Does neurocognition predict personal recovery over time in psychotic disorder patients?

Personal recovery has been recognized as an important goal in patients with psychotic disorders. It is defined as a deeply personal, unique process of living a satisfying life even with the limitations caused by the illness. Neurocognitive impairments are a core feature of psychotic disorders and proven to be a key determinant of functional outcomes, such as daily- and social functioning, work and independent living. However, the relationship with personal recovery remains unclear. Few studies investigated the relationship, and the findings remains inconclusive. This study explores the relationship between neurocognition and personal recovery, both cross-sectionally and over a year time.

Data from baseline and T1 (one year later) was used from the UP's cohort; this is a longitudinal observational study (n = 366) of schizophrenia spectrum disorder patients. Personal recovery was assessed using the ReQOL and the Individual Recovery Outcomes Counter (I.ROC). Neurocognition was assessed using the BACS (composite score and subdomains). Linear mixed models were used to analyze the association between neurocognition and personal recovery over time.

Global neurocognition and neurocognitive domains (verbal memory, working memory, motor speed, verbal fluency, attention and executive function) were not associated with personal recovery at baseline and after a one-year period. The models controlling for age and sex explained only a small proportion of the variance, adding the PANSS-R significantly improved the explained variance. Additional analyses showed robust finding across different personal recovery measures using the I.ROC. Personal recovery improved with 6.9% between baseline and one year later: the ReQOL improved from 57.6% to 64.5%, the I.ROC improved from 43.9% to 50.8%.

Neurocognition did not predict personal recovery in this study. Patients with and without neurocognitive impairments showed similar levels of personal recovery at baseline and over a one-year time. This finding suggests that personal recovery can be accomplished in the presence of neurocognitive impairments and highlights the importance of addressing both domains independently. Psychotic symptoms are a stronger predictor of personal recovery than neurocognitive impairments. Future research is needed to investigate possible indirect relationships through metacognition.