Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-20T01:51:12.080Z Has data issue: false hasContentIssue false

Developmental trajectories of premorbid functioning predict cognitive remediation treatment response in first-episode schizophrenia

Published online by Cambridge University Press:  09 November 2022

Susan S. Kuo*
Affiliation:
Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
Joseph Ventura
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
Jennifer K. Forsyth
Affiliation:
Department of Psychology, University of Washington, Seattle, USA
Kenneth L. Subotnik
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
Luana R. Turner
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
Keith H. Nuechterlein
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA Department of Psychology, UCLA, Los Angeles, USA
*
Author for correspondence: Susan S. Kuo, E-mail: susankuo@broadinstitute.org

Abstract

Background

Cognitive development after schizophrenia onset can be shaped by interventions such as cognitive remediation, yet no study to date has investigated whether patterns of early behavioral development may predict later cognitive changes following intervention. We therefore investigated the extent to which premorbid adjustment trajectories predict cognitive remediation gains in schizophrenia.

Methods

In a total sample of 215 participants (170 first-episode schizophrenia participants and 45 controls), we classified premorbid functioning trajectories from childhood through late adolescence using the Cannon-Spoor Premorbid Adjustment Scale. For the 62 schizophrenia participants who underwent 6 months of computer-assisted, bottom-up cognitive remediation interventions, we identified MATRICS Consensus Cognitive Battery scores for which participants demonstrated mean changes after intervention, then evaluated whether developmental trajectories predicted these changes.

Results

Growth mixture models supported three premorbid functioning trajectories: stable-good, deteriorating, and stable-poor adjustment. Schizophrenia participants demonstrated significant cognitive remediation gains in processing speed, verbal learning, and overall cognition. Notably, participants with stable-poor trajectories demonstrated significantly greater improvements in processing speed compared to participants with deteriorating trajectories.

Conclusions

This is the first study to our knowledge to characterize the associations between premorbid functioning trajectories and cognitive remediation gains after schizophrenia onset, indicating that 6 months of bottom-up cognitive remediation appears to be sufficient to yield a full standard deviation gain in processing speed for individuals with early, enduring functioning difficulties. Our findings highlight the connection between trajectories of premorbid and postmorbid functioning in schizophrenia and emphasize the utility of considering the lifespan developmental course in personalizing therapeutic interventions.

