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Inicio Spanish Journal of Psychiatry and Mental Health Long-term trajectories of clinical staging in first-episode psychosis and their ...
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Disponible online el 9 de marzo de 2024
Long-term trajectories of clinical staging in first-episode psychosis and their associated cognitive outcome: A 21-year follow-up study
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Manuel J. Cuestaa,b,
Autor para correspondencia
mcuestaz@cfnavarra.es

Corresponding author.
, Ana M. Sánchez-Torresb,d, Lucia Moreno-Izcoa,b, Elena García de Jalónb,c, Gustavo J. Gil-Berrozpea,b, Victor Peraltab,c, SEGPEPs Group
a Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
b Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
c Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
d Department of Health Sciences, Universidad Pública de Navarra (UPNA), Pamplona, Spain
Alejandro Ballesterose, Lourdes Fañanásf,g, Lucia Jandal, Sergi Papiolg,h,i, David Peraltal, María Ribeiroj,k, Ángela Roseroj, Amalia Zarzuelak,l, Eloi Ginéj,k, Esther Rosadoj,k
e Red de Salud Mental de Álava, Vitoria-Gasteiz, Spain
f Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
g Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
h Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich 80336, Germany
i Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich 80336, Germany
j Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
k Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
l Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
Este artículo ha recibido
Recibido 27 Noviembre 2023. Aceptado 13 Febrero 2024
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Table 1. Sociodemographic and clinical features of the participants (n=173).
Table 2. Neuropsychological performance in MATRICS Consensus Cognitive Battery (MCCB) at the 21-year follow-up across clinical stages (Kruskal–Wallis tests).
Table 3. Mixed linear models of MCCB cognitive functions at the 21-year follow-up and staging adjusted with covariates (age at follow-up, gender, WAT_IQ, dose-years of antipsychotics and dose-years of anticholinergics.
Table 4. Transitions of clinical staging from baseline clinical staging to clinical staging at 2, 5, 10 years, and clinical staging at the end of follow-up.
Table 5. MCCB cognitive differences between patients that transitioned from stages 2 to stages with partial remission or progression during the critical period of follow-up (Kruskal–Wallis tests).
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Abstract

Cognitive deficits are already present before psychosis onset but are a key feature of first-episode psychosis (FEP). The objective of this study was to investigate the cognitive outcomes of a cohort of FEP patients who were diagnosed using the clinical staging approach and were followed for up to 21 years.

We analyzed data from 173 participants with first-admission psychosis who were followed-up for a mean of 20.9 years. The clinical staging assessment was adapted from the clinical staging framework developed by McGorry et al.1 Cognitive assessment was performed using the MATRICS Consensus Cognitive Battery (MMCB) at the end of follow-up.

FEP patients who were longitudinally diagnosed in the lowest clinical stages (stages 2A and 2B) showed better performance in attention, processing speed, and MCCB overall composite score than those in the highest clinical stages (stages 4A and 4B). There was a significant linear trend association between worsening of all MCCB cognitive functions and MCCB overall composite score and progression in clinical staging. Furthermore, the interval between two and five years of follow-up appears to be associated with deficits in processing speed as a cognitive marker.

Our results support the validation of the clinical staging model over a long-term course of FEP based on neuropsychological performance. A decline in some cognitive functions, such as processing speed, may facilitate the transition of patients to an advanced stage during the critical period of first-episode psychosis.

Keywords:
Staging
Cognitive impairment
Long term
Follow-up
First-episode psychosis

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