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Annotation

Seidman LJ, Giuliano AJ, Meyer EC, Addington J, Cadenhead KS, Cannon TD, McGlashan TH, Perkins DO, Tsuang MT, Walker EF, Woods SW, Bearden CE, Christensen BK, Hawkins K, Heaton R, Keefe RS, Heinssen R, Cornblatt BA, . Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis. Arch Gen Psychiatry . 2010 Jun ; 67(6):578-88. PubMed Abstract

Comments on Paper and Primary News
Comment by:  Patrick McGorry, SRF Advisor
Submitted 7 July 2010 Posted 7 July 2010

If you look at the conclusion by the authors of this excellent piece of research, it seems pretty clear that neurocognitive variables add nothing to the predictive value of the clinical variables alone, which is what we have found in our research, too. So, sadly, predictive power of the neurocognitive variables is no help. There has been a lot of hype regarding cognition in schizophrenia, but little useful progress, and this excellent paper illustrates that, in my view.

View all comments by Patrick McGorry


Comment by:  Richard Keefe
Submitted 8 July 2010 Posted 8 July 2010

Reply to comment by Patrick McGorry
In response to Professor McGorry's comments, it is hard to imagine that neurocognitive measures really “add nothing” to the prediction of psychosis. The Seidman paper focuses primarily on neuropsychological measures that were collected in each of several research projects. They tended to be standard tests that are clear measures of general neuropsychological function known to be severely impaired in schizophrenia. However, the breakdown of cognitive function that occurs prior to the onset of psychosis may require more specific cognitive indices that best reflect how an individual maintains a sense of reality.

How the human brain staves off hallucinations and delusions is likely not a cognitive function that is easily measured with standard neuropsychology. Recent models describe how perception depends upon learning-dependent prediction, and how impairments in these cognitive processes may lead to chronic misperception of reality and subsequent hallucinations and delusions (Keefe et...  Read more


View all comments by Richard Keefe

Comment by:  Alison Yung (Disclosure)
Submitted 22 July 2010 Posted 23 July 2010
  I recommend this paper

I agree with the previous two commentators that this is an excellent paper. An interesting finding was that neuropsychological difficulties were present in clinical high-risk (CHR) individuals who later developed psychosis, but they were not as marked as impairments found in people with first-episode schizophrenia. The authors commented that this phenomenon might be evidence of cognitive decline occurring during the prodromal phase. This could indicate that a “process” is occurring, suggesting a discontinuity between pre-psychotic and psychotic states, rather than just an accumulation of psychotic symptoms of increasing frequency and intensity. Wood et al. found evidence of cognitive decline in the peri-onset phase in ultra high-risk individuals, but this finding was not supported by Hawkins et al.

Related to the issue of whether there is any discontinuity between the prodrome and first-episode psychosis is the question of whether we have the threshold of “psychosis” right. As we...  Read more


View all comments by Alison Yung

Comment by:  Joachim KlosterkötterRalf Pukrop
Submitted 8 August 2010 Posted 8 August 2010

When the eight centers participating in the NAPLES group decided to bring their own data gained from independently conducted trials into a large communal pool, the plan, although followed with great interest by other prodrome research centers worldwide, was also regarded as problematic. There is, in fact, a methodological difference in achieving a large database by pooling data a posteriori versus performing a prospective longitudinal multicenter research project such as the European Prediction of Psychosis Study (EPOS) (Ruhrmann et al., 2010). Previous NAPLES publications have convinced the scientific community, however, that the methodological problem of the disparate data collection can still be largely solved with the aid of appropriate integration procedures. The similarity of the ascertainment and the diagnostic methods made it possible to form a standardized protocol for mapping data into a new scheme representing the common components across sites. Through this careful processing, a solid database for the important...  Read more


View all comments by Joachim Klosterkötter
View all comments by Ralf Pukrop
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