Type
Original Article
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, D. N., Strauss, G. P., Barchard, K. A., Vertinski, M., Carpenter, W. T., & Buchanan, R. W. (2013). Differences in developmental changes in academic and social premorbid adjustment between males and females with schizophrenia. Schizophrenia Research, 146(1–3), 132137. doi: 10.1016/j.schres.2013.01.032CrossRefGoogle ScholarPubMed
Bechi, M., Agostoni, G., Buonocore, M., Bosinelli, F., Spangaro, M., Bianchi, L., … Bosia, M. (2020). The influence of premorbid adjustment and autistic traits on social cognitive dysfunction in schizophrenia. Journal of the International Neuropsychological Society, 26(3), 276285. doi: 10.1017/s1355617719000961CrossRefGoogle ScholarPubMed
Bell, M., Bryson, G., Greig, T., Corcoran, C., & Wexler, B. E. (2001). Neurocognitive enhancement therapy with work therapy: Effects on neuropsychological test performance. Archives of General Psychiatry, 58(8), 763768. doi: 10.1001/archpsyc.58.8.763CrossRefGoogle ScholarPubMed
Best, M. W., & Bowie, C. R. (2017). A review of cognitive remediation approaches for schizophrenia: From top-down to bottom-up, brain training to psychotherapy. Expert Review of Neurotherapeutics, 17(7), 713723. doi: 10.1080/14737175.2017.1331128CrossRefGoogle ScholarPubMed
Bowie, C. R., Bell, M. D., Fiszdon, J. M., Johannesen, J. K., Lindenmayer, J. P., McGurk, S. R., … Wykes, T. (2020). Cognitive remediation for schizophrenia: An expert working group white paper on core techniques. Schizophrenia Research, 215, 4953. doi: 10.1016/j.schres.2019.10.047CrossRefGoogle Scholar
Bowie, C. R., Grossman, M., Gupta, M., Oyewumi, L. K., & Harvey, P. D. (2014). Cognitive remediation in schizophrenia: Efficacy and effectiveness in patients with early versus long-term course of illness. Early Intervention in Psychiatry, 8(1), 3238. doi: 10.1111/eip.12029CrossRefGoogle ScholarPubMed
Brill, N., Reichenberg, A., Weiser, M., & Rabinowitz, J. (2008). Validity of the premorbid adjustment scale. Schizophrenia Bulletin, 34(5), 981983. doi: 10.1093/schbul/sbm128CrossRefGoogle ScholarPubMed
Buonocore, M., Bosinelli, F., Bechi, M., Spangaro, M., Piantanida, M., Cocchi, F., … Bosia, M. (2019). The role of premorbid adjustment in schizophrenia: Focus on cognitive remediation outcome. Neuropsychological Rehabilitation, 29(10), 16111624. doi: 10.1080/09602011.2018.1433048CrossRefGoogle ScholarPubMed
Cannon-Spoor, H. E., Potkin, S. G., & Wyatt, R. J. (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin, 8(3), 470484. doi: 10.1093/schbul/8.3.470CrossRefGoogle ScholarPubMed
Catalan, A., Salazar de Pablo, G., Vaquerizo Serrano, J., Mosillo, P., Baldwin, H., Fernández-Rivas, A., … Fusar-Poli, P. (2021). Annual research review: Prevention of psychosis in adolescents - systematic review and meta-analysis of advances in detection, prognosis and intervention. Journal of Child Psychology and Psychiatry, 62(5), 657673. doi: 10.1111/jcpp.13322CrossRefGoogle ScholarPubMed
Chan, C. C., Shanahan, M., Ospina, L. H., Larsen, E. M., & Burdick, K. E. (2019). Premorbid adjustment trajectories in schizophrenia and bipolar disorder: A transdiagnostic cluster analysis. Psychiatry Research, 272, 655662. doi: 10.1016/j.psychres.2018.12.169CrossRefGoogle ScholarPubMed
Clissold, M., & Crowe, S. F. (2019). Comparing the effect of the subcategories of atypical antipsychotic medications on cognition in schizophrenia using a meta-analytic approach. Journal of Clinical and Experimental Neuropsychology, 41(1), 2642. doi: 10.1080/13803395.2018.1488952CrossRefGoogle ScholarPubMed
Cole, V. T., Apud, J. A., Weinberger, D. R., & Dickinson, D. (2012). Using latent class growth analysis to form trajectories of premorbid adjustment in schizophrenia. Journal of Abnormal Psychology, 121(2), 388395. doi: 10.1037/a0026922CrossRefGoogle ScholarPubMed
Corbera, S., Wexler, B. E., Poltorak, A., Thime, W. R., & Kurtz, M. M. (2017). Cognitive remediation for adults with schizophrenia: Does age matter? Psychiatry Research, 247, 2127. doi: 10.1016/j.psychres.2016.10.084CrossRefGoogle ScholarPubMed
