Skip to main content
SpringerLink
Log in

Is processing speed predictive of functional outcome in psychosis?

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

To investigate the contribution of processing speed in the prediction of various domains of outcome in psychosis.

Method

Data were drawn from the UK700 Case Management Trial of 708 patients with chronic psychotic illness. Regression analyses were applied to investigate cross-sectional and longitudinal associations between processing speed at baseline and measures of service use, social outcome and subjective outcome, taking into account current psychopathology and adjusting for baseline values of the outcome measure.

Results

Cross-sectionally, processing speed was associated with all three domains of outcome, although only associations in the social and subjective outcome domain remained significant after controlling for psychopathology and the effects differed between and within domains of outcome. Prospectively, only the subjective outcome measure of number of met and unmet needs (CAN) was weakly associated with baseline neurocognitive performance after adjustment for baseline needs. Other associations disappeared after adjustment for the baseline measure of outcome and/or baseline psychopathology.

Conclusion

The finding of weak cross-sectional associations in the absence of specific and unconfounded longitudinal associations suggests that processing speed is an independent dimension of disease severity rather than a causal factor impacting on social outcome. Nevertheless, longitudinal change in patient reported needs may be weakly sensitive to baseline cognitive impairment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Addington J, McCleary L, Munroe-Blum H (1998), Relationship between cognitive and social dysfunction in schizophrenia. Schizophr Res 34(1–2):59–66

    Article  PubMed  CAS  Google Scholar 

  2. Addington J, Saeedi H, Addington D (2005) The course of cognitive functioning in first episode psychosis: changes over time and impact on outcome. Schizophr Res 78(1):35–43

    PubMed  Google Scholar 

  3. Breier A et al. (1992) Course of illness and predictors of outcome in chronic schizophrenia: implications for pathophysiology. Br J Psychiatry 161(Suppl 18):38–43

    Google Scholar 

  4. Brekke JS, Kohrt B, Green MF (2001) Neuropsychological functioning as a moderator of the relationship between psychosocial functioning and the subjective experience of self and life in schizophrenia. Schizophr Bull 27(4):697–708

    PubMed  CAS  Google Scholar 

  5. Bryson G, Bell MD (2003) Initial and final work performance in schizohrenia: cognitive and symptom predictors. J Nerv Ment Dis 191(2):87–92

    Article  PubMed  Google Scholar 

  6. Burns T et al. (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. UK 700 Group. Lancet 353(9171):2185–2189

    Article  PubMed  CAS  Google Scholar 

  7. Carlsson R et al. (2006) Neuropsychological functions predict 1- and 3-year outcome in first-episode psychosis. Acta Psychiatr Scand 113(2):102–111

    Article  PubMed  CAS  Google Scholar 

  8. Dickinson D et al. (2004) General and specific cognitive deficits in schizophrenia. Biol Psychiatry 55:826–833

    Article  PubMed  Google Scholar 

  9. Dickinson D, Coursey RD (2002) Independence and overlap among neurocognitive correlates of community functioning in schizophrenia. Schizophr Res 56(1–2):161–170

    Article  PubMed  Google Scholar 

  10. Fujii DE, Wylie AM (2002) Neurocognition and community outcome in schizophrenia: long-term predictive validity. Schizophr Res 59:219–223

    Article  Google Scholar 

  11. Gilvarry CM et al. (2001) Neuropsychological performance of psychotic patients in community care: results from the UK700 study. Acta Psychiatr Scand Suppl 408:81–91

    Article  PubMed  Google Scholar 

  12. Gold JM et al. (2002) Cognitive correlates of job tenure among patients with severe mental illness. Am J Psychiatry 159(8):1395–1402

    Article  PubMed  Google Scholar 

  13. Green MF (1996) What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 153(3):321–330

    PubMed  CAS  Google Scholar 

  14. Green MF et al. (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “Right Stuff”? Schizophr Bull 26(1):119–136

    PubMed  CAS  Google Scholar 

  15. Green MF, Kern RS, Heaton RK (2004) Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res 72(1):41–51

    Article  PubMed  Google Scholar 

  16. Hassiotis A et al. (2001) Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management. Report from the UK700 trial. Br J Psychiatry 178:166–171

    Article  PubMed  CAS  Google Scholar 

  17. Holthausen EA et al. (2007) Predictive value of cognition for different domains of outcome in recent-onset schizophrenia. Psychiatry Res 149(1–3):71–80

