Studies to date indicate that cognitive problems in individuals with psychosis increase up until the end of the first psychotic episode and subsequently remain relatively stable after onset of psychotic illness. In a novel test of this topic, we examined in a remote, rural region of China (Ningxia Province) the association between duration of untreated psychosis and cognitive function over a much longer time span than previously reported. Untreated individuals with psychosis (n=206) with a median DUP of 23.6 years were assessed using the Chinese version of the Structured Clinical Interview for DSM-IV, and an adapted 9-test version of the MATRICS Consensus Cognition Battery (MCCB). The main results showed that 3 of the 9 subdomains of the cognitive tests related to executive functioning (visual learning, problem solving, and processing speed) decreased significantly as duration of untreated psychosis increased. Based on the annualized effect sizes of these declines, the median duration of untreated psychosis (23 years) was associated with reductions in these cognitive test scores ranging from 35% to 84%. If confirmed, this finding that long-term untreated psychosis is associated with decreases in selective cognitive abilities would challenge the conventional view that cognition in psychosis is characterized by stable deficits that develop early and are fully explained by a neurodevelopmental etiology. Implications for understandings of the natural long-term course of psychosis, and for providing community-based treatment for psychosis in remote rural regions of low-and-middle-income countries, will be discussed.
Speaker Biography - Lawrence Yang
Associate Professor of Social and Behavioral Sciences, NYU- College of Global Public Health
Dr. Lawrence Yang is an Associate Professor of Social and Behavioral Sciences at NYU- College of Global Public Health. Dr. Yang directs the Global Mental Health and Stigma Program at the College of Global Public Health. He is also an Adjunct Associate Professor of Epidemiology at Columbia University, where he was faculty for 11 years. Dr. Yang received his Ph.D. in clinical psychology from Boston University and completed his clinical training at Harvard Medical School. He received a T32 NIMH-sponsored post-doctoral fellowship at Columbia University in psychiatric epidemiology. Dr. Yang’s research focuses on the social factors that influence course of schizophrenia, and he has received training in clinical psychology, anthropology, and psychiatric epidemiology. First, from his National Institutes of Mental Health K-award, he has formulated theoretical work on how culture relates to stigma and implementing interventions for Chinese immigrants with psychosis in New York City. Second, Dr. Yang was PI of a recently-completed 5-year National Institutes of Mental Health R01 grant examining the neurocognitive and social cognitive underpinnings of the new "clinical high risk state for psychosis" designation, a potentially transformative new syndrome to detect psychotic signs before symptoms develop into a full psychotic disorder. Third, Dr. Yang has extensive research in global mental health. He has received an R01 examining the cognition in the ‘natural state’ of psychosis in a large untreated, community sample of individuals with psychosis (n=400), who have not yet received any antipsychotic medications, compared with a treated sample (n=400) and healthy controls (n=400) in China. He also leads an evaluation of barriers and facilitators to mental health intervention scale-up in Latin America (Chile, Brazil and Argentina) via a R01 National Institutes of Mental Health Hub Grant. He has over 100 publications, including publications in the British Journal of Psychiatry and The Lancet. Dr. Yang has received eight Early Career Awards, six of which are national, for his work.
Seminars are FREE and open to the public. If you can not attend, Videotapes of Public Health seminars are archived through the UC Irvine OpenCourseWare program - please visit OpenCourseWare: http://ocw.uci.edu.