Preliminary examination of the validity of the NIH toolbox cognition battery in treatment-resistant psychosis

Abstract

Objective: Prior research has suggested that treatment-resistant psychosis (TRP) may be a categorically distinct subtype from treatment-responsive psychotic disorders. However, relatively few studies have investigated the cognitive profile of individuals with TRP. Moreover, no prior studies have investigated the effectiveness of using the NIH Toolbox Cognition Battery (NTCB) for assessing cognition among psychiatric inpatients despite its promising efficiency and practicality in such settings. The current study aimed to investigate the validity of the NTCB and the associated cognitive profile of inpatients with TRP.

Methods: Participants (N = 38) were administered the NTCB and a neuropsychological test battery. The Positive and Negative Syndrome Scale and the Routine Assessment of Patient Progress measured psychosis symptomatology and daily functioning, respectively.

Results: Results showed deficits relative to normative values in fluid cognitive abilities using the NTCB, as predicted. There was strong convergent validity and adequate divergent validity between the NTCB subtests and corresponding neuropsychological measures, though no NTCB subtest correlated with performance on the Wisconsin Card Sorting Task. NTCB performance correlated with positive and disorganized symptoms of psychosis as well as daily functioning.

Conclusions: Taken together, the NTCB appears to be a relatively strong tool for cognitive screening among psychiatric inpatients and may be used to identify which patients might benefit from further neuropsychological evaluation.

Keywords:

• treatment-resistant
• psychosis
• schizophrenia
• cognition
• NIH Toolbox
• assessment

Acknowledgements

RFW was supported by a Continuing Professional Development Award from UBC. WGH was supported by the Jack Bell Chair in Schizophrenia. The authors would like to thank the patients and clinical team at the BC Psychosis Program for their participation and support in this research.

Disclosure statement

OL declares receipt of consulting fees from Perception Neuroscience Holding Inc. RFW has received consulting fees or grants and/or sat on advisory boards for: Medscape, Lundbeck, Otsuka, Janssen, and ThermoFisher/Affymetrix. WGH has received consulting fees or sat on paid advisory boards for: the Canadian Agency for Drugs and Technology in Health, AlphaSights, Guidepoint, In Silico, Otsuka, Lundbeck, and Newron. IJT has received consulting fees or sat on advisory boards for Lundbeck Canada, Sumitomo Dainippon, and Community Living British Columbia (CLBC).

Additional information

Funding

This work was supported by the UBC Institute of Mental Health Centre for Care and Research and the BC Mental Health and Substance Use Services Research Institute.