2025, Vol. 5, Issue 2, Part A

Author(s)
James Carter, Olivia Turner and David Brooks

Abstract
Cognitive dysfunction is increasingly recognised as a central component of psychotic disorders, especially within the context of the first episode of psychosis (FEP). This study investigates the neurocognitive performance of individuals experiencing FEP compared to matched healthy controls, employing a comprehensive battery of cognitive tests to derive detailed neurocognitive profiles. Drawing upon prior evidence that cognitive deficits in attention, working memory, processing speed, executive functions, and verbal learning are present early in the course of psychotic illness, we sought to determine the nature, magnitude, and pattern of deficits and to explore whether specific cognitive domains distinguish FEP participants from controls. Participants included 80 individuals diagnosed with FEP (within 12?months of onset) and 80 healthy control participants, matched for age, sex, and education. Each participant completed assessments measuring processing speed (Digit Symbol Substitution Test, Trail Making Test A), attention (Continuous Performance Test), working memory (Digit Span Backward), verbal learning and memory (Rey Auditory Verbal Learning Test), and executive functions (Stroop Colour and Word Test, Wisconsin Card Sorting Test). Differences between groups were examined using multivariate analysis of variance, followed by latent class cluster analysis to identify distinct neurocognitive profiles. Results indicated that the FEP group exhibited significant impairments across all domains relative to controls (p?<?.001), with largest effect sizes observed for processing speed (Hedges’ g???1.1) and working memory (g???0.9). Cluster analysis revealed three distinct neurocognitive profiles “intact/moderate deficits”, “moderate/severe deficits”, and “severe global deficits”—with the majority of FEP participants (~65?%) falling into the two deficit groups, whereas 90?% of controls were classified in the intact/moderate group. Moreover, greater severity of cognitive deficits was significantly associated with higher negative symptom scores and poorer functional status (r?=?-0.45, p?<?.001). The findings underscore that marked cognitive dysfunction is evident at the very onset of psychotic illness and that heterogeneity exists in cognitive profiles among FEP patients. These results highlight the need for early neurocognitive assessment and stratified interventions targeting core deficits in processing speed and working memory to potentially improve functional outcomes in FEP.

DOI: https://doi.org/10.22271/27891623.2025.v5.i2a.76

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