Premorbid functioning trajectories and the one-year course of cognitive performance in first-episode psychosis: a cluster analysis in PSYSCAN

IF 3 Q2 PSYCHIATRY

Schizophrenia Research-Cognition Pub Date : 2025-09-26 DOI:10.1016/j.scog.2025.100391

Margot I.E. Slot , Hendrika H. van Hell , Inge Winter-van Rossum , George Gifford , Paola Dazzan , Arija Maat , Lieuwe De Haan , Benedicto Crespo-Facorro , Birte Y. Glenthøj , Colm McDonald , Thérèse van Amelsvoort , Celso Arango , Irina Falkenberg , Barnaby Nelson , Silvana Galderisi , Mark Weiser , Gabriele Sachs , Anke Maatz , Jun Soo Kwon , the PSYSCAN Consortium , René S. Kahn

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Abstract

Background

We examined the course of cognitive performance in first-episode psychosis (FEP) compared to healthy controls (HC), and whether this varied across subgroups of patients defined by premorbid functioning (PMF) trajectories, using a clustering approach.

Methods

Data were collected in 302 FEP and 136 HC subjects participating in PSYSCAN (HEALTH.2013.2.2.1-2-FEP). K-means clustering (Euclidean distance) was used to cluster longitudinal trajectories of different PMF domains simultaneously. Since PMF was assessed retrospectively using the Premorbid Adjustment Scale (PAS), findings should be interpreted with caution, although PAS ratings have shown reasonable validity against prospective data.

Results

As expected, FEP showed impaired performance across all cognitive domains compared to HC. We identified four trajectories of PMF: a normal premorbid developmental trajectory (globally-normal, 21 %), stable intermediate PMF across domains (stable-intermediate, 29 %), stable poor or deteriorating PMF in the academic domain (normal-social/poor-academic, 29 %), and a globally impaired group with poor/deteriorating PMF across domains (globally-poor, 21 %). These clusters showed distinct levels of post-onset impairments in sustained visual attention, visual working memory and emotion recognition.

Conclusions

This study confirms a positive association between PMF and cognitive performance in the early years following psychosis onset. It aligns with findings that individuals later diagnosed with schizophrenia already show developmental deficits/lags from childhood to early adolescence compared to normally developing children. As PMF can be considered a proxy for cognitive reserve, our results suggest that higher reserve acts as a buffer against cognitive decline and supports better performance on sustained visual attention, complex visual working memory, and aspects of emotion recognition.

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首发精神病的发病前功能轨迹和一年的认知表现过程：PSYSCAN的聚类分析

背景：我们使用聚类方法研究了首发精神病患者（FEP）与健康对照组（HC）的认知表现过程，以及这是否在由病前功能（PMF）轨迹定义的患者亚组中有所不同。方法收集参加心理扫描（HEALTH.2013.2.2.1-2-FEP）的302例FEP和136例HC受试者的数据。采用k均值聚类（欧几里得距离）对不同PMF域的纵向轨迹同时聚类。由于PMF是使用病前调整量表（PAS）进行回顾性评估的，因此研究结果应谨慎解释，尽管PAS评分相对于前瞻性数据显示出合理的有效性。结果正如预期的那样，与HC相比，FEP在所有认知领域都表现出受损的表现。我们确定了PMF的四种轨迹：正常的病前发展轨迹（全球正常，21%），跨领域稳定的中度PMF（稳定-中级，29%），学术领域稳定的差或恶化的PMF（正常-社会/差-学术，29%），以及跨领域差/恶化的PMF的全球受损群体（全球差，21%）。这些群体在持续视觉注意、视觉工作记忆和情绪识别方面表现出不同程度的发病后损伤。结论：本研究证实了精神病发病早期PMF与认知表现之间的正相关。这与后来被诊断为精神分裂症的个体与正常发育的儿童相比，从童年到青春期早期已经表现出发育缺陷/滞后的发现相一致。由于PMF可以被认为是认知储备的代表，我们的研究结果表明，较高的储备可以缓冲认知衰退，并支持在持续视觉注意，复杂视觉工作记忆和情绪识别方面的更好表现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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