Cognitive functioning in First-Episode Psychosis before antipsychotics

Understanding the baseline cognitive impairments in first-episode psychosis (FEP) before pharmacological intervention is crucial for understanding the intrinsic nature of psychosis. Recent research has increasingly focused on the cognitive deficits observed in FEP patients, recognizing them as potential early indicators of disease progression and functional outcomes. This study reviews over 50 studies with more than 5,500 participants to assess the extent of cognitive impairments in FEP patients across various domains such as processing speed, memory, and executive function.
The research questions addressed by the study include the level of cognitive impairment in antipsychotic drug-naive FEP patients compared to healthy controls, the variability in cognitive functioning within the FEP patient group, and how study methodologies and sample differences affect the findings on cognitive impairments in FEP. Understanding cognitive functions in antipsychotic drug-naive patients provides insight into the disorder’s primary manifestations and the effects of antipsychotic medications.
The meta-analysis followed PRISMA and MOOSE guidelines and included primary studies involving antipsychotic drug-naive individuals diagnosed with FEP. Cognitive function assessments were grouped into seven domains, and studies needed to provide data on the Duration of Untreated Psychosis (DUP). The analysis focused on very early psychosis to ensure that cognitive impairments observed were less likely to be influenced by extended periods of untreated psychosis.
Results from the study showed significant cognitive impairments in antipsychotic drug-naive FEP patients across all measured domains compared to healthy controls. The analysis also revealed substantial heterogeneity in effect sizes across studies, indicating variability in cognitive performance within the FEP patient group. The study highlighted the importance of personalized care for patients with FEP due to the diversity of cognitive impairments observed.
Strengths of the study include a large sample size, diverse geographic locations of participants, and a thorough assessment of cognitive domains. Limitations included heterogeneity among included studies, potential publication bias, and challenges in assessing actively psychotic patients. The study’s implications suggest incorporating systematic cognitive testing early in the diagnostic process to guide treatment strategies and long-term management plans.
In conclusion, this study emphasizes the need for cognitive assessments as a standard part of care for FEP patients to optimize treatment strategies and improve outcomes. Policies should support the integration of cognitive assessments into mental health care protocols and allocate resources for cognitive support programs to ensure accessibility for all affected individuals. Further research on cognitive impairments in FEP without the influence of antipsychotic drugs could provide valuable insights into the disorder’s natural progression.