Symptom Dimensions and Cognitive Impairments in Individuals at Clinical High Risk for Psychosis

Understanding the intricate relationships between symptom dimensions, clusters, and cognitive impairments is crucial for early detection and intervention in individuals at clinical high risk for psychosis. This study delves into this complex interplay in a clinical high risk sample with the aim of predicting the conversion to psychosis.

A comprehensive cognitive assessment was performed in 744 clinical high risk individuals. The study included a 3-year follow-up period to allow assessment of conversion to psychosis. Symptom profiles were determined using the Structured Interview for Prodromal Syndromes. By applying factor analysis, symptom dimensions were categorized as dominant negative symptoms (NS), positive symptoms-stressful, and positive symptoms-odd. The factor scores were used to define 3 dominant symptom groups. Latent class analysis (LCA) and the factor mixture model (FMM) were employed to identify discrete clusters based on symptom patterns. The 3-class solution was chosen for the LCA and FMM analysis.

Individuals in the dominant NS group exhibited significantly higher conversion rates to psychosis than those in the other groups. Specific cognitive variables, including performance on the Brief Visuospatial Memory Test-Revised (odds ratio = 0.702, p = .001) and Neuropsychological Assessment Battery Mazes Test (odds ratio = 0.776, p = .024), significantly predicted conversion to psychosis. Notably, cognitive impairments associated with NS and positive symptoms-stressful groups affected different cognitive domains. LCA and FMM cluster 1, which was characterized by severe NS and positive symptoms-odd, exhibited more impairments in cognitive domains than other clusters. No significant difference in the conversion rate was observed among the LCA and FMM clusters.

These findings highlight the importance of NS in the development of psychosis and suggest specific cognitive domains that are affected by symptom dimensions.