Neurocognitive functioning of subjects with putative pre-psychotic states and early psychosis Chen-Chung Liu a, ⁎, Mau-Sun Hua b , Tzung-Jeng Hwang a , Chien-Yeh Chiu b , Chih-Min Liu a , Ming H. Hsieh a , Yi-Ling Chien a , Yi-Ting Lin a , Hai-Gwo Hwu a a Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan b Department of Psychology, National Taiwan University, Taipei, Taiwan abstract article info Article history: Received 27 August 2014 Received in revised form 11 February 2015 Accepted 6 March 2015 Available online 20 March 2015 Keywords: At-risk mental state Neurocognition Pre-psychotic Psychosis Schizophrenia Ultra-high risk Background: The neurocognitive functioning of patients with schizophrenia is likely to decline at the early stage of the illness. More evidence is needed to determine whether deficits in certain domains of neurocognition precede the onset of illness and can predict the onset of psychosis. Methods: Subjects were recruited from the SOPRES study in Taiwan. A neuropsychological battery including the continuous performance test, Wisconsin Card Sorting Test, Wechsler Adult Intelligence Scale-Third Edition, Trail Making Tests, Mandarin version of the Verbal Fluency Test, and Wechsler Memory Scale—Third Edition, was ap- plied at baseline and 1-year follow-up. Neurocognitive profiles derived from these tests were categorized into 9 domains for comparisons among subjects with different levels of clinical severity. Results: A total of 324 participants, including 49 with first episode psychosis (FEP), 53 with ultra-high risk (UHR), 42 with intermediate risk (IR), 43 with marginal risk (MR), and 137 normal controls completed a baseline assess- ment and 71% of the participants completed a 1-year follow-up assessment. The profiles of the UHR and IR groups were identical at baseline. Those who converted to FEP later on (UHR+) showed relatively poorer performance than non-converters (UHR-) at baseline. At follow-up the performance of UHR + was compatible to that of FEP, while UHR- generally improved. Conclusions: By including subjects with early putative pre-psychotic states, our study clarifies some inconsis- tencies about the timing and stability of changes in neurocognitive functioning that occur at the start of psychosis; it also raises questions regarding the feasibility of using neurocognitive deficits to predict the risks of transition to psychosis. © 2015 Elsevier B.V. All rights reserved. 1. Introduction Studies in chronic schizophrenia have demonstrated significant neurocognitive impairments at schizophrenia onset, with the impair- ments persisting yet non-progressive (Goldberg et al., 1993; Heaton et al., 1994), and other studies have re-iterated this presentation (Addington et al., 2005; Hoff et al., 2005; Albus et al., 2006; Lewandowski et al., 2011). Recent neurobiological studies revealed that the brain abnormalities in patients with schizophrenia precede or become apparent at around the time of transition to frank psychosis (Howes et al., 2009; Takahashi et al., 2009; Fusar-Poli et al., 2011, 2012b), thus suggesting that neurocognitive deficits resulting from such brain abnormalities should be evident during the prodrome and inception of psychosis. The patterns of neurocognitive deficits during this critical period have been described previously (Keefe et al., 2006b; Lencz et al., 2006; Eastvold et al., 2007; Pukrop et al., 2007). The large scale North American Prodrome Longitudinal Study (NAPLS) suggested that indi- viduals with high risk of psychosis already had significant neuropsycho- logical difficulties, particularly in those who later became psychotic, although such impairments are generally less severe than in first- episode schizophrenia and did not add much information to the predic- tion of psychosis beyond clinical criteria (Seidman et al., 2010). A recent meta-analysis summarized that neurocognitive deficits are relatively consistent in subjects at high risk for psychosis, yet the im- pairments indeed cover a wide range of cognitive domains, including general intelligence, executive function, verbal and visual memory, ver- bal fluency, attention and working memory, and social cognition (Fusar- Poli et al., 2012b). Specifically, deficits in verbal fluency and memory functioning may be associated with subsequent transition to psychosis and may serve as important indicators of risk of transition to psychosis (Fusar-Poli et al., 2012b). However, more evidence is needed to test the generalizability and applicability of these findings, as the emergence of Schizophrenia Research 164 (2015) 40–46 ⁎ Corresponding author at: Department of Psychiatry, National Taiwan University Hospital, No. 7 Chung Shan S. Rd, Taipei 10002, Taiwan. Tel.: +886 2 23123456x66130; fax: +886 2 23753663. E-mail address: chchliu@ntu.edu.tw (C.-C. Liu). http://dx.doi.org/10.1016/j.schres.2015.03.006 0920-9964/© 2015 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres