Neurocognition and Social Cognition Predicting 1-Year Outcomes in First-Episode Psychosis

Abstract

Cognitive performance at illness onset may predict outcomes in first-episode psychosis (FEP), and the change in cognition may associate with clinical changes. Cognitive testing was administered to 54 FEP participants 2 months after entering treatment and to 39 participants after 1 year. We investigated whether baseline cognition predicted 1-year outcomes beyond positive, negative, and affective symptoms and whether the trajectory of cognition associated with clinical change. Baseline overall neurocognitive performance predicted the 1-year social and occupational level, occupational status, and maintaining of life goals. The domain of processing speed associated with the 1-year remission, occupational status, and maintaining of life goals. Baseline social cognition associated with occupational status a year later and the need for hospital treatment during the 1st year after FEP. Most of the associations were retained beyond baseline positive and affective symptom levels, but when accounting for negative symptoms, cognition no longer predicted 1-year outcomes, highlighting how negative symptoms overlap with cognition. The trajectory of neurocognitive performance over the year did not associate with changes in symptoms or functioning. Cognitive testing at the beginning of treatment provided information on the 1-year outcome in FEP beyond positive and affective symptom levels. In particular, the domains of processing speed and social cognition could be targets for interventions that aim to improve the outcome after FEP.

Longitudinal clinical and functional outcome in distinct cognitive subgroups of first-episode psychosis: a cluster analysis

“… 2014 ; Fortgang, Srihari, & Cannon, 2020 ; Jurado & Rosselli, 2007 ; Lindgren et al . 2020 ). More longitudinal studies are required to gain more insight into the relationship between cognitive function and negative symptoms in FEP.…”

“…However, the relationship between cognitive function and negative symptoms seems complex. Severe negative symptoms such as lack of motivation or decreased effort may impact cognitive performance but similarly, cognitive impairment could affect the manifestation of negative symptoms as more preserved cognitive function may be essential for the ability to plan, initiate, motivate and carry out daily activities (Beck, Himelstein, Bredemeier, Silverstein, & Grant, 2018;Fervaha et al 2014;Fortgang, Srihari, & Cannon, 2020;Jurado & Rosselli, 2007;Lindgren et al 2020). More longitudinal studies are required to gain more insight into the relationship between cognitive function and negative symptoms in FEP.…”

“…During past years, cognitive impairment received substantial attention because of its presence prior to illness onset and associations with both clinical and functional outcomes over time (Helldin, Mohn, Olsson, & Hjärthag, 2020;Johansson, Hjärthag, & Helldin, 2020;Lindgren, Holm, Kieseppä, & Suvisaari, 2020;Santesteban-Echarri et al 2017). Some authors have considered cognitive dysfunction to be the core feature of schizophrenia (Heinrichs, 2005).…”

Cognitive Inflexibility Predicts Negative Symptoms Severity in Patients with First-Episode Psychosis: A 1-Year Follow-Up Study

“…This has lent support to the hypothesis of some overlap between negative and cognitive symptoms and highlighted the intricate interplay among cognition, negative symptoms, and functioning, with mixed findings in prior reports. In FEP patients, meta-analytic findings have demonstrated the substantial relationship of cognition with future psychosocial functioning, after accounting for negative symptoms [17], whereas a separate report found that the inclusion of negative symptoms in the analysis eliminated the predictive power of cognition for 1-year outcomes, underscoring the intersection between negative symptoms and cognition [25]. Moreover, some reports in CHR individuals have shown a predictive relationship between cognitive variables and functioning through the partial mediation of negative symptoms [67,68].…”

“…No association was found between TMT-A and negative symptoms [24]. Another study which included measures from WAIS, the WMS, the TMT, verbal fluency, the tapping task, and the continuous performance test identical pairs found cognitive functions to be correlated inversely with negative symptoms but not with positive or affective symptoms one year after admission [25]. A third study, revealed that improvements over time in general cognitive function, working memory, and verbal learning were mediated by improvements in positive and negative symptomatology [26].…”