Cognitive clusters in naturalistic psychiatric treatment for early course psychosis
Embargo Date
2027-10-28
OA Version
Citation
Abstract
Cognitive dysfunction and deficits are key components of psychosis and schizophrenia-spectrum disorders. Cognitive abilities of individuals with first-episode psychosis (FEP) at the outset of treatment have been found to be correlated to disease progression and recovery outcomes. Additionally, an individual’s history of trauma, adherence to medication, and insight regarding their diagnosis can impact their cognition at the start of treatment. Previous literature has shown that traumatic experiences, poorer medication adherence, and poorer insight is associated with decreased cognitive functioning. However, few studies have examined cognitive subgroups that exist amongst this population and the effects of cognitive functioning at the outset of treatment (baseline). Understanding an individual’s medical history and life experiences can provide crucial contextual information and provide clarity for best interventions as the patient moves through the treatment process. The present study examines individuals with FEP at the time of entry into treatment (which can be considered a subsample of those with FEP). Moreover, this study aims to identify and characterize cognitive subgroups with regard to traumatic experiences, medication adherence, and insight for patients with FEP at the outset of treatment. Specifically, a total of 43 individuals with FEP were assessed with the Brief Assessment of Cognition for Schizophrenia (BACS) for baseline cognitive performance and completed self-report assessments to determine total trauma experiences (Life Events Checklist; LEC-5), medication adherence (Medication Adherence Form), and insight (Birchwood Insight Scale; BIS). Assessments were administered and completed at patient entry to the Advancing Services for Psychosis Integration and Recovery (ASPIRE) Clinic, an early course psychosis clinic, at the Beth Israel Deaconess Medical Center in Boston, MA. Bivariate correlations were conducted, which resulted in significant positive correlations between trauma experiences and verbal fluency performance on the BACS, and between trauma experiences and symbol coding performance on the BACS. Two cognitive subgroups were also found via Principal Component Analysis: a “High Cognition” and “Low Cognition” cluster. A series of independent t-tests were run to examine the differences between the two clusters. These clusters were characterized by a significant difference in performance on symbol coding and Tower of London performance on the BACS. There were no significant differences between the two clusters in terms of trauma experiences, insight, or medication adherence. Given the pilot nature of this study, future larger-scale research is necessary to fully elucidate these associations.
Description
2024
License
Attribution 4.0 International