Substance use and cognition in early psychosis

Alissa Pencer; Jean Addington

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Table 1

Initial Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses of substance abuse or dependence in 266 patients with first-episode psychosis

Substance abuse diagnosis	No. (and %) of patients
No substance abuse	138 (52)
Substance abuse	128 (48)
Cannabis and alcohol	37 (14)
Cannabis	35 (13)
Alcohol	32 (12)
Cannabis, alcohol and hallucinogens	13 (5)
Cocaine	5 (2)
Cannabis and hallucinogens	3 (1)
Alcohol and hallucinogens	2 (1)
Hallucinogens	1 (0.5)

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Table 2

Mean scores for cognitive measures at initial assessment of 237 patients with first-episode psychosis

Cognitive measure	Mean score (and SD)	Range
Verbal fluency
Category fluency	37.6 (9.1)	12–67
Letter fluency	32.3 (10.0)	4–61
Visual-spatial ability and motor speed
Digit symbol	8.7 (2.7)	3–20
Trails A	35.3 (15.3)
Memory
Immediate verbal memory	21.1 (22.1)	1–96
Delayed verbal memory	22.1 (20.2)	1–95
Immediate serial learning	40.2 (11.4)	8–67
Delayed serial learning	7.4 (3.2)	0–15
Visual memory (Rey recall)	20.6 (7.0)	0–36
Executive functioning
WCST categories	5.1 (1.7)	0–6
WCST perseverative errors	14.7 (13.3)	4–94
Trails B	83.6 (52.4)	15–300
Visual attention (CPT)	85.5 (10.9)	0–99
Early information processing (SPAN)	46.5 (9.3)	13–62

Note: SD = standard deviation; WCST = Wisconsin Card Sorting Test; CPT = Continuous Performance Test; SPAN = Forced-Choice Span of Apprehension Test.

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Table 3

Significance of correlations between cognitive functioning and level of substance use at the initial assessment and 1-year and 2-year follow-ups

Cognitive measure	Substance used; significance of correlation^*

	Alcohol	Cannabis	Cocaine	Stimulants	Hallucinogens
Verbal fluency
Category fluency	NS	NS, −0.21, NS	NS	NS	NS
Letter fluency	NS	NS	NS	NS	NS
Visual-spatial ability and motor speed
Digit symbol	NS	NS	NS	NS	NS
Trails A	NS, −0.29, NS	NS	NS	NS	NS
Memory
Immediate verbal memory	NS	NS	NS, NS, 0.29	NS	NS
Delayed verbal memory	NS	NS	NS, NS, 0.32	NS	NS
Immediate serial learning	0.20, NS, NS	NS	NS	0.14, NS,NS	0.14, NS, NS
Delayed serial learning	NS	NS	NS	NS	NS
Visual memory (Rey recall)	NS, 0.23, NS	NS	NS	NS	NS
Executive functioning
WCST categories	NS	NS	NS	NS	NS
WCST perseverative errors	NS	NS	NS	NS	NS
Trails B	NS, −0.22, −0.31	NS	NS	NS	NS
Visual attention (CPT)	NS	NS	NS	NS	NS
Early information processing (SPAN)	NS	NS	NS	NS	NS

Note: NS = not significant.
↵* Where there are 3 cell entries, the first refers to the first assessment data, the second to the 1-yr follow-up data and the third to the 2-yr follow-up data; p < 0.05.