Early Substance Use Cessation Improves Cognition-10 Years Outcome in First-Episode Psychosis Patients

Area of Science:

• Neuroscience
• Psychiatry
• Addiction Medicine

Background:

• Cognitive impairment is a significant concern in first-episode psychosis (FEP), potentially influenced by non-remitting symptoms, premorbid functioning, education, and socioeconomic factors.
• Substance use is prevalent in psychosis and may confound associations with cognitive outcomes, with existing research showing mixed results on its long-term impact.
• This study addresses the need for long-term data on substance use and cognition in a representative FEP sample.

Purpose of the Study:

• To investigate the long-term associations between substance use patterns and cognitive trajectories in patients with first-episode psychosis.
• To examine how different substance use patterns (persistent, episodic, cessation, non-use) affect various cognitive domains over a 10-year period.

Main Methods:

• A cohort of 195 first-episode psychosis patients was assessed for neurocognition, symptoms, and functioning at 1, 2, 5, and 10 years post-treatment initiation.
• Cognitive test scores were analyzed using factor analysis to create indices for motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning.
• Linear mixed-effects modeling was used to analyze data from four groups based on substance use patterns in the first two years: persistent, episodic, stop-users, and nonusers.

Main Results:

• Gender, premorbid academic functioning, and education were key predictors of cognitive trajectories.
• Patients who ceased substance use within two years showed improvements in motor speed and verbal learning, unlike other groups.
• Early substance use cessation was associated with superior verbal fluency performance compared to nonusers, while persistent users exhibited impaired visuomotor processing.

Conclusions:

• Early cessation of substance use in first-episode psychosis is associated with less cognitive impairment and some cognitive improvement over time.
• This suggests that early substance use cessation may indicate better cognitive reserves and a potentially milder course of illness.
• Findings highlight the importance of addressing substance use in the early stages of psychosis to potentially improve long-term cognitive outcomes.