Understanding how psychosis affects the mind, especially before any treatment begins, is crucial for developing effective care. A recent comprehensive review delved into this by examining people experiencing their first episode of psychosis (FEP) who have not yet received any antipsychotic medications. The aim was to measure how their cognitive functions—like memory, attention, and problem-solving—compare to those of healthy individuals, without the complicating effects of medication.
Researchers scoured PubMed for studies on this topic and analyzed data from fifty studies, involving over 2,500 individuals with FEP and nearly 3,000 healthy controls. They looked into various cognitive areas using a standard set of tests known for assessing cognitive function in schizophrenia and related disorders.
The findings were significant. Across all areas of cognitive function tested—ranging from how fast people process information, to verbal and visual learning, working memory, attention, problem-solving, and executive functions (like planning and flexibility)—those with FEP showed substantial impairments compared to healthy controls. The differences weren't minor; they were marked and consistent across all cognitive domains.
Moreover, there was a notable variability within the FEP group itself. This means that while, on average, individuals with FEP struggle more with cognitive tasks than healthy individuals, the degree of struggle varies widely among them. Some may face relatively minor challenges, while others may experience profound difficulties that could significantly affect their daily lives and long-term outcomes.
This variability underscores a critical point: identifying individuals with more severe cognitive impairments early on could be key. These individuals might benefit most from targeted interventions like cognitive remediation therapies, which aim to improve cognitive functions. The findings highlight the importance of early cognitive assessment in psychosis care, aiming not just at treating psychosis symptoms but also at addressing cognitive impairments to improve overall outcomes and quality of life.
Lee M et al. JAMA Psychiatry. 2024