Deste, G., Barlati, S., Galluzzo, A., Corsini, P., Valsecchi, P., Turrina, C., & Vita, A. (2019). Effectiveness of cognitive remediation in early versus chronic schizophrenia: A preliminary report. Frontiers in Psychiatry, 10, 236. doi: 10.3389/fpsyt.2019.00236CrossRefGoogle ScholarPubMed
Dunn, O. J. (1961). Multiple comparisons among means. Journal of the American Statistical Association, 56(293), 5264. doi: 10.2307/2282330CrossRefGoogle Scholar
Eack, S. M., Hogarty, G. E., Cho, R. Y., Prasad, K. M., Greenwald, D. P., Hogarty, S. S., & Keshavan, M. S. (2010). Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: Results from a 2-year randomized controlled trial. Archives of General Psychiatry, 67(7), 674682. doi: 10.1001/archgenpsychiatry.2010.63CrossRefGoogle ScholarPubMed
Fett, A. K., Viechtbauer, W., Dominguez, M. D., Penn, D. L., van Os, J., & Krabbendam, L. (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis. Neuroscience and Biobehavioral Reviews, 35(3), 573588. doi: 10.1016/j.neubiorev.2010.07.001CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1995). Structured clinical interview for DSM-IV axis I disorders. New York: New York State Psychiatric Institute.Google Scholar
Fisher, M., Loewy, R., Carter, C., Lee, A., Ragland, J. D., Niendam, T., … Vinogradov, S. (2015). Neuroplasticity-based auditory training via laptop computer improves cognition in young individuals with recent onset schizophrenia. Schizophrenia Bulletin, 41(1), 250258. doi: 10.1093/schbul/sbt232CrossRefGoogle ScholarPubMed
Friedman-Yakoobian, M. S., Parrish, E. M., Eack, S. M., & Keshavan, M. S. (2020). Neurocognitive and social cognitive training for youth at clinical high risk (CHR) for psychosis: A randomized controlled feasibility trial. Schizophrenia Research, 243, 302306. doi: 10.1016/j.schres.2020.09.005.CrossRefGoogle ScholarPubMed
Glenthøj, L. B., Hjorthøj, C., Kristensen, T. D., Davidson, C. A., & Nordentoft, M. (2017). The effect of cognitive remediation in individuals at ultra-high risk for psychosis: A systematic review. npj Schizophrenia, 3(1), 20. doi: 10.1038/s41537-017-0021-9CrossRefGoogle ScholarPubMed
Goldstein, M. J., Judd, L. L., Rodnick, E. H., & LaPolla, A. (1969). Psychophysiological and behavioral effects of phenothiazine administration in acute schizophrenics as a function of premorbid status. Journal of Psychiatric Research, 6(4), 271287. doi: 10.1016/0022-3956(69)90021-1CrossRefGoogle Scholar
Green, M. F., Kern, R. S., & Heaton, R. K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: Implications for MATRICS. Schizophrenia Research, 72(1), 4151. doi: 10.1016/j.schres.2004.09.009CrossRefGoogle ScholarPubMed
Hatzimanolis, A., Stefanatou, P., Kattoulas, E., Ralli, I., Dimitrakopoulos, S., Foteli, S., … Stefanis, N. C. (2020). Familial and socioeconomic contributions to premorbid functioning in psychosis: Impact on age at onset and treatment response. European Psychiatry, 63(1), e44. doi: 10.1192/j.eurpsy.2020.41CrossRefGoogle ScholarPubMed
Hauser, M., Zhang, J. P., Sheridan, E. M., Burdick, K. E., Mogil, R., Kane, J. M., … Correll, C. U. (2017). Neuropsychological test performance to enhance identification of subjects at clinical high risk for psychosis and to be most promising for predictive algorithms for conversion to psychosis: A meta-analysis. Journal of Clinical Psychiatry, 78(1), e28e40. doi: 10.4088/JCP.15r10197CrossRefGoogle ScholarPubMed
Horton, L. E., Tarbox, S. I., Olino, T. M., & Haas, G. L. (2015). Trajectories of premorbid childhood and adolescent functioning in schizophrenia-spectrum psychoses: A first-episode study. Psychiatry Research, 227(2–3), 339346. doi: 10.1016/j.psychres.2015.02.013CrossRefGoogle ScholarPubMed
Klein, D. F., & Rosen, B. (1973). Premorbid asocial adjustment and response to phenothiazine treatment among schizophrenic inpatients. Archives of General Psychiatry, 29(4), 480485. doi: 10.1001/archpsyc.1973.04200040034006CrossRefGoogle ScholarPubMed
Knowles, E. E., David, A. S., & Reichenberg, A. (2010). Processing speed deficits in schizophrenia: Reexamining the evidence. American Journal of Psychiatry, 167(7), 828835. doi: 10.1176/appi.ajp.2010.09070937CrossRefGoogle ScholarPubMed
