Neurocognitive deficits may be a red flag for psychosis

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While schizophrenia is best known for episodes of psychosis - a break with reality during which an individual may experience delusions and hallucinations - it is also marked by chronic neurocognitive deficits, such as problems with memory and attention. A multi-site cognition study led by psychologists at Beth Israel Deaconess Medical Center (BIDMC) found that these neurocognitive symptoms are evident prior to the onset of psychosis in a high-risk stage of the disorder called the prodromal phase. Published today online in advance of print in JAMA Psychiatry, the findings suggest that these impairments may serve as early warning signs of schizophrenia, as well as potential targets for intervention that could mitigate the onset of the psychotic disorder and significantly improve cognitive function.

“To our knowledge, this is the largest and most definitive study of cognition in the high-risk period before onset of for psychosis/schizophrenia,” said corresponding author Larry J. Seidman, PhD, a psychologist at BIDMC and professor of psychology at Harvard Medical School. “This is part of a paradigm shift in the way we are focusing on the earlier, prodromal phase of the disorder in an effort to identify those most likely to develop psychosis.”

Seidman and colleagues collected neurocognitive functioning data from participants at eight university-based, outpatient programs in the United States and Canada over the course of four years. The observational study compared 689 males and females deemed at clinical high risk (CHR) of developing psychosis to 264 male and female healthy controls (HC). Using 19 standard tests of executive and visuospatial abilities, attention and working memory, verbal abilities and declarative memory, the researchers found that the high-risk group performed significantly worse than the control group on all 19 measures. Among the high-risk individuals only, those who later progressed to a psychotic disorder performed significantly worse than their high-risk peers who did not develop psychosis during the study.

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does this apply to bipolar disorder as well?

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My cognitive deficit emerged about a week or two before I had my psychosis.

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i had trouble thinking i remember i complained to a dr about it and he put me on lithium. I was also in my head a lot my friends were telling me. I took the lithium for like two weeks and then a friend of mine started to tease me about being on lithium. he said i was going to develop an enlarged forehead. needless to say i stopped it. The psychosis broke about six months later. Ive never been the same since even though the doctors tell me I have bipolar disorder. Bipolar disorder must be bad, because I can identify with a lot of people on this site, in a lot of ways. Most people with bipolar disorder don’t go completely nuts like I do. I don’t get it.

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It says red flag for ‘psychosis’ as opposed to just schizophrenia so I guess it would include bipolar and depression with psychosis. Though maybe with bipolar/depression with psychosis the cognitive deficits would be less.

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This could be helpful information as my niece is starting school now. Her father has schizophrenia and her mother has DID, so we have been watching her very closely for early signs.

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My cognitive deficits(executive functioning,visuospatial) were present quite a few years,I would say, before I saw a psychiatrist. How much they are related to a learning difficulty or the severe mental illness I wouldn’t like to say. I think though there is a higher incidence of SMI among those with learning difficulties/disabilities.