Lawrence Yang1,2, Michael Phillips2,3, Matcheri Keshavan4, Ezra Susser2, William Stone4, Hui Li5, Fei Deng3, Hanhui Chen3, Bing Cai3, Zhizhong Wang3, Margaux Grivel1, Debbie Huang2; 1New York University, 2Columbia University, 3Shanghai Mental Health Center, 4Harvard Medical School, 5Florida A&M
Introduction: Many individuals with chronic psychotic disorders in under-resourced settings have a prolonged duration of untreated psychosis (DUP) prior to their first contact with medical treatment. This ongoing study in a northwestern province of China (Ningxia) identifies such a cohort and conducts a detailed assessment of their cognitive functioning prior to initiation of medication. Methods: This NIMH-funded collaboration between the Shanghai Mental Health Center, Harvard Medical School, Columbia University and New York University ascertained untreated individuals with psychosis from Ningxia Province who are enrolled in China’s national registry of community-dwelling individuals with major mental illnesses. After providing informed consent, their DSM-IV (or DSM-5) diagnosis was assessed using an adapted Chinese version of SCID, their current symptomatology using the Positive and Negative Syndrome Scale, and their cognitive functioning using the MATRICS Consensus Cognitive Battery. Results: These interim analyses compare the symptomatic and cognitive characteristics of earlier-onset cases (DUP<5 years) vs. medium (DUP 6-10 years) and long-onset cases (DUP >10 years) and also compare our findings to those from first-contact studies in high-income countries. Discussion: The identification and treatment of individuals with untreated chronic psychotic disorders is a high priority in low- and middle-income countries worldwide. Detailed cognitive assessment of these individuals with widely varying DUP prior to initiating treatment provides a detailed picture of the cognitive trajectory of untreated psychosis. This can then be compared to the cognitive trajectory of treated psychosis to assess the possible influence of antipsychotic medication on the natural history of cognitive decline in schizophrenia.
