Cross-sectional study comparing cognitive function in treatment responsive versus treatment non-responsive schizophrenia: evidence from the STRATA study
Robin M Murray,
Richard Drake,
Stephen Lawrie,
Laura Kassoumeri,
James Walters,
Shon Lewis,
Anna Murphy,
James MacCabe,
Oliver D Howes,
Edward Millgate,
Eugenia Kravariti,
Alice Egerton,
Jacek Donocik,
Tracy Collier,
Jane Lees,
Charlotte Stockton-Powdrell,
Bill Deakin
Affiliations
Robin M Murray
NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
Richard Drake
Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
Stephen Lawrie
1 Psychiatry, NHS Lothian, Edinburgh, UK
Laura Kassoumeri
Department of Psychosis Studies, King’s College London Institute of Psychiatry Psychology and Neuroscience, London, UK
James Walters
MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
Shon Lewis
professor of adult psychiatry
Anna Murphy
Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
James MacCabe
NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
Oliver D Howes
Department of Psychosis Studies, King`s College London Institute of Psychiatry Psychology and Neuroscience, London, UK
Edward Millgate
Department of Psychosis Studies, King’s College London Institute of Psychiatry Psychology and Neuroscience, London, UK
Eugenia Kravariti
Department of Psychosis Studies, King’s College London Institute of Psychiatry Psychology and Neuroscience, London, UK
Alice Egerton
Department of Psychosis Studies, King’s College London Institute of Psychiatry Psychology and Neuroscience, London, UK
Jacek Donocik
Department of Psychosis Studies, King’s College London Institute of Psychiatry Psychology and Neuroscience, London, UK
Tracy Collier
Department of Psychosis Studies, King’s College London Institute of Psychiatry Psychology and Neuroscience, London, UK
Jane Lees
Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
Charlotte Stockton-Powdrell
Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
Bill Deakin
Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
Background 70%–84% of individuals with antipsychotic treatment resistance show non-response from the first episode. Emerging cross-sectional evidence comparing cognitive profiles in treatment resistant schizophrenia to treatment-responsive schizophrenia has indicated that verbal memory and language functions may be more impaired in treatment resistance. We sought to confirm this finding by comparing cognitive performance between antipsychotic non-responders (NR) and responders (R) using a brief cognitive battery for schizophrenia, with a primary focus on verbal tasks compared against other measures of cognition.Design Cross-sectional.Setting This cross-sectional study recruited antipsychotic treatment R and antipsychotic NR across four UK sites. Cognitive performance was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS).Participants One hundred and six participants aged 18–65 years with a diagnosis of schizophrenia or schizophreniform disorder were recruited according to their treatment response, with 52 NR and 54 R cases.Outcomes Composite and subscale scores of cognitive performance on the BACS. Group (R vs NR) differences in cognitive scores were investigated using univariable and multivariable linear regressions adjusted for age, gender and illness duration.Results Univariable regression models observed no significant differences between R and NR groups on any measure of the BACS, including verbal memory (ß=−1.99, 95% CI −6.63 to 2.66, p=0.398) and verbal fluency (ß=1.23, 95% CI −2.46 to 4.91, p=0.510). This pattern of findings was consistent in multivariable models.Conclusions The lack of group difference in cognition in our sample is likely due to a lack of clinical distinction between our groups. Future investigations should aim to use machine learning methods using longitudinal first episode samples to identify responder subtypes within schizophrenia, and how cognitive factors may interact within this.Trail registration number REC: 15/LO/0038.
