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Cognitive function at first episode in patients subsequently developing treatment-resistant schizophrenia.

Juan M Aguirre¹, Camila Díaz Dellarossa², Daniella Barbagelata¹

¹Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile.

Schizophrenia Research

|February 2, 2025

Summary

Treatment-resistant schizophrenia (TRS) patients exhibit slower processing speed even in the first episode. This early cognitive deficit may help identify individuals needing prompt interventions like clozapine.

Keywords:

Cognitive impairment Cohort study First-episode Neuropsychological Schizophrenia Treatment-resistance

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Area of Science:

Neuroscience
Psychiatry
Cognitive Psychology

Background:

Cognitive deficits in schizophrenia are often studied in chronic patients, making it hard to distinguish disease effects from chronicity or medication.
Identifying early cognitive differences in treatment-resistant schizophrenia (TRS) is crucial for understanding its nature and finding potential markers.

Purpose of the Study:

To investigate cognitive performance differences in first-episode schizophrenia patients, distinguishing between treatment-resistant (TRS) and treatment-responsive (TRESP) groups.
To identify early cognitive markers associated with treatment resistance in schizophrenia.

Main Methods:

A cohort study involving 81 first-episode schizophrenia patients in Chile, classified using TRRIP criteria or clozapine prescription.
Comparison with 57 healthy controls, with cognitive function assessed using the MATRICS Consensus Cognitive Battery.
Statistical analyses controlled for age, sex, symptom severity, antipsychotic dose, and duration of untreated psychosis (DUP).

Main Results:

Multivariable analyses indicated worse performance in TRS patients for processing speed, verbal fluency, attention/vigilance, and working memory compared to TRESP.
After corrections, only speed of processing remained a significant difference.
Even after accounting for symptom severity, antipsychotic dose, and DUP, TRS subjects showed significantly lower processing speed, though not significant after multiple comparison corrections.

Conclusions:

Treatment-resistant schizophrenia patients demonstrate slower processing speed from the first episode, independent of symptom severity, medication, and DUP.
Processing speed is a potential early indicator for identifying patients with treatment resistance, enabling timely interventions like clozapine initiation.