Clarifying the diversity of first-episode psychosis: Neuropsychological correlates of clinical symptoms

Background: Psychosis is marked by heterogeneity, which complicates effective treatment. Aims: Subgroups of first-episode psychosis could be found by identifying neuropsychological correlates of psychiatric symptoms. Methods: Ninety-two outpatients with first-episode psychosis were evaluated with the Positive and Negative Syndrome Scale (PANSS) and a comprehensive neuropsychological test battery. Results: Factor analysis of PANSS revealed five symptom dimensions. Negative symptoms were correlated with widespread neuropsychological dysfunction. Disorganization symptoms were correlated with more focused deficits in executive function, attention and processing speed implicating dysfunction in frontal-subcortical circuits. Asocial, positive and affective symptoms were not associated with cognition. Conclusions: In first-episode psychosis, neuropsychological deficits are associated with negative and disorganization symptom dimensions, which appear to be marked by different cognitive profiles. These findings have implications for improving symptom-specific treatment.