Kuo, S. S., Almasy, L., Gur, R. C., Prasad, K., Roalf, D. R., Gur, R. E., … Pogue-Geile, M. F. (2018). Cognition and community functioning in schizophrenia: The nature of the relationship. Journal of Abnormal Psychology, 127(2), 216227. doi: 10.1037/abn0000326CrossRefGoogle ScholarPubMed
MacBeth, A., & Gumley, A. (2008). Premorbid adjustment, symptom development and quality of life in first episode psychosis: A systematic review and critical reappraisal. Acta Psychiatrica Scandinavica, 117(2), 8599. doi: 10.1111/j.1600-0447.2007.01134.xCrossRefGoogle ScholarPubMed
Mahncke, H. W., Connor, B. B., Appelman, J., Ahsanuddin, O. N., Hardy, J. L., Wood, R. A., … Merzenich, M. M. (2006). Memory enhancement in healthy older adults using a brain plasticity-based training program: A randomized, controlled study. Proceedings of the National Academy of Sciences of the USA, 103(33), 1252312528. doi: 10.1073/pnas.0605194103CrossRefGoogle ScholarPubMed
Medalia, A., Herlands, T., & Revheim, N. (2009). Cognitive remediation for psychological disorders: Therapist guide (1st ed.). New York, NY: Oxford University Press.10.1093/med:psych/9780195383713.001.0001CrossRefGoogle Scholar
Miyamoto, S., Miyake, N., Jarskog, L. F., Fleischhacker, W. W., & Lieberman, J. A. (2012). Pharmacological treatment of schizophrenia: A critical review of the pharmacology and clinical effects of current and future therapeutic agents. Molecular Psychiatry, 17(12), 12061227. doi: 10.1038/mp.2012.47CrossRefGoogle ScholarPubMed
Morice, R., Urbanc, S., & McNicol, D. (1985). The Premorbid Adjustment Scale (PAS): Its use in an Australian study. Australian and New Zealand Journal of Psychiatry, 19(4), 390395. doi: 10.3109/00048678509158847CrossRefGoogle Scholar
Mothersill, D., & Donohoe, G. (2019). Neural effects of cognitive training in schizophrenia: A systematic review and activation likelihood estimation meta-analysis. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4(8), 688696. doi: 10.1016/j.bpsc.2019.03.005Google ScholarPubMed
Murray, R. M., & Lewis, S. W. (1987). Is schizophrenia a neurodevelopmental disorder? British Medical Journal (Clinical Research Edition), 295(6600), 681682. doi: 10.1136/bmj.295.6600.681CrossRefGoogle ScholarPubMed
Muthén, L. K., & Muthén, B. O. (2010). Mplus: Statistical analysis with latent variables: User's guide. Los Angeles: Muthén & Muthén.Google Scholar
Nielsen, R. E., Levander, S., Kjaersdam Telléus, G., Jensen, S. O., Østergaard Christensen, T., & Leucht, S. (2015). Second-generation antipsychotic effect on cognition in patients with schizophrenia – a meta-analysis of randomized clinical trials. Acta Psychiatrica Scandinavica, 131(3), 185196. doi: 10.1111/acps.12374CrossRefGoogle ScholarPubMed
Nieman, D. H., Ruhrmann, S., Dragt, S., Soen, F., van Tricht, M. J., Koelman, J. H., … de Haan, L. (2014). Psychosis prediction: Stratification of risk estimation with information-processing and premorbid functioning variables. Schizophrenia Bulletin, 40(6), 14821490. doi: 10.1093/schbul/sbt145CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Green, M. F., Kern, R. S., Baade, L. E., Barch, D. M., Cohen, J. D., … Marder, S. R. (2008). The MATRICS Consensus Cognitive Battery, part 1: Test selection, reliability, and validity. American Journal of Psychiatry, 165(2), 203213. doi: 10.1176/appi.ajp.2007.07010042CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., McEwen, S. C., Ventura, J., Subotnik, K. L., Turner, L. R., Boucher, M., … Hayata, J. N. (2021). Aerobic exercise enhances cognitive training effects in first episode schizophrenia: Randomized clinical trial demonstrates cognitive and functional gains.10.1017/S0033291722001696CrossRefGoogle Scholar
Nuechterlein, K. H., Ventura, J., Subotnik, K. L., Gretchen-Doorly, D., Turner, L. R., Casaus, L. R., … Medalia, A. (2020). A randomized controlled trial of cognitive remediation and long-acting injectable risperidone after a first episode of schizophrenia: Improving cognition and work/school functioning. Psychological Medicine, 52(8), 15171526. doi: 10.1017/S0033291720003335.CrossRefGoogle ScholarPubMed
Oliver, D., Reilly, T. J., Baccaredda Boy, O., Petros, N., Davies, C., Borgwardt, S., … Fusar-Poli, P. (2020). What causes the onset of psychosis in individuals at clinical high risk? A meta-analysis of risk and protective factors. Schizophrenia Bulletin, 46(1), 110120. doi: 10.1093/schbul/sbz039CrossRefGoogle Scholar
