Schizophrenia Bulletin Advance Access originally published online on April 4, 2007
Schizophrenia Bulletin 2007 33(3):761-771; doi:10.1093/schbul/sbm018
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Cognitive Functioning in the Schizophrenia Prodrome
2 Department of Psychiatry, Specialized Outpatient Service for Early Psychosis, Psychiatric Outpatient Services, 4101 Bruderholz, Switzerland
3 Department of Psychiatry, Psychiatric Outpatient Clinic of the University of Berne, 3010 Bern, Switzerland
4 Faculty of Psychology, University of Basel, 4031 Basel, Switzerland
5 Department of Psychiatry, Child and Adolescent Psychiatric Department, 4101 Bruderholz, Switzerland
6 Translational Medicine Neuroscience, Exploratory Development, Novartis Pharma AG, 4056 Basel, Switzerland
1 To whom correspondence should be addressed; tel: +41-61-425-45-45, fax: +41-61-425-45-46, e-mail: andor.simon{at}tiscalinet.ch.
In the last decade, there has been an increasing interest in cognitive alterations during the early course of schizophrenia. From a clinical perspective, a better understanding of cognitive functioning in putative at-risk states for schizophrenia is essential for developing optimal early intervention models. Two approaches have more recently been combined to assess the entire course of the initial schizophrenia prodrome: the predictive "basic symptom at-risk" (BS) and the ultra high-risk (UHR) criteria. Basic symptoms are considered to be present during the entire disease progression, including the initial prodrome, while the onset of symptoms captured by the UHR criteria expresses further disease progression toward frank psychosis. The present study investigated the cognitive functioning in 93 subjects who met either BS or UHR criteria and thus were assumed to be at different points on the putative trajectory to psychosis. We compared them with 43 patients with a first episode of psychosis and to 49 help-seeking patient controls. All groups performed significantly below normative values. Both at-risk groups performed at intermediate levels between the first-episode (FE) group and normative values. The UHR group demonstrated intermediate performance between the FE and BS groups. Overall, auditory working memory, verbal fluency/processing speed, and declarative verbal memory were impaired the most. Our results suggest that cognitive impairments may still be modest in the early stages of the initial schizophrenia prodrome and thus support current efforts to intervene in the early course of impending schizophrenia because early intervention may prevent or delay the onset of frank psychosis and thus prevent further cognitive damage.
Keywords: prodrome / at-risk state / basic symptoms / ultra high risk / cognition
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