Cowman Megan, Hodgekins Jo, Griffiths Siân Lowri, Frawley Emma, O'Connor Karen, Fowler David, Birchwood Max, Donohoe Gary
Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland.
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
Br J Psychiatry. 2025 Mar 26:1-8. doi: 10.1192/bjp.2025.3.
While cognitive impairment is a core feature of psychosis, significant heterogeneity in cognitive and clinical outcomes is observed.
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.
A total of 323 individuals with FEP were included. Two-step hierarchical and -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).
Three distinct cognitive clusters were identified: a cognitively intact group ( = 59), a moderately impaired group ( = 77) and a more severely impaired group ( = 122). Three distinct clinical clusters were identified: a subgroup characterised by predominant mood symptoms ( = 76), a subgroup characterised by predominant negative symptoms ( = 19) and a subgroup characterised by overall mild symptom severity ( = 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.
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.
虽然认知障碍是精神病的核心特征，但在认知和临床结果方面存在显著的异质性。
本研究的目的是识别首发精神病（FEP）中的认知和临床亚组，并确定这些特征是否与随时间推移的功能结果相关。
共纳入323例FEP患者。使用基线认知和临床变量进行两步分层和均值聚类分析。采用一般线性混合模型研究基线认知和临床聚类是否与随访时间点（6 - 9个月、12个月和15个月）的功能相关。
识别出三个不同的认知聚类：认知完好组（n = 59）、中度受损组（n = 77）和重度受损组（n = 122）。识别出三个不同的临床聚类：以主要情绪症状为特征的亚组（n = 76）、以主要阴性症状为特征的亚组（n = 19）和以总体症状严重程度较轻为特征的亚组（n = 94）。认知受损更严重的亚组在基线时也有更严重的阴性症状。认知聚类与后期的社会和职业功能显著相关，并与随时间的变化相关。临床聚类与后期社会功能相关，但与职业功能无关，且与随时间的变化无关。
基线认知障碍可预测后期的社会和职业功能以及随时间的变化。这表明认知特征在预后和治疗需求方面提供了有价值的信息。
