Cognitive Screening in First-Episode Psychosis in Aotearoa New Zealand

Psychosis occurs where a person has a break from reality, characterised by hallucinations and delusions, often accompanied by disorganized thinking and speech. The first episode of psychosis (FEP), as part of a psychotic or bipolar disorder, is usually experienced before age 25 and can significantly disrupt a young person’s transition into adulthood. FEP often affects education, employment, relationships, and independent living. Cognitive impairment, such as problems with memory, attention and problem-solving, is a core feature of FEP, affecting up to 75% of people with the disorder. Cognitive impairment often continues after psychosis resolves, which contributes to longer-term poor functioning, reduced self-confidence, and relapse. Addressing cognitive impairment is therefore a high priority for young adults with FEP. To effectively target cognitive impairment in treatment, assessment is required. In Canterbury, the early intervention service for FEP (Totara House, Te Whatu Ora Waitaha) faces barriers to cognitive assessment, including high caseloads and limited data on suitable cognitive assessment tools and how cognitive assessment may inform treatment planning. A suitable, brief cognitive screening tool is a significant unmet need in FEP services. This project addresses these issues by examining the feasibility, user experience, and cultural appropriateness of the Screen for Cognitive Impairment in Psychiatry (SCIP), for young adults with FEP. Participants will only receive access to the SCIP screening tool because they have enrolled in this study, as no cognitive screening is currently taking place at Totara House. Participants will complete the SCIP, a brief, standardised cognitive assessment administered by the principal investigator or another trained member of the research team. The tool involves a series of short verbal and written tasks assessing immediate and delayed recall, working memory, verbal fluency, and processing speed. Each task is delivered face-to-face using simple materials (paper, pencil, and a stopwatch). The assessment takes approximately 10–15 minutes per participant to complete. The SCIP will be administered at 6 weeks after entry to the service (baseline), and on discharge (typically between 18-24 months after admission). A survey assessing the suitability of the SCIP will be administered to all participants immediately after the first time the SCIP has been administered. A small number (n = 20) will also take part in a qualitative interview about their experience. The interview will be undertaken with the first 10 Maori and first 10 non-Maori participants who opt-in. The interview will take place between the same day to two weeks after the SCIP testing, depending on patient preference and interviewer availability. Training for the researcher administering the SCIP will take place via a video workshop from the SCIP developer, and in person training with a clinical psychologist with expertise in neuropsychology, and who has had direct training with the SCIP developer. Additionally, there will be fortnightly supervision with this same clinical psychologist.