Comparing cognitive clusters across first- and multiple-episode of psychosis.

Highlights • Compared to patients who recently experienced a first-episode of psychosis (FEP), a larger proportion of patients who have had multiple episodes of psychosis (MEP) present with severe and widespread cognitive impairment. • Multiplicity of psychotic episodes may have a detrimental influence on cognitive impairment. • The increased risk of cognitive impairment in more domains as the illness progresses may be explained in part by the fact that illness chronicity is associated with a lack of educational and vocational opportunities. • It may be beneficial to adapt the content of cognitive remediation therapy to patients' cognitive profiles as well, rather than to stage of illness only. Abstract Cognitive impairments in psychotic disorders (PD) present heterogeneously across patients. Between 2 and 5 clusters have been identified in previous studies with first-episode (FEP) and multiple-episodes of psychosis (MEP) patients suggesting different profiles of impairment. Past findings suggest there are differences between FEP and MEP patients regarding severity and number of affected cognitive domains. Heterogeneity of cognitive deficits in PD has perhaps hindered our understanding of their course. The present study compared non-affective FEP and MEP patients to assess whether illness chronicity could influence cognitive impairment profiles. We analyzed cognitive data, collected with the Cogstate Schizophrenia Battery, of FEP and MEP patients using cluster analysis. We compared clustering methods to obtain a more robust solution. For FEP patients, data were collected at their entry to a specialized clinic; the MEP group consisted of in- and outpatients. Results suggested cognitive heterogeneity was similar in FEP and MEP samples, although in different proportions. Three clusters were identified as the most stable solution and comprised groups of patients with either 1- no cognitive impairment (over-representation of FEP), 2- generalized deficits (over-representation of MEP), or 3- intermediate impairments. These findings encourage early interventions adapted to the profile of impairment. [ABSTRACT FROM AUTHOR]