Advancing study of cognitive impairments for antipsychotic-naïve psychosis comparing high-income versus low- and middle-income countries with a focus on urban China: Systematic review of cognition and study methodology

Lawrence H. Yang, Bernalyn Ruiz, Amar D. Mandavia, Margaux M. Grivel, Liang Y. Wong, Michael R. Phillips, Matcheri S. Keshavan, Huijun Li, Jeffrey A. Lieberman, Ezra Susser, Larry J. Seidman, William S. Stone

Research output: Contribution to journalReview article


Background: Comparing the course of antipsychotic-naïve psychosis in low- and middle-income countries (LMIC) may help to illuminate core pathophysiologies associated with this condition. Previous reviews-primarily from high-income countries (HIC)-identified cognitive deficits in antipsychotic-naïve, first-episode psychosis, but did not examine whether individuals with psychosis with longer duration of untreated psychosis (DUP > 5 years) were included, nor whether LMIC were broadly represented. Method: A comprehensive search of PUBMED from January 2002-August 2018 identified 36 studies that compared cognitive functioning in antipsychotic-naïve individuals with psychosis (IWP) and healthy controls, 20 from HIC and 16 from LMIC. Results: A key gap was identified in that LMIC study samples were primarily shorter DUP (<5 years) and were primarily conducted in urban China. Most studies matched cases and controls for age and gender but only 9 (24%) had sufficient statistical power for cognitive comparisons. Compared with healthy controls, performance of antipsychotic-naïve IWP was significantly worse in 81.3% (230/283) of different tests of cognitive domains assessed (90.1% in LMIC [118/131] and 73.7% [112/152] in HIC). Conclusions: Most LMIC studies of cognition in antipsychotic-naïve IWP adopted standardized procedures and, like HIC studies, found broad-based impairments in cognitive functioning. However, these LMIC studies were often underpowered and primarily included samples typical of HIC: primarily male, young-adult, high-school educated IWP, in their first episode of illness with relatively short DUP (<5 years). To enhance understanding of the long-term natural course of cognitive impairments in untreated psychosis, future studies from LMIC should recruit community-dwelling IWP from rural areas where DUP may be longer.

Original languageEnglish (US)
JournalSchizophrenia Research
StateAccepted/In press - Jan 1 2020



  • Cognition
  • Countries
  • Low- and middle-income
  • Schizophrenia
  • Untreated

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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