Examining the Longitudinal Trajectory of Cognition in Individuals Receiving Coordinated Specialty Care Services for Early Psychosis

Ananya Saluja (1), Kelsey A. Johnson (1), Daphne Ying(1), Paulo Lizano (1,2) Raquelle I. Mesholam-Gately (1,2), Matcheri S. Keshavan (1,2)

1. Beth Israel Deaconess Medical Center, Boston, MA
2. Harvard Medical School Department of Psychiatry, Boston, MA

Background Cognitive impairment is a core feature of psychosis-spectrum disorders; however, the course of cognitive functioning, particularly during the first episode of psychosis (FEP), is not well understood. Current research shows that the Coordinated Specialty Care (CSC) model is the best approach to treatment for youth with FEP. The aim of this study was to examine the trajectory of cognition in individuals receiving CSC in the early acute phase of their psychosis, when the maximum clinical improvement is likely to occur.

Method Longitudinal data on cognition were collected from 9/21 to 1/24 in a real-world clinical sample at the ASPIRE Clinic in Boston, Massachusetts. Clients’ scores on the Brief Assessment of Cognition in Schizophrenia (BACS) were assessed at three timepoints: baseline (n = 32), at 6-month follow-up, and at 12-month follow-up (combined n = 17). t-tests were used to compare BACS z-scores across timepoints and test their associations with clinical domains such as hallucinations, functioning, and quality of life.

Results BACS total scores were higher at follow-up; however, differences in individual tasks were not significant. There was a small negative correlation between clinician-rated disorganization & total BACS scores (approaching significance). Other clinical domains were not significantly correlated with BACS scores. Both social and role functioning were significantly correlated with BACS total scores.

Conclusions CSC services are the gold standard treatment for FEP; improved outcomes by 12 months in treatment provide evidence of an effective treatment model. Thus, if cognitive improvement is linked to symptomatic change, we are likely to see higher BACS scores in patients at the ASPIRE Clinic. The link between cognitive performance and positive and negative symptoms should further be explored in future studies by examining correlations between PANSS and BACS scores. Additionally, as CSC services continue to grow nationwide, examining the longitudinal trajectory of cognition in a large