PMID- 38277145 OWN - NLM STAT- MEDLINE DCOM- 20240129 LR - 20240206 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 7 IP - 1 DP - 2024 Jan 2 TI - Duration of Untreated Prodromal Psychosis and Cognitive Impairments. PG - e2353426 LID - 10.1001/jamanetworkopen.2023.53426 [doi] LID - e2353426 AB - IMPORTANCE: The possible association between the duration of untreated prodromal symptoms (DUPrS) and cognitive functioning in individuals at clinical high risk (CHR) for psychosis remains underexplored. OBJECTIVE: To investigate the intricate interplay between DUPrS, cognitive performance, and conversion outcomes, shedding light on the potential role of DUPrS in shaping cognitive trajectories and psychosis risk in individuals at CHR for psychosis. DESIGN, SETTING, AND PARTICIPANTS: This cohort study of individuals at CHR for psychosis was conducted at the Shanghai Mental Health Center in China from January 10, 2016, to December 29, 2021. Participants at CHR for psychosis typically exhibit attenuated positive symptoms; they were identified according to the Structured Interview for Prodromal Syndromes, underwent baseline neuropsychological assessments, and were evaluated at a 3-year clinical follow-up. Data were analyzed from August 25, 2021, to May 10, 2023. EXPOSURE: Duration of untreated prodromal symptoms and cognitive impairments in individuals at CHR for psychosis. MAIN OUTCOMES AND MEASURES: The primary study outcome was conversion to psychosis. The DUPrS was categorized into 3 groups based on percentiles (33rd percentile for short [/=10 months]). The DUPrS, cognitive variables, and the risk of conversion to psychosis were explored through quantile regression and Cox proportional hazards regression analyses. RESULTS: This study included 506 individuals (median age, 19 [IQR, 16-21] years; 53.6% [n = 271] women). The mean (SD) DUPrS was 7.8 (6.857) months, and the median (IQR) was 6 (3-11) months. The short and median DUPrS groups displayed poorer cognitive performance than the long DUPrS group in the Brief Visuospatial Memory Test-Revised (BVMT-R) (Kruskal-Wallis chi2 = 8.801; P = .01) and Category Fluency Test (CFT) (Kruskal-Wallis chi2 = 6.670; P = .04). Quantile regression analysis revealed positive correlations between DUPrS rank and BVMT-R scores (<90th percentile of DUPrS rank) and CFT scores (within the 20th-70th percentile range of DUPrS rank). Among the 506 participants, 20.8% (95% CI, 17.4%-24.5%) converted to psychosis within 3 years. Cox proportional hazards regression analysis identified lower educational attainment (hazard ratio [HR], 0.912; 95% CI, 0.834-0.998), pronounced negative symptoms (HR, 1.044; 95% CI, 1.005-1.084), and impaired performance on the Neuropsychological Assessment Battery: Mazes (HR, 0.961; 95% CI, 0.924-0.999) and BVMT-R (HR, 0.949; 95% CI, 0.916-0.984) tests as factors associated with conversion. CONCLUSIONS AND RELEVANCE: The finding of this cohort study suggest the intricate interplay between DUPrS, cognitive performance, and conversion risk in individuals at CHR for psychosis. The findings emphasize the importance of considering both DUPrS and cognitive functioning in assessing the trajectory of these individuals. FAU - Zhang, TianHong AU - Zhang T AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Cui, HuiRu AU - Cui H AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Wei, YanYan AU - Wei Y AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Tang, XiaoChen AU - Tang X AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Xu, LiHua AU - Xu L AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Hu, YeGang AU - Hu Y AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Tang, YingYing AU - Tang Y AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Liu, HaiChun AU - Liu H AD - Department of Automation, Shanghai Jiao Tong University, Shanghai, China. FAU - Wang, ZiXuan AU - Wang Z AD - Shanghai Xinlianxin Psychological Counseling Co Ltd, Shanghai, PR China. FAU - Chen, Tao AU - Chen T AD - Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada. AD - Labor and Worklife Program, Harvard University, Cambridge, Massachusetts. FAU - Li, ChunBo AU - Li C AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Wang, JiJun AU - Wang J AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. AD - Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Science, Shanghai, PR China. AD - Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China. LA - eng PT - Journal Article DEP - 20240102 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 SB - IM MH - Humans MH - Female MH - Young Adult MH - Adult MH - Cohort Studies MH - Prodromal Symptoms MH - China/epidemiology MH - *Psychotic Disorders/diagnosis/psychology MH - *Cognitive Dysfunction/diagnosis PMC - PMC10818213 COIS- Conflict of Interest Disclosures: None reported. EDAT- 2024/01/26 12:45 MHDA- 2024/01/29 06:44 PMCR- 2024/01/26 CRDT- 2024/01/26 11:33 PHST- 2024/01/29 06:44 [medline] PHST- 2024/01/26 12:45 [pubmed] PHST- 2024/01/26 11:33 [entrez] PHST- 2024/01/26 00:00 [pmc-release] AID - 2814304 [pii] AID - zoi231569 [pii] AID - 10.1001/jamanetworkopen.2023.53426 [doi] PST - epublish SO - JAMA Netw Open. 2024 Jan 2;7(1):e2353426. doi: 10.1001/jamanetworkopen.2023.53426.