rubio-Abadal
  • , Judith Usall
  • , Ramón Landín-Romero
  • , Edith Pomarol-Clotet
  • , Ángela Ibáñez
  • , Jose M. López-Ilundain
  •  & Vicente Balanzá-Martínez

Corresponding author

Correspondence to M. J. Cuesta.

Ethics declarations

Conflict of interest

Dr. Cuesta has received research funding from the Spanish Ministry of Science and Innovation (Carlos III Health Institute), the Government of Navarre and the “Plan Nacional sobre Drogas” from the Spanish Ministry of Health. Dr. Gonzalez-Pinto has received grants and served as consultant, advisor or CME speaker for the following entities: Almirall, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Glaxo-Smith-Kline, Janssen-Cilag, Jazz, Johnson & Johnson, Lundbeck, Merck, Otsuka, Pfizer, Sanofi-Aventis, Servier, Shering-Plough, Solvay, the Spanish Ministry of Science and Innovation (CIBERSAM), the Ministry of Science (Carlos III Institute), the Basque Government, the Stanley Medical Research Institute, and Wyeth. Dr. R. Rodriguez-Jimenez has been a consultant for, spoken in activities of, or received grants from: Instituto de Salud Carlos III, Fondo de Investigación Sanitaria (FIS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid Regional Government (S2010/BMD-2422 AGES), Janssen Cilag, Lundbeck, Otsuka, Pfizer, Ferrer, Juste. Dr. Vieta has received grants and served as consultant, advisor or CME speaker for the following entities: AB-Biotics, Actavis, Allergan, AstraZeneca, Bristol-Myers Squibb, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, Shire, Sunovion, Takeda, Telefónica, the Brain and Behaviour Foundation, the Spanish Ministry of Science and Innovation (CIBERSAM), the Seventh European Framework Programme (ENBREC), and the Stanley Medical Research Institute. The rest of authors have no conflicts of interest to declare.

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Sánchez-Torres, A.M., Moreno-Izco, L., Lorente-Omeñaca, R. et al. Individual trajectories of cognitive performance in first episode psychosis: a 2-year follow-up study. Eur Arch Psychiatry Clin Neurosci 268, 699–711 (2018). https://doi.org/10.1007/s00406-017-0857-z

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