    Article  PubMed  Google Scholar 

  18. Jablensky A, Schwartz R, Tomov T (1980) WHO collaborative study of impairments and disabilities associated with schizophrenic disorders: a preliminary communication. Objective and methods. Acta Psychiatr Scand Suppl 285(62):152–163

    Article  Google Scholar 

  19. Jacobsson L et al. (1978) The comprehesive psychopathological rating scale—CPRS—in patients with schizophrenic syndromes. Inter-rater reliability and in relation to Martens’ S-scale. Acta Psychiatr Scand Suppl 271:39–44

    Article  PubMed  Google Scholar 

  20. Lehman AF, Ward NC, Linn LS (1982) Chronic mental patients: the quality of life issue. Am J Psychiatry 139(10):1271–1276

    PubMed  CAS  Google Scholar 

  21. Lezak M (1995) Neuropsychological assessment, 3rd edn. Oxford University Press, New York

    Google Scholar 

  22. Lieberman JA et al. (1996) Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the patholophysiology of schizophrenia. J Clin Psychiatry 57(Suppl 9):5–9

    PubMed  Google Scholar 

  23. Lysaker PH et al. (2005) Relationship of impaired processing speed and flexibility of abstract thought to improvements in work performance over time in schizophrenia. Schizophr Res 75(2–3):211–218

    Article  PubMed  Google Scholar 

  24. Malla AK et al. (2002) Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychol Med 32(6):1109–1119

    Article  PubMed  CAS  Google Scholar 

  25. Malla A, Payne J (2005) First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull 31(3):650–671

    Article  PubMed  Google Scholar 

  26. Mc Guffin P, Farmer A, Harvey I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Arch Gen Psychiatry 48:764–770

    CAS  Google Scholar 

  27. McGurk SR, Meltzer HY (2000) The role of cognition in vocational functioning in schizophrenia. Schizophr Res 45(3):175–184

    Article  PubMed  CAS  Google Scholar 

  28. Metcalfe C et al. (2005) Intensive case management for severe psychotic illness: is there a general benefit for patients with complex needs? A secondary analysis of the UK700 trial data. Soc Psychiatry Psychiatr Epidemiol 40(9):718–724

    Article  PubMed  Google Scholar 

  29. Milev P et al. (2005) Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 162(3):495–506

    Article  PubMed  Google Scholar 

  30. Nelson HE, Willison JR (1991) The revised national adult reading test manual, 2nd edn. Windsor, NFER-Nelson, UK

    Google Scholar 

  31. Norman RM et al. (1999) Symptoms and cognition as predictors of community functioning: a prospective analysis. Am J Psychiatry 156(3):400–405

    PubMed  CAS  Google Scholar 

  32. Norman RMG et al. (2005) Social support and three-year symptom and admission outcomes for first-episode psychosis. Schizophr Res 80:227–234

    Article  PubMed  Google Scholar 

  33. Oliver JP et al. (1997) Measuring the quality of life of severely mentally ill people using the Lancashire quality of life profile. Soc Psychiatry Psychiatr Epidemiol 32(2):76–83

    Article  PubMed  CAS  Google Scholar 

  34. van Os J et al. (1999) To what extent does symptomatic improvement result in better outcome in psychotic illness? UK700 Group. Psychol Med 29(5):1183–1195

    Article  PubMed  Google Scholar 

  35. van Os J, Wright P, Murray RM (1997) Risk factors for emergence and persistence of psychosis. In: Weller M, Van Kammen D (Eds) Progress in clinical psychiatry. W. B. Saunders Company LTD, London, pp 152–206

    Google Scholar 

  36. Phelan M et al. (1995) The Camberwell assessment of need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 167(5):589–595

    Article  PubMed  CAS  Google Scholar 

  37. Prouteau A et al. (2005) Cognitive predictors of psychosocial functioning outcome in schizophrenia: a follow-up study of subjects participating in a rehabilitation program. Schizophr Res 77(2–3):343–353

    Article  PubMed  Google Scholar 

  38. Reitan RM (1958) Validity of the trail making test as an indicator of organic brain dysfunction. Percept Mot Skills 8:271–276

