Top

Child and Adolescent Psychiatry and Mental Health

Published in:

Open Access 01-12-2023 | Research

Neurocognition and functioning in adolescents at clinical high risk for psychosis

Authors: Martina Maria Mensi, Marika Orlandi, Erica Casini, Ana Catalan, Gonzalo Salazar de Pablo, Paolo Fusar-Poli, Renato Borgatti

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2023

Abstract

Background

Once psychosis has set in, it is difficult for patients to achieve full recovery. Prevention of psychosis and early intervention are promising for improving the outcomes of this disorder. In the last two decades, neurocognition has been studied as a biomarker for clinical-high risk for psychosis (CHR-P). However, neurocognitive functioning has been under-investigated in adolescents.

Methods

We enrolled 116 adolescents from 12 to 17 years old (mean = 15.27, SD = 1.56; 76 females). This 3-year cohort study aimed to identify differences in neurocognitive and overall functioning in three groups of adolescent patients divided according to the semi-structured interview Comprehensive Assessment of At-Risk Mental States (CAARMS): adolescents with established psychosis, adolescents with CHR-P, and adolescents not meeting either criteria (non-CHR-P). To differentiate the profiles, clinicians administered cognitive evaluation and neuropsychological tasks. Moreover, they filled in scales to assess their global, social, and role functioning and a questionnaire to assess the severity of the disease.

Results

We made a between-group comparison on neurocognitive measures and found that the CHR-P and the psychosis groups differed in processing speed (TMT-A; p = .002 in BVN categorial fluency (p = .018), and Rey–Osterrieth complex figure drawing from memory task (p = .014), with psychosis group showing worse performance. No differences emerged between non-CHR-P and CHR-P (p = .014) individuals. CHR-P had better functioning than the psychosis group but worse than the non-CHR-P one.

Conclusions

These results confirm that neurocognition can be a helpful biomarker in identifying specific subgroups of adolescents with emerging psychopathology and help clinicians develop stratified preventive approaches.

Available only for authorised users

Radua J, Ramella-Cravaro V, Ioannidis JPA, Reichenberg A, Phiphopthatsanee N, Amir T, et al. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry. 2018;17:49–66. https://doi.org/10.1002/WPS.20490.CrossRef

Vita A, Barlati S. Recovery from schizophrenia: is it possible? Curr Opin Psychiatry. 2018;31:246–55. https://doi.org/10.1097/YCO.0000000000000407.CrossRef

Millan MJ, Andrieux A, Bartzokis G, Cadenhead K, Dazzan P, Fusar-Poli P, et al. Altering the course of schizophrenia: progress and perspectives. Nat Rev Drug Discov. 2016;15:485–515. https://doi.org/10.1038/NRD.2016.28.CrossRef

Fusar-Poli P, Bauer M, Borgwardt S, Bechdolf A, Correll CU, Do KQ, et al. European college of neuropsychopharmacology network on the prevention of mental disorders and mental health promotion (ECNP PMD-MHP). Eur Neuropsychopharmacol. 2019;29:1301–11. https://doi.org/10.1016/J.EURONEURO.2019.09.006.CrossRef

Fusar-Poli P, Borgwardt S, Bechdolf A, Addington J, Riecher-Rössler A, Schultze-Lutter F, et al. The psychosis high-risk state: A comprehensive state-of-the-art review. Arch Gen Psychiatry. 2013;70:107–20.

Fusar-Poli P, Salazar De Pablo G, Correll CU, Meyer-Lindenberg A, Millan MJ, Borgwardt S, et al. Prevention of psychosis: advances in detection, prognosis, and intervention. JAMA Psychiat. 2020;77:755–65. https://doi.org/10.1001/JAMAPSYCHIATRY.2019.4779.CrossRef

Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, et al. Preventive strategies for mental health. Lancet Psychiatry. 2018;5:591–604. https://doi.org/10.1016/S2215-0366(18)30057-9.CrossRef

Catalan A, Salazar de Pablo G, Vaquerizo Serrano J, Mosillo P, Baldwin H, Fernández-Rivas A, et al. Annual Research Review: Prevention of psychosis in adolescents—systematic review and meta-analysis of advances in detection, prognosis and intervention. J Child Psychol Psychiatry. 2021;62:657–73. https://doi.org/10.1111/JCPP.13322.CrossRef

Catalan A, Salazar De Pablo G, Aymerich C, Damiani S, Sordi V, Radua J, et al. Neurocognitive functioning in individuals at clinical high risk for psychosis: a systematic review and meta-analysis. JAMA Psychiatr. 2021;78:859–67. https://doi.org/10.1001/jamapsychiatry.2021.1290.CrossRef

10.

