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Schizophr Bull. 2015 Nov;41(6):1237-47. doi: 10.1093/schbul/sbv120. Epub 2015 Sep 25.

Relationship of Cognition to Clinical Response in First-Episode Schizophrenia Spectrum Disorders.

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Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY;
Department of Mathematics, Hofstra University, Hempstead, NY;
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY;
Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada;
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY;
Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM.
Litwin Zucker Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA.


First-episode schizophrenia (FES) spectrum disorders are associated with pronounced cognitive dysfunction across all domains. However, less is known about the course of cognitive functioning, following the first presentation of psychosis, and the relationship of cognition to clinical course during initial treatment. The present longitudinal study examined the magnitude of neurocognitive impairment, using the MATRICS Consensus Cognitive Battery, in patients experiencing their first episode of psychosis at baseline and after 12 weeks of randomized antipsychotic treatment with either aripiprazole or risperidone. At baseline, FES patients evidenced marked impairments in cognitive functioning. Notably, performance on the mazes task of planning and reasoning significantly predicted the likelihood of meeting stringent criteria for positive symptom remission during the first 12 weeks of the trial. Performance on indices of general cognitive function, working memory, and verbal learning improved over time, but these improvements were mediated by improvements in both positive and negative symptoms. We did not detect any differential effects of antipsychotic medication assignment (aripiprazole vs risperidone) on cognitive functioning. Our results suggest that a brief paper-and-pencil measure reflecting planning/reasoning abilities may index responsivity to antipsychotic medication. However, improvements in cognitive functioning over time were related to clinical symptom improvement, reflecting "pseudospecificity."


aripiprazole; cognition; general cognitive function; planning; psychosis; risperidone

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