TY - JOUR
T1 - Advancing study of cognitive impairments for antipsychotic-naïve psychosis comparing high-income versus low- and middle-income countries with a focus on urban China
T2 - Systematic review of cognition and study methodology
AU - Yang, Lawrence H.
AU - Ruiz, Bernalyn
AU - Mandavia, Amar D.
AU - Grivel, Margaux M.
AU - Wong, Liang Y.
AU - Phillips, Michael R.
AU - Keshavan, Matcheri S.
AU - Li, Huijun
AU - Lieberman, Jeffrey A.
AU - Susser, Ezra
AU - Seidman, Larry J.
AU - Stone, William S.
N1 - Funding Information:
We would like to thank Pinky Li, Marianne Broeker, and Sandy Liu for their assistance in formatting the tables and manuscript. Dr.'s Yang, Phillips, Susser, Keshavan, Stone and Seidman were supported by funds from NIMH R01-MH108385 (PI: Yang, mPI: Phillips, mPI: Keshavan) entitled “Characterizing Cognition across the Lifespan in Untreated Psychosis in China.” Dr. Lieberman was supported by funds from NIMH 1U01MH121766-01 and NIMH 1R01 MH113861-01 . We also dedicate this manuscript posthumously to beloved friend and collaborator, Larry Seidman.
Funding Information:
The authors have declared that there are no conflicts of interest in relation to the subject of this study. We declare that no authors have support from any company for the submitted work. Dr.'s Yang, Phillips, Susser, Keshavan, Stone and Seidman were supported by funds from NIMH R01-MH108385 (PI: Yang) entitled “Characterizing Cognition across the Lifespan in Untreated Psychosis in China.”
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - Cognition
KW - Countries
KW - Low- and middle-income
KW - Schizophrenia
KW - Untreated
KW - Psychotic Disorders/complications
KW - Humans
KW - Male
KW - Antipsychotic Agents/therapeutic use
KW - Cognitive Dysfunction/drug therapy
KW - Adult
KW - Developing Countries
KW - Schizophrenia/drug therapy
KW - China/epidemiology
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U2 - 10.1016/j.schres.2020.01.026
DO - 10.1016/j.schres.2020.01.026
M3 - Review article
C2 - 32269004
AN - SCOPUS:85082876476
SN - 0920-9964
VL - 220
SP - 1
EP - 15
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -