Two-year domain-specific cognitive trajectories following a first episode of psychosis and early intervention: A...

Cognitive impairment is a core feature of psychotic disorders and predicts long-term outcomes. However, cognitive trajectories following first-episode psychosis (FEP) are heterogeneous. We hypothesized the presence of distinct global and domain-specific cognitive trajectories over two years, with differential baseline predictors and distal outcomes associated with trajectory membership.

Data were drawn from the RAISE-ETP study (N = 404, aged 15-40). Cognition was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline, 12, and 24 months. Latent growth modelling was used to identify trajectory classes for global cognition and six individual cognitive domains.

Cognitive trajectories were largely stable, with modest improvements. Two trajectories emerged for global cognition, verbal fluency, motor speed and working memory; three for executive function and processing speed; four for verbal memory. Higher education was associated with less impaired classes across global cognition (OR = 0.34, 95% CI 0.20-0.59) and all domains. Less impaired cognitive trajectories were linked to higher quality of life (SMD = -0.91, 95% CI -1.42--0.39) and lower symptom severity. Associations with depressive symptoms were heterogeneous: greater severity accompanied more impaired working memory and executive function trajectories but less impaired motor speed, verbal memory, and verbal fluency trajectories.

Class membership was primarily differentiated by baseline cognitive performance; baseline individual differences may contribute to heterogeneity in clinical and functional outcomes. Domain-specific analyses revealed associations with clinical outcomes not apparent from global cognition alone, highlighting the importance of early identification and personalized cognitive interventions in FEP.