Cognitive Impairment and Duration of Untreated First Episode Psychoses in Pakistan

The relationship between duration of untreated psychoses and the outcome provides the ground for the current emphasis on early intervention in psychoses.Cognitive deterioration had been shown in studies with patients with a first psychotic episode (Addington & Addington, 2002; Amminger, Edwards, Brewer, Harrigan, & McGorry. 2000; Bilder, Goldmann, Robinson, Reiter, Bell, & Bates, et al. 2000). Patients in their first episode psychosis also appear to have severe impairments in sequencing, organizational flexibility, planning ability and strategy use. Findings indicating that first-episode patients perform less well on free recall than on verbal memory tests have led to the suggestion that difficulty with free recall is possibly secondary to impaired executive functioning (Hutton, Puri, Duncan, Robbins, Barnes & Joyce, 1998).Mohamed, Paulsen, mO'Leary, Arndt and Andreasen (1999) found certain facets of executive functioning such as sequencing, organization and flexibility to be highly impaired in first episode psychosis when compared with controls. Impairments in certain cognitive tasks with and without a motor component had also been demonstrated.Bilder et al. (2000) found that memory was more impaired in patients with first episode psychosis than in 36 healthy controls. Another sample of first-episode patients was retested during remission to prevent the effects of acute psychosis. No changes in the initially identified deficits in verbal and spatial memory were found, suggesting that memory deficits were present irrespective of the illness status (Hoff, Sakuma, Wieneke, Horon, Kushner& DeLisi, 1999).Spatial working memory impairment can be a central part of psychotic disorders. Models of working memory are normally associated with several cognitive sub-processes (Baddeley, 1986) and a range of different processing deficits could give rise to impairments on spatial working memory tasks. Relationships between the clinical symptoms and performance on the delayedmatching-to-sample task were found to be mediated entirely through their relationship with the spatial working memory measures (Pantelis, Stuart, Nelson, Robbins & Barnes, 2001).It has already been debated as to whether DUP could affect the cognitive functioning during early psychosis. Perkins, Gu, Boteva, and Lieberman (2005) found that at the beginning of treatment, duration of initially untreated psychosis was associated with the severity of negative symptoms but not with the severity of positive symptoms, general psychopathology, or neuro-cognitive function. Duration of untreated psychosis was thought to be a potentially modifiable prognostic factor. Similar findings had been reported by other researchers (Barnes, Leeson, Mutsatsa, Watt, Hutton, & Joyce, 2008).Most of the studies have been conducted in developed countries. It is acknowledged that socio-cultural factors have a significant impact on various aspects of psychopathology and mental health care, including symptom profile, outcome and methods of assessment and diagnosis of psychotic disorders (Alarcon, Westermeyer, Foulks & Ruiz, 1999; Kulhara, & Chakrabarti 2001). The current study assumed that cognitive functioning of patients with first episode psychosis will be affected by the length of duration of untreated psychosis.MethodParticipantsSixty patients with first episode psychosis (41 men and 19 women), within an age range of 18 and 35 years (M = 26.15, SD = 5.29) were drawn from in and outpatient psychiatry departments from different hospitals of Lahore and Faisalabad. An informed consent was obtained from the guardians/caretakers of patients, for the participation in the study.Patients with FEP were identified by following the criterion of DSM-IV-TR (American Psychiatrists Association, 2000) which included schizophrenia, schizophrenoform disorder, schizoaffective disorder, delusional disorder, substance-induced psychotic disorder, brief psychotic disorder, and psychotic disorder not otherwise specified. …