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3 July 2018

Using affective cognition to enhance precision psychiatry

Precision psychiatry is a promising new approach that seeks to improve outcomes in highly heterogeneous clinical populations.

Frontiers in Psychiatry recently published an interesting opinion piece on Using Affective Cognition to Enhance Precision Psychiatry 1 by Dr Jack Cotter, Clinical Science Team Lead at Cambridge Cognition, and Dr Jenny Barnett, Chief Scientific Officer at Cambridge Cognition.

Here we will summarise the key elements of the piece: What are precision psychiatry and affective cognition? How can they work together to potentially enhance treatment efficacy?

What is precision medicine?

The term precision medicine refers to:

“An emerging approach for treatment and prevention that takes into account each person’s variability in genes, environment, and lifestyle” 2

National Research Council (US) Committee on a Framework for Developing a new Taxonomy of Disease, 2011

Precision medicine as applied to the field of psychiatry is in its infancy relative to other branches of medicine, though the transition from generalised to more personalised practices has the potential to revolutionize the field, particularly in the context of treatment efficacy3.

What is hot and cold cognition?

Cold cognition refers to cognitive functioning which is emotion-independent, such as an individual’s ability to match patterns or to recall a list of numbers4.

Hot cognition, also known as “affective cognition”, refers to emotion-laden cognitive processes, including measures of perceptual and attentional biases (for example, in relation to happy or sad facial expressions), reward processing and feedback sensitivity5.

What does affective cognition mean for precision psychiatry?

Cold cognitive processes have been widely investigated in relation to psychiatric disorders and are an important predictor of functional decline, though deficits in these domains are thought to be largely distinct from the severity of an individual’s clinical symptoms6.

In contrast, hot cognitive processes are thought to be closely associated with clinical symptoms and may be one of the causal factors in the onset and maintenance of psychiatric disorders4. Normalising of these processes after administration of antidepressant medication has also been shown to predict later clinical improvement among patients with mood disorders7, 8, suggesting that these measures may serve as a biomarker not only of depression vulnerability, but also as an early indicator of treatment efficacy.

In conclusion, performance on hot cognitive tasks could potentially help clinicians to establish whether a treatment is effective more quickly than conventional approaches to patient care, which would have important implications for improving the lives of patients while also reducing the significant financial burden associated with untreated depression on society1.

The real-world application of affective cognitive assessment is still in its early stages. Nevertheless, this may have the potential to enhance the effectiveness of individualised approaches to psychiatric treatment1.

Dr Cotter, Clinical Science Team Lead and lead author on the article commented:

“Affective cognitive assessment is an exciting area of research with a variety of potential clinical applications. We are currently developing a range of related tasks which we hope will help to enhance precision medicine across a range of psychiatric disorders.”

Jack Cotter, PhD

References 

  1. Cotter J, Barnett JH. Using Affective Cognition to Enhance Precision Psychiatry. Front Psychiatry. 2018;9:288. doi:10.3389/fpsyt.2018.00288.
  2. National Research Council (US) Committee on A Framework for Developing a New Taxonomy of Disease. Toward Precision Medicine. Washington, D.C.: National Academies Press; 2011. doi:10.17226/13284.
  3. Fernandes BS, Williams LM, Steiner J, Leboyer M, Carvalho AF, Berk M. The new field of ‘precision psychiatry.’ BMC Med. 2017;15(1):80. doi:10.1186/s12916-017-0849-x.
  4. Roiser JP, Sahakian BJ. Hot and cold cognition in depression. CNS Spectrums / FirstView Artic CNS Spectrums. 2013. doi:10.1017/S1092852913000072.
  5. Elliott R, Zahn R, Deakin JFW, Anderson IM. Affective cognition and its disruption in mood disorders. Neuropsychopharmacology. 2011;36(1):153-182. doi:10.1038/npp.2010.77.
  6. Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med. 2014;44(10):2029-2040. doi:10.1017/S0033291713002535.
  7. Godlewska BR, Browning M, Norbury R, Cowen PJ, Harmer CJ. Early changes in emotional processing as a marker of clinical response to SSRI treatment in depression. Transl Psychiatry. 2016;6(11):e957-e957. doi:10.1038/tp.2016.130.
  8. Shiroma PR, Thuras P, Johns B, Lim KO. Emotion recognition processing as early predictor of response to 8-week citalopram treatment in late-life depression. Int J Geriatr Psychiatry. 2014;29(11):1132-1139. doi:10.1002/gps.4104.

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