Visual working memory deterioration preceding relapse in psychosis

Abstract

Background: Relapse is common after the first episode of psychosis and can have potentially irreversible consequences, yet it is poorly understood and difficult to predict. Examining changes in cognitive function preceding relapse may be useful in enriching our understanding towards the underlying mechanism of psychotic relapse. It is hypothesized that relapse in fully remitted first-episode psychosis patients was preceded by working memory deterioration. Method: Visual and verbal working memory were monitored prospectively in a 1-year randomized controlled trial of remitted first-episode psychosis patients assigned to medication continuation (quetiapine 400 mg/d) or discontinuation (placebo). Relapse (recurrence of positive symptoms of psychosis), visual (Visual Patterns Test) and verbal (Letter-Number Span Test) working memory, and stressful life events were assessed monthly. Results: One hundred and two remitted first-episode patients participated in the study (relapsers=53 and non-relapsers=49). Logistic regression analyses showed that relapse was associated with visual working memory deterioration 2 months before relapse (odds ratio [OR] = 3.07; 95% CI, 1.19-7.92; P = 0.02), more stressful life events 1 month before relapse (OR = 2.11, 95% CI, 1.20-3.72; P = 0.01), and medication discontinuation (OR = 5.52; 95% CI, 2.08-14.62; P = 0.001). Conclusions: We found that visual working memory deterioration beginning 2 months before relapse in remitted first-episode psychosis patients may reflect early brain dysfunction that heralds a psychotic relapse. The observed cognitive deterioration also occurred independent of any change in psychopathology prior to relapse. Testable predictors of relapse would be an important addition to the long-term management of patients with psychosis.