Symptomatological and neuropsychological hints can be used to predict psychosis, attending psychiatrist at National Taiwan University Hospital Liu Chen-chung (劉震鐘) said yesterday.
Liu made the remarks at this year’s International Symposium on Brain and Mind Sciences in Taipei, which focused on early detection and treatment of schizophrenia.
In his presentation on the neuropsychological study of early schizophrenia, Liu made public the results of a follow-up study on the psychopathological progress of early schizophrenia-like disorders, a five-year project sponsored by the National Health Research Institute from 2006 to 2010.
Led by National Taiwan University professor emeritus of psychiatry Hwu Hai-gwo (胡海國), the project aimed to follow not only participants with first-episode psychosis (FEP) or ultra-high-risk (UHR) for psychosis, now also called attenuated psychosis syndrome (APS), but also those at intermediate risk and marginal risk of psychosis.
“It echoes a recent proposal that if you want to monitor the pathogenesis of schizophrenia, [you should] not only focus on the late prodromal state like APS,” but also the earlier stages, Liu said.
By conducting a combination of neuropsychological tests, besides the FEP group, putative pre-psychotic participants were categorized into a UHR group, intermediate risk group (IRG) and marginal risk group, with the UHR group divided into those who transitioned into full-blown psychosis during the follow-up (UHR positive) and those who did not (UHR negative).
A total of 318 participants, divided into five groups, including the four mentioned above and a control group, were given baseline assessments, Liu said.
Liu said that although it was expected that there would be a gradient in the wellbeing of neurocognitive function among the groups, the result “was not so clear.”
The FEP, UHR and IRG groups all manifested verbal memory and processing speed deficits.
“Even [the participants who had been categorized to be at] a very early stage, the MR stage … showed some cognitive declines,” Liu said.
And while the FEP group performed worse among the clinical subjects, in terms of the test results, “the difference among the other three groups was not so significant,” Liu added.
“In some indicators, the UHR negative performed even worse than the UHR positive,” Liu added. “The baseline neurocognitive function of UHR subjects [thus] provided limited evidence to differentiate those who converted to FEP from those who did not later on.”
“And this is why we need to dig into other biomarkers,” such as the underlying neural mechanism causing the emergence of psychosis, “to get stronger predictors,” Liu said.