Department of Psychiatry

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Browsing Department of Psychiatry by browse.metadata.advisor "Emsley, R."

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    Neurocognition and thought disorder : it’s association, temporal stability and outcome correlates in first-episode psychosis
    (Stellenbosch : Stellenbosch University, 2015-04) Olivier, Marius Riaan; Emsley, R.; Stellenbosch University. Faculty of Health Sciences. Dept. of Psychiatry.
    ENGLISH ABSTRACT: Abstract Neurocognitive deficits and thought disorder in schizophrenia have generally been accepted as core features of the illness, yet their underlying relationship, response to treatment, and correlations with outcome remain unclear. Most of the studies to date have used cross-sectional designs and focussed on stable patients already on treatment. The purpose of this study was to assess changes in neurocognition and thought disorder in antipsychotic naïve or minimally treated first episode psychosis (FEP) patients, over the course of 12 months of treatment according to a standard algorithm with flupenthixol decanoate (FD) long acting injectable antipsychotic. This was a prospective, non-comparative, open-label, longitudinal study of 42 patients with FEP. There was an initial wash-out phase of up to 7 days after which treatment was initiated with oral flupenthixol, 1 to 4 mg/day for 1 week prior to when the first long-acting FD was given. The starting dose of FD was 10mg every second week, with dose increases allowed at 6-week intervals. The Matrics Consensus Cognitive Battery (MCCB) and Rorschach Percerptual Thinking Index (PTI) were used as the primary co-measures for the assessment of neurocognition, thought disorder and perceptual disturbances respectively, at baseline prior to treatment, at month 6 and month 12. The main findings of this study were as follows: we confirmed the presence of significant neurocognitive impairment, thought disorder and perceptual disturbances prior to treatment, with improvement in neurocognitive performance and thought disorder from baseline to 6 months, with form perception improving later between month 6 and month 12. Improvements in symptoms were associated with improvements in neurocognitive performance, thought disorder and perceptual disturbances but a degree of residual impairment was evident at month 12. This study confirmed the association between neurocognition and form perception per se as well as their relative stability in FEP after initial improvement with treatment. We found support for the correlation between the amount of improvement in neurocognition, thought and perceptual disorder with outcome. We found the Social and Occupational Functioning Scale (SOFAS) to be a more robust measure of social and functional outcome with highest level of education (HLOE), substance abuse, reasoning-and-problem solving, form perception and Rorschach PTI emerging as predictors in a best subset regression analysis. The findings of this study suggest that neurocognitive impairments, thought disorder and perceptual disturbances have both state and trait like features, that patients benefit from treatment with a low-dose FGA, and that residual neurocognitive and perceptual impairment after treatment may indicate persisting underlying cerebral pathology.