Sex-based differences in neurocognitive functioning in first-episode psychosis: An exploratory analysis

Sex differences are described in neurocognition in first-episode psychosis, but evidence to date is still inconsistent. Our aim was to explore these differences, considering the effect of clinical and sociodemographic covariates.

We performed an observational descriptive study. 191 persons with first-episode psychosis completed a clinical and neuropsychological battery, with Positive and Negative Syndrome Scale, Global Assessment of Functioning, Scale to Assess Unawareness in Mental Disorders, Wisconsin Card Sorting Test, Stroop Test, Trail Making Test, California Verbal Learning Test, and Continuous Performance Test. We analyzed mean differences between men and women and performed ANCOVAs to examine the effect of relevant covariates.

After adjusting for covariates, an effect of sex accounted for a more frequent use of serial clustering in short-term free recall tasks in men than in women Both immediate recall and long-term recall were associated with education level and diagnosis, semantic clustering and cued recall intrusions were related to education level.. Women performed better than men in Wisconsin Card Sorting Test, with education level also contributing significantly.

Sex differences appear in verbal memory in first-episode psychosis, linked with factors underlying accuracy scores such as encoding strategies. Women show greater advantage in executive functioning. Diagnosis and education level show significant effects in these differences. Early interventions for psychosis are encouraged to target specific needs considering an intersectional approach, to optimize cognitive rehabilitation in FEP.