Cognition in First-Episode Psychosis: From Phenomenology to Intervention

Available research has clearly demonstrated that individuals with longstanding psychotic disorders have deficits in cognitive functioning that (i) have deleterious effects on their everyday functioning and (ii) can be partially ameliorated via available treatment options. Despite the fact that the cognitive deficits that accompany psychotic disorders are largely present by the time of the first-episode of psychosis, the nature of these associations in first-episode psychosis is less clear. Data are mixed with regard to a possible association between neurocognition and real-world functioning among individuals with first-episode psychosis, possibly due in part to methodological limitations of available studies. Although cognitive remediation has shown promise in ameliorating cognitive and functional deficits among individuals with longstanding psychotic disorder, these associations are not as robust for individuals with first-episode psychosis. With regard to pharmacological treatment, available data suggest that antipsychotic medications do not produce meaningful gains in cognitive functioning. Data in support of other pro-cognitive pharmacological agents are also limited. Ultimately, further research using methodologically sound approaches is needed to clarify the role of cognitive deficits in the disability that accompanies first-episode psychosis and to identify the most effective interventions with which to ameliorate these cognitive deficits.