Cognition, clinical insight crucial in first-episode psychosis
Cognitive function and clinical insight play significant roles in mediating symptoms for those with first-episode psychosis, according to a study published in the Journal of Psychiatric Research.
“It is well-established that the initial years following the onset of symptoms of psychosis characterize a critical period for intervention,” Lindsay A. Bornheimer, PhD, of the department of psychiatry at the University of Michigan, and colleagues wrote.
“In particular, the risk for suicide death among individuals during a first episode of psychosis is elevated by 60% within the first year of treatment compared to individuals with longer durations and more chronic psychotic disorders.”
Bornheimer and colleagues sought to examine the mediating role of cognition and clinical insight in relationships between positive and negative symptoms, depression and suicidal ideation among individuals experiencing first-episode psychosis.
The researchers analyzed information obtained from 404 participants aged 15 to 40, enrolled in the Recovery After an Initial Schizophrenia Episode project. They recorded positive and negative symptoms from baseline by the Positive and Negative Syndrome Scale, where higher scores indicate increased presence and higher severity. Cognitive function was measured through the Brief Assessment of Cognition in Schizophrenia, which assessed six distinct aspects. Depression was assessed with the Calgary Depression Scale for Schizophrenia (CDSS), where symptoms were measured within 2 weeks of evaluation on eight of nine items within the scale. Suicidal ideation was also gauged by the CDSS, a single item whose score arose from incidence across four times of assessment following baseline within a 2-year period.
Results showed that stronger working memory was linked to a significant decrease in likelihood of suicidal ideation (b = -0.034, standard error = 0.02, OR = 0.967, P < .05), but likelihood of suicidal ideation significantly increased when clinical insight was stronger (b = 0.191, SE = 0.08, OR = 1.21, P < .01) and was likely to increase when both positive symptoms (b = 0.422, SE = 0.20, OR = 1.52, P < .05) and symptoms of depression were greater (b = 0.545, SE = 0.15, OR = 1.70, P < .001).
“Given our finding of working memory mediating the relationships between baseline positive and negative symptoms and suicide ideation over time, it is similarly
important to assess for potential suicide risk in relation to cognition, even with the knowledge that its relationships with community functioning and suicide-related outcomes are mixed,” Bornheimer and colleagues wrote.