Short-Term Cognitive Dynamic Trajectories Comparisons in Early Psychosis

Cognitive impairment is a core feature of psychosis, yet its short-term dynamic trajectories across the early psychosis continuum (healthy controls [HC], clinical high risk [CHR] for psychosis, first-episode schizophrenia [FES]) remain unclear. This study aimed to characterize short-term cognitive changes in HC, CHR, and FES and identify conversion-related cognitive markers via 3-year CHR follow-up.

A total of 74 HC, 201 medication-naive CHR, 91 medication-naive FES the Shanghai At Risk for Psychosis-extended (SHARP-extended) program (January 2016-December 2024). All completed baseline and 2 weeks to 3 months follow-up cognitive assessments using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB). CHR participants (n = 166) were followed for 3 years to classify them as converters (CHR-C, n = 35) and non-converters (CHR-NC, n = 131).

CHR showed broader short-term cognitive improvements (across most domains except emotional intelligence), while HC improved selectively (Trail Making Test, Hopkins Verbal Learning Test, emotional intelligence) and FES improved only in 3 domains (Trail Making Test, visuospatial memory, sustained attention; all P < .05). Sustained attention had a significant time effect (F = 4.218, P = .041); emotional intelligence had a group × time interaction (F = 3.606, P = .029). Among 166 CHR, processing speed (F = 5.583, P = .019) and visuospatial memory (F = 4.502, P = .035) had time × conversion interactions.

Cognitive dynamic trajectories are stage-specific across the early psychosis continuum, with CHR exhibiting greater cognitive malleability. Processing speed and visuospatial memory emerge as phase-specific markers of psychosis conversion in CHR, distinct from FES-related social cognitive changes. These findings may refine early psychosis risk stratification and cognitive monitoring protocols.