TY - JOUR
T1 - Cognitive function and treatment response trajectories in first-episode schizophrenia
T2 - evidence from a prospective cohort study
AU - Millgate, Edward
AU - Griffiths, Kira
AU - Egerton, Alice
AU - Kravariti, Eugenia
AU - Casetta, Cecilia
AU - Deakin, Bill
AU - Drake, Richard
AU - Howes, Oliver D.
AU - Kassoumeri, Laura
AU - Khan, Sobia
AU - Lankshear, Steve
AU - Lees, Jane
AU - Lewis, Shon
AU - Mikulskaya, Elena
AU - Oloyede, Ebenezer
AU - Owens, Rebecca
AU - Pollard, Rebecca
AU - Rich, Nathalie
AU - Smart, Sophie
AU - Segev, Aviv
AU - Verena Sendt, Kyra
AU - MacCabe, James
N1 - Funding Information:
STRATA is funded by a grant from the Medical Research Council (MRC) to JM (grant reference MR/L011794). EM’s PhD is funded by the MRC-doctoral training partnership studentship in Biomedical Sciences at King’s College London. JM, EK, AE and ODH are part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.
Publisher Copyright:
©
PY - 2022/11/21
Y1 - 2022/11/21
N2 - Objectives This prospective cohort study tested for associations between baseline cognitive performance in individuals early within their first episode and antipsychotic treatment of psychosis. We hypothesised that poorer cognitive functioning at the initial assessment would be associated with poorer antipsychotic response following the subsequent 6 weeks. Design Prospective cohort. Setting National Health Service users with a first-episode schizophrenia diagnosis, recently starting antipsychotic medication, recruited from two UK sites (King's College London, UK and University of Manchester, UK). Participants attended three study visits following screening. Participants Eighty-nine participants were recruited, with 46 included in the main analysis. Participants required to be within the first 2 years of illness onset, had received minimal antipsychotic treatment, have the capacity to provide consent, and be able to read and write in English. Participants were excluded if they met remission criteria or showed mild to no symptoms. Primary and secondary outcome measures Antipsychotic response was determined at 6 weeks using the Positive and Negative Syndrome Scale (PANSS), with cognitive performance assessed at each visit using the Brief Assessment of Cognition in Schizophrenia (BACS). The groups identified (responders and non-responders) from trajectory analyses, as well as from >20% PANSS criteria, were compared on baseline BACS performance. Results Trajectory analyses identified 84.78% of the sample as treatment responsive, and the remaining 15.22% as treatment non-responsive. Unadjusted and adjusted logistic regressions observed no significant relationship between baseline BACS on subscale and total performance (BACS t-score: OR=0.98, p=0.620, Cohen's d=0.218) and antipsychotic response at 6 weeks. Conclusions This investigation identified two clear trajectories of treatment response in the first 6 weeks of antipsychotic treatment. Responder and non-responder groups did not significantly differ on performance on the BACS, suggesting that larger samples may be required or that an association between cognitive performance and antipsychotic response is not observable in the first 2 years of illness onset. Trial registration number REC: 17/NI/0209.
AB - Objectives This prospective cohort study tested for associations between baseline cognitive performance in individuals early within their first episode and antipsychotic treatment of psychosis. We hypothesised that poorer cognitive functioning at the initial assessment would be associated with poorer antipsychotic response following the subsequent 6 weeks. Design Prospective cohort. Setting National Health Service users with a first-episode schizophrenia diagnosis, recently starting antipsychotic medication, recruited from two UK sites (King's College London, UK and University of Manchester, UK). Participants attended three study visits following screening. Participants Eighty-nine participants were recruited, with 46 included in the main analysis. Participants required to be within the first 2 years of illness onset, had received minimal antipsychotic treatment, have the capacity to provide consent, and be able to read and write in English. Participants were excluded if they met remission criteria or showed mild to no symptoms. Primary and secondary outcome measures Antipsychotic response was determined at 6 weeks using the Positive and Negative Syndrome Scale (PANSS), with cognitive performance assessed at each visit using the Brief Assessment of Cognition in Schizophrenia (BACS). The groups identified (responders and non-responders) from trajectory analyses, as well as from >20% PANSS criteria, were compared on baseline BACS performance. Results Trajectory analyses identified 84.78% of the sample as treatment responsive, and the remaining 15.22% as treatment non-responsive. Unadjusted and adjusted logistic regressions observed no significant relationship between baseline BACS on subscale and total performance (BACS t-score: OR=0.98, p=0.620, Cohen's d=0.218) and antipsychotic response at 6 weeks. Conclusions This investigation identified two clear trajectories of treatment response in the first 6 weeks of antipsychotic treatment. Responder and non-responder groups did not significantly differ on performance on the BACS, suggesting that larger samples may be required or that an association between cognitive performance and antipsychotic response is not observable in the first 2 years of illness onset. Trial registration number REC: 17/NI/0209.
KW - Adult psychiatry
KW - MENTAL HEALTH
KW - Schizophrenia & psychotic disorders
UR - http://www.scopus.com/inward/record.url?scp=85142344981&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2022-062570
DO - 10.1136/bmjopen-2022-062570
M3 - Article
C2 - 36410817
AN - SCOPUS:85142344981
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e062570
ER -