Mensi MM, Molteni S, Iorio M, Filosi E, Ballante E, Balottin U, et al. Prognostic accuracy of DSM-5 attenuated psychosis syndrome in adolescents: prospective real-world 5-year cohort study. Schizophr Bull. 2021;47:1663–73. https://doi.org/10.1093/schbul/sbab041.CrossRef

11.

Pelizza L, Azzali S, Garlassi S, Paterlini F, Scazza I, Chiri LR, et al. Adolescents at ultra-high risk of psychosis in Italian neuropsychiatry services: prevalence, psychopathology and transition rate. Eur Child Adolesc Psychiatry. 2018;27:725–37.CrossRef

12.

Bang M, Kim KR, Song YY, Baek S, Lee E, An SK. Neurocognitive impairments in individuals at ultra-high risk for psychosis: who will really convert? Aust N Z J Psychiatry. 2015;49:462–70. https://doi.org/10.1177/0004867414561527.CrossRef

13.

Bora E, Lin A, Wood SJ, Yung AR, Mcgorry PD, Pantelis C. Cognitive deficits in youth with familial and clinical high risk to psychosis: a systematic review and meta-analysis. Acta Psychiatr Scand. 2014;130:1–15. https://doi.org/10.1111/ACPS.12261.CrossRef

14.

Frommann I, Pukrop R, Brinkmeyer J, Bechdolf A, Ruhrmann S, Berning J, et al. Neuropsychological profiles in different at-risk states of psychosis: executive control impairment in the early—and additional memory dysfunction in the late—prodromal state. Schizophr Bull. 2011;37:861. https://doi.org/10.1093/SCHBUL/SBP155.CrossRef

15.

Kim HS, Shin NY, Jang JH, Kim E, Shim G, Park HY, et al. Social cognition and neurocognition as predictors of conversion to psychosis in individuals at ultra-high risk. Schizophr Res. 2011;130:170–5.CrossRef

16.

Tor J, Dolz M, Sintes-Estevez A, de la Serna E, Puig O, Muñoz-Samons D, et al. Neuropsychological profile of children and adolescents with psychosis risk syndrome: the CAPRIS study. Eur Child Adolesc Psychiatry. 2020;29:1311–24. https://doi.org/10.1007/S00787-019-01459-6.CrossRef

17.

Ziermans T, De Wit S, Schothorst P, Sprong M, Van Engeland H, Kahn R, et al. Neurocognitive and clinical predictors of long-term outcome in adolescents at ultra-high risk for psychosis: a 6-year follow-up. PLoS ONE. 2014. https://doi.org/10.1371/journal.pone.0093994.CrossRef

18.

Yung AR, Yung AR, Pan Yuen H, Mcgorry PD, Phillips LJ, Kelly D, et al. Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust New Zeal J Psychiatry. 2005;39:964–71. https://doi.org/10.1080/j.1440-1614.2005.01714.x.CrossRef

19.

Molteni S, Filosi E, Mensi MM, Spada G, Zandrini C, Ferro F, et al. Predictors of outcomes in adolescents with clinical high risk for psychosis, other psychiatric symptoms, and psychosis: a longitudinal protocol study. Front Psychiatry. 2019. https://doi.org/10.3389/fpsyt.2019.00787.CrossRef

20.

Mensi MM. 2021 20211220_PSY_CAARMS-NPS_MMM_01.

21.

Wechsler, D. 2003. Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). APA PsycTests. https://doi.org/10.1037/t15174-000.

22.

Wechsler, D. 2008. Wechsler Adult Intelligence Scale--Fourth Edition (WAIS-IV). APA PsycTests. https://doi.org/10.1037/t15169-000.

23.

Fusar-Poli P, Hobson R, Raduelli M, Balottin U. Reliability and validity of the comprehensive assessment of the at risk mental state, Italian version (CAARMS-I). Curr Pharm Des. 2012;18:386–91. https://doi.org/10.2174/138161212799316118.CrossRef

24.

Paterlini F, Pelizza L, Galli G, Azzali S, Scazza I, Garlassi S, et al. Interrater reliability of the authorized Italian version of the comprehensive assessment of at-risk mental states (CAARMS-ITA). J Psychopathol. 2019;25:24–8.

25.

Spada G, Molteni S, Pistone C, Chiappedi M, McGuire P, Fusar-Poli P, et al. Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study. Eur Child Adolesc Psychiatry. 2016;25:91–106.CrossRef

26.

Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell’Olio M, et al. Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry. 2005;39:964–71. https://doi.org/10.1111/j.1440-1614.2005.01714.x.CrossRef

27.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Virginia: American Psychiatric Association; 2013.CrossRef

28.

Mensi MM, Balottin L, Rogantini C, Orlandi M, Galvani M, Figini S, et al. Focus on family functioning in anorexia nervosa: new perspectives using the Lausanne Trilogue Play. Psychiatry Res. 2020;288:112968. https://doi.org/10.1016/j.psychres.2020.112968.CrossRef

29.

Balottin L, Mannarini S, Mensi MM, Chiappedi M, Gatta M. Triadic interactions in families of adolescents with anorexia nervosa and families of adolescents with internalizing disorders. Front Psychol. 2017;7:1–13. https://doi.org/10.3389/fpsyg.2016.02046.CrossRef

30.

Hollingshead A. 1975. Four Factor Index of Social Status. New Haven, CT: Yale University Department of Psychology.

31.

Kaufman J, Birmaher B, Axelson D, Pereplitchikova F, Brent D, Ryan N. Schedule for Affective Disorders and Schizophrenia for School-Aged Children: Present and Lifetime Version (K-SADS-PL) DSM-5. In: Child and Adolescent Research and Education, New Heaven; 2016.

32.

Kaufman J, Birmaher B, Rao U, Ryan N, [a cura di Sogos C, Di Noia SP, et al. 2019 K-SADS-PL DSM-5 Intervista diagnostica per la valutazione dei disturbi psicopatologici in bambini e adolescenti. [Schedule for Affective Disorders and Schizophrenia for School-Aged Children: Present and Lifetime Version (K-SADS-PL) DSM-5]. Erickson, (ed). Trento.

33.

First MB, Williams JBW, Janet SB, Spitzer RL. Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Virginia: American Psychiatric Association; 2017.

34.

Spector H. 2013 Long-term IQ stability using the WISC-IV and WAIS-IV among a sample of special education students—ProQuest. ProQuest Dissertations Publishing, Fairleigh Dickinson University.

35.

Osterrieth PA. Le test de copie d’une figure complexe; contribution à l’étude de la perception et de la mémoire [Test of copying a complex figure; contribution to the study of perception and memory]. Arch Psychol (Geneve). 1944;30:206–356.

36.

Conson M, Siciliano M, Baiano C, Zappullo I, Senese VP, Santangelo G. Normative data of the Rey-Osterrieth Complex Figure for Italian-speaking elementary school children. Neurol Sci. 2019;40:2045–50. https://doi.org/10.1007/s10072-019-03929-w.CrossRef

37.

Caffarra P, Vezzadini G, Dieci F, Zonato F, Venneri A. Rey-Osterrieth complex figure: normative values in an Italian population sample. Neurol Sci. 2014;22:443–7. https://doi.org/10.1007/S100720200003.CrossRef

38.

Mondini S, Mapelli D, Vestri A, Bislacchi P. 2003 Una batteria di test per lo screening neuropsicologica. In: Esame Neuropsicologico Breve (ENB), Milano: Raffaello Cortina (eds).

39.

Reitan R, Wolfson D. The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. 2nd ed. Tucson: Neuropsychology Press; 1993.

40.

Gugliotta M, Bisiacchi P, Cendron M, Tressoldi PE, Vio C. 2009 Batteria di Valutazione Neuropsicologica per l’Adolescenza [Neuropsychological Evaluation Battery for Adolescence]. Trento.

41.

Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Aluwahlia S, et al. A children’s global assessment scale (CGAS). Arch Gen Psychiatry. 1983;40:1228–31. https://doi.org/10.1001/archpsyc.1983.01790100074010.CrossRef

42.

Goldman HH, Skodol AE, Lave TR. Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry. 1992;149:1148–56. https://doi.org/10.1176/ajp.149.9.1148.CrossRef

43.

Niendam T, Bearden C, Johnson J, Cannon T. Global Functioning: Role Scale (GF: Role). Los Angeles: University of California; 2006.

44.

Auther A, Smith C, Corblatt B. Global Functioning: Social Scale (GF: Social). Glen Oaks: Zucker-Hillside Hospital; 2006.

45.

Guy W. 1976 Clinical global impression (C.G.I.), ECDEU: Assessment Manual for Psychopharmacology (revised). Department of Health, Education, and Welfare, Rockville. 217–221.

46.

