Negative symptoms, cognition, and community functioning in early psychosis

Negative symptoms are associated with poorer cognitive functioning in psychosis, and both negative symptoms and cognition are associated with poorer community functioning, even in the early course of illness. Current conceptualizations of negative symptoms in psychosis have identified separate subdomains, not all of which may be affected in every patient; however, few studies have examined associations between specific negative symptom subdomains and cognition and functioning in early psychosis.

Participants with schizophrenia spectrum disorders (SSD; n = 26) or mood disorders with psychosis (MDP; n = 41) within the first 6.5 years of illness were assessed at two timepoints on negative symptoms (BNSS and CAINS), cognition, and functioning. Group comparisons and correlations among measures were conducted, and linear regression predicting functioning at follow-up by baseline negative symptoms and cognition were run.

Groups did not differ on negative symptoms or cognition at either timepoint. The SSD group had more impaired functioning at both timepoints. BNSS and CAINS total scores and several subscales correlated with cognition at both timepoints transdiagnostically. At baseline, BNSS Anhedonia, Asociality, and total score and CAINS Motivation and Pleasure and total score significantly predicted MIRECC GAF symptoms at follow-up and BNSS Asociality, Avolition, and BNSS and CAINS total scores predicted MIRECC GAF social functioning at follow-up. Cognition did not predict functioning at follow-up.

Baseline negative symptoms of amotivation and anhedonia, but not cognition, predicted measures of functioning at follow-up. These findings suggest that interventions targeting motivation and hedonic capacity early in treatment may improve future functioning.