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- Title
Cognitive Impairments in Drug-Naive Patients With First-Episode Negative Symptom–Dominant Psychosis.
- Authors
Zhang, TianHong; Wei, YanYan; Tang, XiaoChen; Cui, HuiRu; Hu, YeGang; Xu, LiHua; Liu, HaiChun; Wang, ZiXuan; Chen, Tao; Hu, Qiang; Li, ChunBo; Wang, JiJun
- Abstract
Key Points: Question: Does a distinct subtype of first-episode psychosis (FEP) characterized by predominant negative symptoms (negative symptom–dominant [NSD] psychosis) exhibit specific cognitive impairments? Findings: In this cross-sectional study, 788 patients with NSD exhibited more pronounced cognitive impairment compared with those with positive symptom–dominant or general symptom–dominant psychosis, particularly in processing speed and attention domains. The severity of cognitive impairment was positively associated with the intensity of negative symptoms, underscoring the pivotal role of negative symptoms in shaping cognitive deficits among individuals with first-episode psychosis. Meaning: The findings of this study suggest the existence of a distinct clinical subtype, NSD, within FEP, characterized by pronounced cognitive impairment. Importance: Available antipsychotic medications are predominantly used to treat positive symptoms, such as hallucinations and delusions, in patients with first-episode psychosis (FEP). However, treating negative and cognitive symptoms, which are closely related to functional outcomes, remains a challenge. Objective: To explore the cognitive characteristics of patients with negative symptom–dominant (NSD) psychosis. Design, Setting, and Participants: This large-scale cross-sectional study of patients with FEP was led by the Shanghai Mental Health Center in China from 2016 to 2021, with participants recruited from 10 psychiatric tertiary hospitals. A comprehensive cognitive assessment was performed among 788 patients with FEP who were drug-naive. Symptom profiles were determined using the Positive and Negative Symptoms Scale (PANSS), and NSD was defined as a PANSS score for negative symptoms higher than that for positive and general symptoms. Positive symptom–dominant (PSD) and general symptom–dominant (GSD) psychosis were defined similarly. Data were analyzed in 2023. Exposure: Psychotic symptoms were categorized into 3 groups: NSD, PSD, and GSD. Main Outcomes and Measures: Neurocognitive performance, assessed using the Chinese version of the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery. Results: This study included 788 individuals with FEP (median age, 22 [IQR, 17-28] years; 399 men [50.6%]). Patients with NSD exhibited more-pronounced cognitive impairment than did those with PSD or GSD. Specifically, cognitive differences between the NSD and PSD group, as well as between the NSD and GSD group, were most notable in the processing speed and attention domains (Trail Making [F = 4.410; P =.01], Symbol Coding [F = 4.957; P =.007], Verbal Learning [F = 3.198; P =.04], and Continuous Performance [F = 3.057; P =.05]). Patients with PSD and GSD showed no significant cognitive differences. Cognitive impairment was positively associated with the severity of negative symptoms. Most of the cognitive function tests used were able to differentiate patients with NSD from those with PSD and GSD, with significant differences observed across a range of tests, from Brief Visuospatial Memory Test–Revised (χ2 = 3.968; P =.05) to Brief Assessment of Cognition in Schizophrenia symbol coding (χ2 = 9.765; P =.002). Conclusions and Relevance: The findings of this cross-sectional study of patients with FEP suggest the presence of a clinical subtype characterized by a predominance of negative symptoms and cognitive impairment. This cross-sectional study compares the cognitive characteristics of patients with negative symptom–dominant first-episode psychosis with those of patients diagnosed with positive symptom–dominant and general symptom–dominant first-episode psychosis.
- Subjects
CHINA; CROSS-sectional method; PEARSON correlation (Statistics); COGNITIVE testing; DATA analysis; RESEARCH funding; SYMPTOMS; TERTIARY care; DESCRIPTIVE statistics; CHI-squared test; COGNITION disorders; NEUROPSYCHOLOGICAL tests; STATISTICS; PSYCHOSES; PSYCHIATRIC hospitals; DATA analysis software; REGRESSION analysis
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2415110
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.15110