    Article  Google Scholar 

  39. Robinson DG et al. (2004) Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 161(3):473–479

    Article  PubMed  Google Scholar 

  40. Rosenman S et al. (2003) Dimensional vs. categorical diagnosis in psychosis. Acta Psychiatr Scand 107:378–384

    Article  PubMed  CAS  Google Scholar 

  41. Smith TE et al. (1999) The relative influences of symptoms, insight, and neurocognition on social adjustment in schizophrenia and schizoaffective disorder. J Nerv Ment Dis 187(2):102–108

    Article  PubMed  CAS  Google Scholar 

  42. Sota TL, Heinrichs RW (2004) Demographic, clinical, and neurocognitive predictors of quality of life in schizophrenia patients receiving conventional neuroleptics. Compr Psychiatry 45(5):415–421

    Article  PubMed  Google Scholar 

  43. Spitzer RL, Endicott J, Robins E (1978) Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 35(6):773–782

    PubMed  CAS  Google Scholar 

  44. Stirling J et al. (2003) Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort. Schizophr Res 65(2–3):75–86

    Article  PubMed  Google Scholar 

  45. Tyrer P et al. (1999) Intensive case management for psychotic patients with borderline intelligence. UK 700 Group. Lancet 354(9183):999–1000

    Article  PubMed  CAS  Google Scholar 

  46. UK700Group (1999) Predictors of quality of life in people with severe mental illness. Study methodology with baseline analysis in the UK700 trial. Br J Psychiatry 175:426–432

    Google Scholar 

  47. UK700Group (1999) Comparison of intensive and standard case management for patients with psychosis. Rationale of the trial. UK700 Group. Br J Psychiatry 174:74–78

    Google Scholar 

  48. Verdoux H et al. (2002) Social and clinical consequences of cognitive deficits in early psychosis: a two-year follow-up study of first-admitted patients. Schizophr Res 56(1–2):149–159

    Article  PubMed  Google Scholar 

  49. WHO (1992) WHO coordinated multi-center study on the course and outcome of schizophrenia. WHO, Geneva

    Google Scholar 

Download references

Acknowledgments

The UK700 trial was funded by grants from the UK Department of Health and NHS Research and Development.

Author information

Authors and Affiliations

  1. Dept. of Psychiatry and Neuropsychology, Maastricht University, P.O. BOX 616 (VIJV), 6200 MD, Maastricht, The Netherlands

    Nienke Jabben, Jim van Os & Lydia Krabbendam

  2. Division of Psychological Medicine, Institute of Psychiatry, London, UK

    Jim van Os & Robin Murray

  3. Dept. of Psychiatry, University of Oxford, Oxford, UK

    Tom Burns

  4. Manchester Royal Infirmary, Manchester, UK

    Francis Creed

  5. West of England Forensic Mental Health Service, Fromeside, Bristol, UK

    Theresa Tattan

  6. Central and Northwest London Mental Health NHS Trust, London, UK

    John Green

  7. Division of Neuroscience and Psychological Medicine, Imperial College, London, UK

    Peter Tyrer

Authors
  1. Nienke Jabben
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jim van Os
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tom Burns
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francis Creed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Theresa Tattan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter Tyrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robin Murray
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lydia Krabbendam
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the UK700 Group

Corresponding author

Correspondence to Lydia Krabbendam.

Additional information

The UK700 Group is a collaborative study team involving four clinical centres—Manchester: Tom Butler, Francis Creed, Janelle Fraser, Richard Gater, Peter Huxley, Nick Tarrier, Theresa Tattan. Kings/Maudsley, London: Tom Fahy, Catherine Gilvarry, Kwame Mc Kenzie, Robin Murray, Jim van Os, Elizabeth Walsh. St Marry’s/St Charles, London: John Green, Anna Higgit, Elizabeth van Horn, Donal Leddy, Patricia Thornton, Peter Tyrer. St George’s, London: Rob Bale, Tom Burns, Matthew Fiander, Kate Harvey, Andy Kent, Chiara Samele. York (Health Economics Centre) Sarah Byford, David Torgerson, Ken Wright. Statistical Centre, London: Simon Thompson, Ian White.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jabben, N., van Os, J., Burns, T. et al. Is processing speed predictive of functional outcome in psychosis?. Soc Psychiat Epidemiol 43, 437–444 (2008). https://doi.org/10.1007/s00127-008-0328-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-008-0328-y

Key words

Search

Navigation