Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients

Melissa A. Weibell; Jan Olav Johannessen; Bjørn Auestad; Jørgen Bramness; Kolbjørn Brønnick; Ulrik Haahr; Inge Joa; Tor Ketil Larsen; Ingrid Melle; Stein Opjordsmoen; Bjørn Rishovd Rund; Jan Ivar Røssberg; Erik Simonsen; Per Vaglum; Helen Stain; Svein Friis; Wenche Ten Velden Hegelstad

doi:10.3389/fpsyt.2019.00495

Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients

Melissa A. Weibell^*, Jan Olav Johannessen, Bjørn Auestad, Jørgen Bramness, Kolbjørn Brønnick, Ulrik Haahr, Inge Joa, Tor Ketil Larsen, Ingrid Melle, Stein Opjordsmoen, Bjørn Rishovd Rund, Jan Ivar Røssberg, Erik Simonsen, Per Vaglum, Helen Stain, Svein Friis, Wenche Ten Velden Hegelstad

^*Corresponding author af dette arbejde

2 Citationer (Scopus)

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Abstract

Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.

Originalsprog	Engelsk
Artikelnummer	495
Tidsskrift	Frontiers in Psychiatry
Vol/bind	10
Udgave nummer	JULY
ISSN	1664-0640
DOI	https://doi.org/10.3389/fpsyt.2019.00495
Status	Udgivet - 1 jan. 2019

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10.3389/fpsyt.2019.00495Licens: CC BY

fpsyt-10-00495Forlagets udgivne version, 903 KBLicens: CC BY

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Weibell, M. A., Johannessen, J. O., Auestad, B., Bramness, J., Brønnick, K., Haahr, U., Joa, I., Larsen, T. K., Melle, I., Opjordsmoen, S., Rund, B. R., Røssberg, J. I., Simonsen, E., Vaglum, P., Stain, H., Friis, S., & Ten Velden Hegelstad, W. (2019). Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients. Frontiers in Psychiatry, 10(JULY), [495]. https://doi.org/10.3389/fpsyt.2019.00495

Weibell, MA, Johannessen, JO, Auestad, B, Bramness, J, Brønnick, K, Haahr, U, Joa, I, Larsen, TK, Melle, I, Opjordsmoen, S, Rund, BR, Røssberg, JI, Simonsen, E, Vaglum, P, Stain, H, Friis, S & Ten Velden Hegelstad, W 2019, 'Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients', Frontiers in Psychiatry, bind 10, nr. JULY, 495. https://doi.org/10.3389/fpsyt.2019.00495

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title = "Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients",

abstract = "Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.",

keywords = "Cognition, First-episode psychosis, Neurocognition, Psychosis, Substance use",

author = "Weibell, {Melissa A.} and Johannessen, {Jan Olav} and Bj{\o}rn Auestad and J{\o}rgen Bramness and Kolbj{\o}rn Br{\o}nnick and Ulrik Haahr and Inge Joa and Larsen, {Tor Ketil} and Ingrid Melle and Stein Opjordsmoen and Rund, {Bj{\o}rn Rishovd} and R{\o}ssberg, {Jan Ivar} and Erik Simonsen and Per Vaglum and Helen Stain and Svein Friis and {Ten Velden Hegelstad}, Wenche",

year = "2019",

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doi = "10.3389/fpsyt.2019.00495",

language = "English",

volume = "10",

journal = "Frontiers in Psychiatry",

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T1 - Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients

AU - Weibell, Melissa A.

AU - Johannessen, Jan Olav

AU - Auestad, Bjørn

AU - Bramness, Jørgen

AU - Brønnick, Kolbjørn

AU - Haahr, Ulrik

AU - Joa, Inge

AU - Larsen, Tor Ketil

AU - Melle, Ingrid

AU - Opjordsmoen, Stein

AU - Rund, Bjørn Rishovd

AU - Røssberg, Jan Ivar

AU - Simonsen, Erik

AU - Vaglum, Per

AU - Stain, Helen

AU - Friis, Svein

AU - Ten Velden Hegelstad, Wenche

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.

AB - Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.

KW - Cognition

KW - First-episode psychosis

KW - Neurocognition

KW - Psychosis

KW - Substance use

U2 - 10.3389/fpsyt.2019.00495

DO - 10.3389/fpsyt.2019.00495

M3 - Journal article

C2 - 31354551

AN - SCOPUS:85069769880

SN - 1664-0640

VL - 10

JO - Frontiers in Psychiatry

JF - Frontiers in Psychiatry

IS - JULY

M1 - 495

ER -

Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients

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