Cognitive, social, and vocational functioning of young adults at familial risk for psychosis (FRP) and with early psychosis (EP)

Abstract

Background: Social cognition is suggested to be an important mediating variable in the relationship between neurocognition and vocational function in schizophrenia, and family support may also play a positive role in the vocational function of schizophrenia. However, similar studies in Chinese communities are scarce, especially among individuals at familial risk for psychosis (FRP). This study conducts preliminary work in Hong Kong to understand better the relationships among these important variables and the impact on their social and occupational functions in individuals with early psychosis (EP) and at FRP; and meanwhile a pilot randomised controlled trial (RCT) to evaluate if Chinese Social Cognition and Interaction Training (CSCIT) could improve social and vocational functions among FRP individuals. Methods: First, we conducted a pilot cross-sectional study among 203 participants, including 77 individuals with EP, 49 individuals at FRP, and 77 healthy controls (HC), to compare and explore the relationships between neurocognition, social cognition, social skills, family support, and vocational functions. Second, a pilot RCT was conducted to test the effectiveness of a 9-session CSCIT on those with individuals at FRP in improving social skills and four social cognitive domains as the primary outcomes; and vocational function, mental state, and quality of life as the secondary outcomes at post-treatment and 3 months follow-up. Results: Analyses indicated that visual learning performance dropped in the order from HC, then FRP, to the EP group. Vocational function, social skills, processing speed, verbal learning, and neurocognition (measured by the composite score) were impaired in EP group compared to FRP and HC groups. Reasoning and problem-solving, and working memory were impaired in the EP group compared to the HC group. Meanwhile, neurocognition had a significant positive relationship to social cognition in the EP and FRP groups. Family support had an indirect relationship to the vocational performance mediated by social skills in the EP group. Neurocognition was significantly associated with family support in the FRP group. In addition, CSCIT + TAU group showed promising evidence over the TAU group in both primary and secondary outcomes. Discussion and Implications: This study provides partial support to the hypothetical theoretical model in individuals with EP and individuals at FRP. People with poorer neurocognitive function likely have more problems with social cognition, leading to difficulties in competitive employment; and good family support facilitates their social skills on the job. Additionally, CSCIT shows potential to help FRP individuals to improve their clinical and psychosocial functions.