Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Abstract
Neurocognitive deficits and thought disorder in schizophrenia have
generally been accepted as core features of the illness, yet their
underlying relationship, response to treatment, and correlations with
outcome remain unclear. Most of the studies to date have used
cross-sectional designs and focussed on stable patients already on
treatment. The purpose of this study was to assess changes in
neurocognition and thought disorder in antipsychotic naïve or
minimally treated first episode psychosis (FEP) patients, over the
course of 12 months of treatment according to a standard algorithm
with flupenthixol decanoate (FD) long acting injectable antipsychotic.
This was a prospective, non-comparative, open-label, longitudinal
study of 42 patients with FEP. There was an initial wash-out phase of
up to 7 days after which treatment was initiated with oral flupenthixol,
1 to 4 mg/day for 1 week prior to when the first long-acting FD was
given. The starting dose of FD was 10mg every second week, with
dose increases allowed at 6-week intervals. The Matrics Consensus
Cognitive Battery (MCCB) and Rorschach Percerptual Thinking Index
(PTI) were used as the primary co-measures for the assessment of
neurocognition, thought disorder and perceptual disturbances
respectively, at baseline prior to treatment, at month 6 and month 12.
The main findings of this study were as follows: we confirmed the
presence of significant neurocognitive impairment, thought disorder
and perceptual disturbances prior to treatment, with improvement in
neurocognitive performance and thought disorder from baseline to 6
months, with form perception improving later between month 6 and
month 12. Improvements in symptoms were associated with
improvements in neurocognitive performance, thought disorder and
perceptual disturbances but a degree of residual impairment was
evident at month 12. This study confirmed the association between
neurocognition and form perception per se as well as their relative
stability in FEP after initial improvement with treatment. We found
support for the correlation between the amount of improvement in
neurocognition, thought and perceptual disorder with outcome. We
found the Social and Occupational Functioning Scale (SOFAS) to be
a more robust measure of social and functional outcome with highest
level of education (HLOE), substance abuse, reasoning-and-problem
solving, form perception and Rorschach PTI emerging as predictors
in a best subset regression analysis.
The findings of this study suggest that neurocognitive impairments,
thought disorder and perceptual disturbances have both state and
trait like features, that patients benefit from treatment with a low-dose
FGA, and that residual neurocognitive and perceptual impairment
after treatment may indicate persisting underlying cerebral pathology. / AFRIKAANSE OPSOMMING: Abstrak
Neurokognitiewe inkortinge en gedagteproses versteuring in
skisofrenie word algemeen aanvaar as kern eienskappe van die
siekte, tog is die onderliggende verhouding, die respons op
behandeling, en die verwantskap met uitkoms onduidelik. Die meeste
studies het 'n oorkruis-deursnee navorsingontwerp gebruik en
gefokus op stabiele pasiёnte wat reeds op behandeling was. Die doel
van hierdie studie was om die verandering in neurokognisie,
gedagte vesteuring en perseptuele inkortinge te meet in eersteepisode
psigose pasiёnte wat behandeling naïef was, of wat
minimale behandeling gekry het, oor die verloop van 12 maande, met
die toediening van 'n langwerkende, lae dosis flupenthixol inspuiting.
Hierdie was 'n prospektiewe, nie-vergelykende, oop etiket,
longitudinale studie van 42 eerste episode psigose pasiёnte almal op
behandeling volgens 'n vaste protokol. Daar was 'n inisiёle uitwas
periode van tot 7 dae waarna behandeling begin is op orale
flupethixol, 1 tot 4 mg/dag vir 1 week voordat die eerste
langwerkende flupenthixol inspuiting toegedien was. Die aanvangsdosis
was 10mg elke tweede week met verhogings in dosis elke
sesde week daarna. Die "Matrics Consensus Cognitive Battery''
(MCCB) en Rorschach "Perceptual Thinking Index" (PTI) is gebruik
as die primêre instrumente vir die meting van neurokognisie, gedagte
versteuring en perseptuele inkorting in noue samehang voor
aanvang van behandeling, op maand 6 en op maand 12.
Die hoof bevindinge van hierdie studie was as volg: Ons het die
teenwoordigheid van beduidende neurokognitiewe, gedagte
versteuring en perseptuele inkortinge bevestig voor behandeling, met
verbetering in neurokognitiewe prestasie en gedagte versteuring
tussen basislyn en maand 6, en verbetering in vorm persepsie wat
later gevolg het tussen maand 6 en maand 12. Die verbetering in
simptome was geassosieёr met verbetering in neurokognitiewe
prestasie, gedagte versteuring en perseptuele inkortinge maar teen
maand 12 was 'n graad van residuele neurokognitiewe en
perseptuele inkortinge aanwesig. Hierdie studie het die verwantskap
tussen neurokognisie en vorm persepsie bevestig, asook die
relatiewe stabiliteit daarvan in eerste episode psigose na
aanvanklike verbetering op behandeling. Ons het bewyse gevind wat
die korrelasie tussen neurokognisie, gedagte en perseptuele
versteuring met uitkomste ondersteun. Ons het bevind dat die "Social
and Occuapational Functioning Scale" (SOFAS) 'n meer robuuste
meting van sosiale en funksionele uitkoms is, en dat hoogste
opvoedkundige vlak, substans misbruik, redenering-en-probleem
oplossing, vorm persepsie en die Rorschach PTI as voorspellers
identifiseer was in 'n beste substel regressie analise.
Die bevindinge van hierdie studie suggereer dat neurokognitiewe,
gedagte versteuringe en perseptuele inkortinge oor beide toestand
en trek eienskappe beskik, en dat pasiёnte verbeter het met
behandeling op 'n lae dosis eerste generasie antipsigotikum, en dat
residuele neurokognitiewe en perseptuele inkortinge na behandeling
aanduidend kan wees van onderliggende serebrale patologie.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/97079 |
| Date | 04 1900 |
| Creators | Olivier, Marius Riaan |
| Contributors | Emsley, R., Stellenbosch University. Faculty of Health Sciences. Dept. of Psychiatry. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 346 pages : illustrations |
| Rights | Stellenbosch University |
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