Tripoli Giada, Rodriguez Victoria, Zahid Uzma, Trotta Giulia, Quattrone Andrea, Lang Yifei, Alameda Luis, Spinazzola Edoardo, Stilo Simona, Ferraro Laura, Sartorio Crocettarachele, Seminerio Fabio, Maniaci Giuseppe, La Barbera Daniele, Morgan Craig, Sham Pak C, Murray Robin M, Murray Graham K, Di Forti Marta, Quattrone Diego, La Cascia Caterina
Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy.
University Hospital "Paolo Giaccone", Unit of Psychiatry, Palermo, Italy.
Clin Neuropsychiatry. 2025 Aug;22(4):307-319. doi: 10.36131/cnfioritieditore20250405.
Psychotic disorders are heterogeneous in their clinical presentation and outcome. While early research focused on poor prognoses in schizophrenia, recent longitudinal studies tracking first-episode psychosis (FEP) have identified more favourable outcome trajectories. This study investigates the stability and predictive value of metacognitive and social cognitive impairments-Jumping to Conclusions (JTC) bias and Facial Emotion Recognition (FER) deficits-as intermediate phenotypes of psychosis over a 5-year follow-up period.
A total of 134 FEP patients and 105 population-based controls from the GAP and EU-GEI follow-up study in London were reassessed after an average of 4.8 years. JTC was measured using the 60:40 Beads task, while FER was assessed through the Degraded Facial Affect Recognition (DFAR) task. Clinical, functional, and social outcomes-including hospital admissions, symptom severity, and employment status-were evaluated. Mixed models and regression modeling examined the stability of these cognitive traits and their association with long-term outcomes.
JTC and FER impairments remain stable over time, supporting their classification as intermediate phenotypes. However, neither JTC nor FER was associated with clinical outcomes (hospitalization rates, symptom severity) or social functioning (employment, independent living, relationships). A weak correlation was found between global FER impairment and negative symptoms at follow-up, but no associations emerged with real-world functional measures. Additionally, while patients demonstrated greater impairments than controls, the differences were more quantitative than qualitative, aligning with the psychosis continuum hypothesis.
These findings demonstrate that JTC and FER are stable in people with psychosis and controls. Therefore, they may serve as important treatment targets for early intervention in psychosis. Future research should integrate the potential role of environmental factors as well as genetic influence to deepen our understanding of cognitive impairments in psychotic disorders.
精神障碍在临床表现和预后方面具有异质性。早期研究聚焦于精神分裂症的不良预后，而近期追踪首发精神病（FEP）的纵向研究发现了更有利的预后轨迹。本研究调查了元认知和社会认知障碍——妄下结论（JTC）偏差和面部情绪识别（FER）缺陷——作为精神病中间表型在5年随访期内的稳定性和预测价值。
来自伦敦GAP和EU-GEI随访研究的134例FEP患者和105名基于人群的对照者在平均4.8年后接受重新评估。使用60:40珠子任务测量JTC，通过退化面部表情识别（DFAR）任务评估FER。评估临床、功能和社会结局，包括住院情况、症状严重程度和就业状况。混合模型和回归模型检验了这些认知特征的稳定性及其与长期结局的关联。
JTC和FER障碍随时间保持稳定，支持将它们归类为中间表型。然而，JTC和FER均与临床结局（住院率、症状严重程度）或社会功能（就业、独立生活、人际关系）无关。在随访时发现整体FER障碍与阴性症状之间存在弱相关性，但与实际功能指标无关联。此外，虽然患者的障碍比对照者更严重，但差异更多是数量上的而非质量上的，这与精神病连续体假说相符。
这些发现表明，JTC和FER在精神病患者和对照者中是稳定的。因此，它们可能作为精神病早期干预的重要治疗靶点。未来的研究应整合环境因素以及遗传影响的潜在作用，以加深我们对精神障碍中认知障碍的理解。