Rabinowitz, J., Napryeyenko, O., Burba, B., Martinez, G., Neznanov, N. G., Fischel, T., … Schreiner, A. (2011). Premorbid functioning and treatment response in recent-onset schizophrenia: Prospective study with risperidone long-acting injectable. Journal of Clinical Psychopharmacology, 31(1), 7581. doi: 10.1097/JCP.0b013e31820568c6CrossRefGoogle ScholarPubMed
Ramsay, I. S., & MacDonald, A. W. III. (2015). Brain correlates of cognitive remediation in schizophrenia: Activation likelihood analysis shows preliminary evidence of neural target engagement. Schizophrenia Bulletin, 41(6), 12761284. doi: 10.1093/schbul/sbv025CrossRefGoogle ScholarPubMed
Randers, L., Jepsen, J. R. M., Fagerlund, B., Nordholm, D., Krakauer, K., Hjorthøj, C., … Nordentoft, M. (2021). Generalized neurocognitive impairment in individuals at ultra-high risk for psychosis: The possible key role of slowed processing speed. Brain and Behavior, 11(3), e01962. doi: 10.1002/brb3.1962CrossRefGoogle ScholarPubMed
Seccomandi, B., Agbedjro, D., Bell, M., Keefe, R. S. E., Keshavan, M., Galderisi, S., … Cella, M. (2021). Can IQ moderate the response to cognitive remediation in people with schizophrenia? Journal of Psychiatric Research, 133, 3845. doi: 10.1016/j.jpsychires.2020.12.013CrossRefGoogle ScholarPubMed
Strous, R. D., Alvir, J. M., Robinson, D., Gal, G., Sheitman, B., Chakos, M., & Lieberman, J. A. (2004). Premorbid functioning in schizophrenia: Relation to baseline symptoms, treatment response, and medication side effects. Schizophrenia Bulletin, 30(2), 265278. doi: 10.1093/oxfordjournals.schbul.a007077CrossRefGoogle ScholarPubMed
Tarbox, S. I., Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., Perkins, D. O., … Woods, S. W. (2013). Premorbid functional development and conversion to psychosis in clinical high-risk youths. Development and Psychopathology, 25(4 Pt 1), 11711186. doi: 10.1017/s0954579413000448CrossRefGoogle ScholarPubMed
Velthorst, E., Reichenberg, A., Kapra, O., Goldberg, S., Fromer, M., Fruchter, E., … Weiser, M. (2016). Developmental trajectories of impaired community functioning in schizophrenia. JAMA Psychiatry, 73(1), 4855. doi: 10.1001/jamapsychiatry.2015.2253CrossRefGoogle ScholarPubMed
Ventura, J., Subotnik, K. L., Gitlin, M. J., Gretchen-Doorly, D., Ered, A., Villa, K. F., … Nuechterlein, K. H. (2015). Negative symptoms and functioning during the first year after a recent onset of schizophrenia and 8 years later. Schizophrenia Research, 161(2–3), 407413. doi: 10.1016/j.schres.2014.10.043CrossRefGoogle ScholarPubMed
Ventura, J., Subotnik, K. L., Gretchen-Doorly, D., Casaus, L., Boucher, M., Medalia, A., … Nuechterlein, K. H. (2019). Cognitive remediation can improve negative symptoms and social functioning in first-episode schizophrenia: A randomized controlled trial. Schizophrenia Research, 203, 2431. doi: 10.1016/j.schres.2017.10.005CrossRefGoogle ScholarPubMed
Vinogradov, S., Fisher, M., & de Villers-Sidani, E. (2012). Cognitive training for impaired neural systems in neuropsychiatric illness. Neuropsychopharmacology, 37(1), 4376. doi: 10.1038/npp.2011.251CrossRefGoogle ScholarPubMed
Vita, A., Barlati, S., Ceraso, A., Nibbio, G., Ariu, C., Deste, G., … Wykes, T. (2021). Effectiveness, core elements, and moderators of response of cognitive remediation for schizophrenia: A systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry, 78(8), 848858. doi: 10.1001/jamapsychiatry.2021.0620.CrossRefGoogle ScholarPubMed
Wechsler, D. (2001). Wechsler Test of Adult Reading: WTAR: Psychological corporation.Google Scholar
Weinberger, D. R. (1987). Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry, 44(7), 660669. doi: 10.1001/archpsyc.1987.01800190080012CrossRefGoogle ScholarPubMed
Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. American Journal of Psychiatry, 168(5), 472485. doi: 10.1176/appi.ajp.2010.10060855CrossRefGoogle ScholarPubMed
Supplementary material: File

Kuo et al. supplementary material

Kuo et al. supplementary material

Download Kuo et al. supplementary material(File)
File 405.3 KB