Avila Alessia, Coentre Ricardo, Mendes Tiago, Levy Pedro, Cella Matteo, Novais Filipa
University Clinic of Psychiatry and Medical Psychology, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
Neuroscience and Mental Health Department, North Lisbon University Hospital (CHULN), 1649-028 Lisbon, Portugal.
J Clin Med. 2025 May 9;14(10):3308. doi: 10.3390/jcm14103308.
: Cognitive impairment is a common feature of schizophrenia spectrum disorders and has been associated with functional disruption preceding the onset of psychosis. Understanding how cognitive deficits interact with clinical symptoms and functioning in early psychosis remains challenging. In this study, we aim to investigate whether a distinct "cognitive signature" characterizes functional disruption at the onset of psychosis. : Clinical, cognitive, and functional data were collected from 101 first episode psychosis patients at their first hospitalization. Stepwise regression models were used to identify predictors of global functioning and symptom severity at the time of onset, as well as diagnostic outcomes at discharge. Path analysis was used to explore the relationship among symptom severity, cognition, and functional outcomes. : Deficits in visual memory were selectively predictive of lower functioning and higher global symptom severity at the time of psychosis onset. Reduced visual-spatial abilities were also associated with unemployment at the time preceding hospitalization and predicted a non-affective schizophrenia spectrum diagnosis at discharge. Path analysis found that visual memory fully mediated the relationship between negative symptoms and level of functioning. : Impairment in visual cognition seems to be uniquely associated with functional impairment and global symptom severity at the onset of psychosis and to mediate the relationship between negative symptoms and functioning. The results might indicate a primary relevance of visual cognitive aspects in marking functional disruption and symptom exacerbation at psychosis onset. This might have implications for early detection and inform treatment plans.
认知障碍是精神分裂症谱系障碍的常见特征，并且与精神病发作前的功能紊乱有关。了解认知缺陷如何与早期精神病的临床症状及功能相互作用仍然具有挑战性。在本研究中，我们旨在调查是否存在一种独特的“认知特征”来表征精神病发作时的功能紊乱。
从101例首次发作精神病患者首次住院时收集临床、认知和功能数据。采用逐步回归模型来确定发病时整体功能和症状严重程度的预测因素，以及出院时的诊断结果。路径分析用于探索症状严重程度、认知和功能结果之间的关系。
视觉记忆缺陷在精神病发作时可选择性地预测较低的功能水平和较高的整体症状严重程度。视觉空间能力下降也与住院前的失业有关，并预测出院时为非情感性精神分裂症谱系诊断。路径分析发现视觉记忆完全介导了阴性症状与功能水平之间的关系。
视觉认知障碍似乎在精神病发作时与功能障碍和整体症状严重程度存在独特关联，并介导阴性症状与功能之间的关系。结果可能表明视觉认知方面在标记精神病发作时的功能紊乱和症状加重方面具有首要相关性。这可能对早期检测有影响并为治疗计划提供信息。