Berk M, Ng F, Dodd S, Callaly T, Campbell S, Bernardo M, et al. The validity of the CGI severity and improvement scales as measures of clinical effectiveness suitable for routine clinical use. J Eval Clin Pract. 2008;14:979–83. https://doi.org/10.1111/j.1365-2753.2007.00921.x.CrossRef

47.

Corp IBM. IBM SPSS Statistics for Windows. Armonk: IBM Corp; 2020.

48.

Zhang TH, Cui HR, Wei YY, Tang XC, Xu LH, Hu YG, et al. Neurocognitive assessments are more important among adolescents than adults for predicting psychosis in clinical high risk. Biol psychiatry Cogn Neurosci neuroimaging. 2022;7:56–65. https://doi.org/10.1016/J.BPSC.2021.06.015.CrossRef

49.

Glenthøj LB, Hjorthøj C, Kristensen TD, Davidson CA, Nordentoft M. The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review. NPJ Schizophr. 2017;3:20. https://doi.org/10.1038/S41537-017-0021-9.CrossRef

50.

Cicchetti D, Rogosch FA. A developmental psychopathology perspective on adolescence. J Consult Clin Psychol. 2002;70:6–20.CrossRef

51.

Carrión RE, Auther AM, McLaughlin D, Olsen R, Addington J, Bearden CE, et al. The global functioning: social and role scales-further validation in a large sample of adolescents and young adults at clinical high risk for psychosis. Schizophr Bull. 2019;45:763–72. https://doi.org/10.1093/schbul/sby126.CrossRef

52.

Mensi M, Rogantini C, Nacinovich R, Riva A, Provenzi L, Chiappedi M, et al. Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis. Eur Psychiatry. 2020;63:1–6.CrossRef

53.

Miotto P, Pollini B, Restaneo A, Favaretto G, Sisti D, Rocchi MBL, et al. Symptoms of psychosis in anorexia and bulimia nervosa. Psychiatry Res. 2010;175:237–43. https://doi.org/10.1016/j.psychres.2009.03.011.CrossRef

54.

Sawada K, Kanehara A, Sakakibara E, Eguchi S, Tada M, Satomura Y, et al. Identifying neurocognitive markers for outcome prediction of global functioning in individuals with first-episode and ultra-high-risk for psychosis. Psychiatry Clin Neurosci. 2017;71:318–27. https://doi.org/10.1111/PCN.12522.CrossRef

55.

Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. npj Schizophr. 2015;1:1–10. https://doi.org/10.1038/npjschz.2014.5.CrossRef

56.

Walder DJ, Mittal V, Trotman HD, McMillan AL, Walker EF. Neurocognition and conversion to psychosis in adolescents at high-risk. Schizophr Res. 2008;101:161–8.CrossRef

57.

Seidman LJ, Giuliano AJ, Meyer EC, Addington J, Cadenhead KS, Cannon TD, et al. Neuropsychology of the Prodrome to psychosis in the NAPLS Consortium: relationship to family history and conversion to psychosis. Arch Gen Psychiatry. 2010;67:578–88. https://doi.org/10.1001/ARCHGENPSYCHIATRY.2010.66.CrossRef

58.

Niendam TA, Bearden CE, Zinberg J, Johnson JK, O’Brien M, Cannon TD. The course of neurocognition and social functioning in individuals at ultra high risk for psychosis. Schizophr Bull. 2007;33:772–81.CrossRef

Title: Neurocognition and functioning in adolescents at clinical high risk for psychosis
Authors: Martina Maria Mensi
Marika Orlandi
Erica Casini
Ana Catalan
Gonzalo Salazar de Pablo
Paolo Fusar-Poli
Renato Borgatti
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: Child and Adolescent Psychiatry and Mental Health / Issue 1/2023
Electronic ISSN: 1753-2000
DOI: https://doi.org/10.1186/s13034-023-00567-1

2024 ASCO Annual Meeting

Springer Medicine

Neurocognition and functioning in adolescents at clinical high risk for psychosis

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

The bridge symptoms of childhood trauma, sleep disorder and depressive symptoms: a network analysis

Trajectories of child mental health, physical activity and screen-time during the COVID-19 pandemic considering different family situations: results from a longitudinal birth cohort

Outpatient screening for anxiety and depression symptoms in adolescents with type 1 diabetes - a cross-sectional survey

Male-specific, replicable and functional roles of genetic variants and cerebral gray matter volumes in ADHD: a gene-wide association study across KTN1 and a region-wide functional validation across brain

Work-family interface and children's mental health: a systematic review

Mental health and psychological well-being of Kenyan adolescents from Nairobi and the Coast regions in the context of COVID-19