Cognitive and clinical profiles in first-episode psychosis and their relationship with functional outcomes

Cowman, Megan, Hodgekins, Jo, Griffiths, Siân Lowri, Frawley, Emma, O'Connor, Karen, Fowler, David, Birchwood, Max and Donohoe, Gary (2025) Cognitive and clinical profiles in first-episode psychosis and their relationship with functional outcomes. The British Journal of Psychiatry. ISSN 0007-1250

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Abstract

Background: While cognitive impairment is a core feature of psychosis, significant heterogeneity in cognitive and clinical outcomes is observed. Aims: The aim of this study was to identify cognitive and clinical subgroups in first-episode psychosis (FEP) and determine if these profiles were linked to functional outcomes over time. Method: A total of 323 individuals with FEP were included. Two-step hierarchical and k-means cluster analyses were performed using baseline cognitive and clinical variables. General linear mixed models were used to investigate whether baseline cognitive and clinical clusters were associated with functioning at follow-up time points (6–9, 12 and 15 months). Results: Three distinct cognitive clusters were identified: a cognitively intact group (N = 59), a moderately impaired group (N= 77) and a more severely impaired group (N= 122). Three distinct clinical clusters were identified: a subgroup characterised by predominant mood symptoms (N = 76), a subgroup characterised by predominant negative symptoms (N= 19) and a subgroup characterised by overall mild symptom severity (N = 94). The subgroup with more severely impaired cognition also had more severe negative symptoms at baseline. Cognitive clusters were significantly associated with later social and occupational function, and associated with changes over time. Clinical clusters were associated with later social functioning but not occupational functioning, and were not associated with changes over time. Conclusions: Baseline cognitive impairments are predictive of both later social and occupational function and change over time. This suggests that cognitive profiles offer valuable information in terms of prognosis and treatment needs.

Item Type:	Article
Additional Information:	Data availability: The data that support the findings of this study are not publicly available owing to ethical restrictions and regulation of the privacy of participants’ data, but are available from the corresponding author on reasonable request (G.D.) Funding information: The PSYcHE study was generously funded by the Health Research Board (awarded to G.D., RL-2020-007). The SUPEREDEN study was funded by the National Institute for Health and Care Research (NIHR) under the Programme Grants for Applied Research (awarded to M.B., RP-PG-0109-10 074).
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Mental Health Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health)
Related URLs:	https://www.cambridge.org/core/journals/...
Depositing User:	LivePure Connector
Date Deposited:	03 Nov 2025 16:30
Last Modified:	05 Nov 2025 15:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100878
DOI:	10.1192/bjp.2025.3

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