BJPsych Kaleidoscope October 2019

magazine-coverPsychosis is associated with cognitive decline, but some detail on this has been lacking: is this unique to schizophrenia, is it a continuous process with time, and does it affect all cognitive domains equally?

The truth is that there has been a lack of adequate longer-term follow-up on the matter, but October’s Kaleidoscope reports on a paper that has now done this. Just over 100 individuals with psychosis (65 with schizophrenia) who had an initial comprehensive psychometric battery on first diagnosis, and were then followed up over a decade. The findings showed that cognitive decline occurred in all psychoses, and that deterioration continued over time (the so-called ‘decline hypothesis’) but there were different patterns. In schizophrenia IQ persisted in dropping but progressive deficits were mainly in verbal knowledge and memory, with no subsequent loss of executive functioning; in ‘other psychoses’, later changes were limited to verbal learning. So these data go against the ‘general decline’ hypothesis and show that some areas of cognition are more impacted than others. The paper is a reminder in a world moving from ‘schizophrenia’ to ‘psychoses’ that not all psychotic presentations are ‘equal’.

We all love paper abstracts. Be honest, typically the only part you read, and the reason you turn to this research round-up: too much hard work going through the methods section…

well what’s interesting is that journals have guidelines on information that needs to be included in the main paper, but the abstracts usually lack these, and of course for authors, the abstract is the prime showcase window to convince you of the importance of their work. In other words, it’s all primed for some well-intentioned spin. Kaleidoscope reports on a piece that undertook a cross-sectional review of clinical randomised controlled trials (RCTs) with non-significant primary end-points published in six leading psychiatry and psychology journals – including our own BJPsych – between 2012 and 2017.8 In the included 116 RCTs, spin was found in 56% of abstracts, most commonly in the results and conclusion sections. Interestingly, there was no relationship between industry funding and spin. The findings matter and the authors suggest establishing standards for abstracts and actively inviting reviewers to comment on the presence of any spin in papers assessed; I’m happy to report I found none in theirs.


  1. Longitudinal work tracking cognition over a decade in individuals with psychosis has supported the ‘generalised decline’ hypothesis that such loss is relatively equal across all cognitive domains.
  2. A study of randomised controlled trials found that over half were guilty of ‘spin’ in how they described their findings in their abstracts.
  3. A review of ‘non-specific effects’ in clinical practice has shown that patients new to services appreciate a more optimistic pitch from clinicians, whilst those longer in contact prefer a more guarded prognosis from clinicians.


  1. False, there was variation between domains tested and psychosis category.
  2. True.
  3. True.
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