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Published Online: 1 January 2010

Specific and Generalized Neuropsychological Deficits: A Comparison of Patients With Various First-Episode Psychosis Presentations

Jolanta Zanelli, B.Sc., M.Sc., Abraham Reichenberg, Ph.D., Kevin Morgan, Ph.D., Paul Fearon, M.D., Ph.D., Eugenia Kravariti, Ph.D., Paola Dazzan, M.D., Ph.D., Craig Morgan, M.Sc., Ph.D., … Show All … , Caroline Zanelli, B.Sc., Arsime Demjaha, M.D., Peter B. Jones, M.D., Ph.D., Gillian A Doody, M.D., Ph.D., Shitij Kapur, M.D., Ph.D., and Robin M. Murray, M.D., D.Sc.Authors Info & Affiliations

Publication: American Journal of Psychiatry

Volume 167, Number 1

https://doi.org/10.1176/appi.ajp.2009.09010118

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Abstract

Objective

Overwhelming evidence suggests that compromised neuropsychological function is frequently observed in schizophrenia. Neurocognitive dysfunction has often been reported in other psychotic disorders, although there are inconsistencies in the literature. In the context of four distinct diagnostic groups, the authors compared neuropsychological performance among patients experiencing their first psychotic episode.

Method

Data were derived from a population-based, case-control study of patients with first-episode psychosis. A neuropsychological test battery was administered to patients with a diagnosis of schizophrenia (N=65), bipolar disorder or mania (N=37), depressive psychosis (N=39), or other psychotic disorders (N=46) following index presentation, as well as to healthy comparison subjects (N=177). The presence of specific and generalized cognitive deficits was examined.

Results

The schizophrenia group presented widespread neuropsychological impairments and performed significantly worse than healthy comparison subjects on most neuropsychological measures. Patients with other psychotic disorders and depressive psychosis also demonstrated widespread impairments. Deficits in patients with bipolar disorder or mania were less pervasive but evident in performance scores on verbal memory and fluency tests. Differences between the four patient groups and healthy comparison subjects and among the patient groups were attenuated after controlling for differences in general cognitive ability (IQ).

Conclusions

Early in their course, cognitive deficits are present in all psychotic disorders but are most severe and pervasive in schizophrenia and least pervasive in bipolar disorder and mania.

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Information & Authors

Information

Published In

American Journal of Psychiatry

Volume 167 • Number 1 • January 2010

Pages: 78 - 85

PubMed: 19952077

History

Received: 28 January 2009

Accepted: 21 July 2009

Published online: 1 January 2010

Published in print: January 2010

Authors

Details

Jolanta Zanelli, B.Sc., M.Sc.

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Abraham Reichenberg, Ph.D.

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Kevin Morgan, Ph.D.

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Paul Fearon, M.D., Ph.D.

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Eugenia Kravariti, Ph.D.

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Paola Dazzan, M.D., Ph.D.

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Craig Morgan, M.Sc., Ph.D.

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Caroline Zanelli, B.Sc.

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Arsime Demjaha, M.D.

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Peter B. Jones, M.D., Ph.D.

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Gillian A Doody, M.D., Ph.D.

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Shitij Kapur, M.D., Ph.D.

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Robin M. Murray, M.D., D.Sc.

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Notes

Presented in part as a poster at the International Congress on Schizophrenia Research (ICOSR), Colorado Springs, Colo., March 28–April 1, 2007. Received Jan. 26, 2009; revision received July 24, 2009; accepted August 27, 2009. From the Division of Psychological Medicine, Institute of Psychiatry, King's College, London; Department of Psychology, Westminster University, London; Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London; Department of Psychiatry, University of Cambridge, Cambridge, U.K.; Division of Psychiatry, University of Nottingham, Nottingham, U.K. Address correspondence and reprint requests to Dr. Zanelli, Institute of Psychiatry, PO63, Division of Psychological Medicine and Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; [email protected] (e-mail).

Competing Interests

Dr. Reichenberg has received speaker's honoraria from AstraZeneca (Greece). Dr. Dazzan has received speaker's honoraria and travel support from AstraZeneca, Janssen Pharmaceutica, and Sanofi. Dr. Jones has served as a consultant to Bristol-Myers Squibb, Eli Lilly, and Otsuka. Dr. Kapur has received grant support from AstraZeneca, Bristol-Myers Squibb, and GlaxoSmithKline; he has also received consultant, scientific adviser, and/or speaker's honoraria from AstraZeneca, Bioline, Bristol-Myers Squibb, Eli Lilly, Janssen Pharmaceutica (Johnson and Johnson), Lundbeck, Otsuka, Organon, Pfizer U.S. Pharmaceuticals Group, Servier, Solvay Pharmaceuticals, and Wyeth. Dr. Murray has received speaker's honoraria from AstraZeneca, Janssen Pharmaceutica, Eli Lilly, Bristol-Myers Squibb, and Novartis Pharmaceuticals. Drs. K. Morgan, Fearon, Kravariti, C. Morgan, Demjaha, and Doody and Ms. J. Zanelli and Ms. C. Zanelli report no financial relationships with commercial interests.

Funding Information

Funded by the United Kingdom Medical Research Council.

The present study is part of the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London, and the South London and Maudsley National Health Service Foundation Trust.

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Specific and Generalized Neuropsychological Deficits: A Comparison of Patients With Various First-Episode Psychosis Presentations

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