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New Study Highlights Cognitive Impairment in Drug-Naive First-Episode Psychosis Patients

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A recent meta-analysis conducted by Maria Lee and colleagues has revealed significant cognitive impairments in individuals with first-episode psychosis (FEP) before the administration of antipsychotic medication.

The study, published in JAMA Psychiatry, underscores the profound cognitive challenges faced by individuals experiencing psychosis for the first time. The research highlights both the extent and variability of cognitive deficits in these patients, providing crucial insights for clinical practices.

The primary objective of this systematic review and meta-analysis was to quantify cognitive impairment at the onset of psychosis and to assess the variability in cognitive function compared to healthy controls. This analysis is crucial as it examines cognitive performance before any potential influence from antipsychotic treatments.

The researchers performed a comprehensive search of PubMed articles up to 15 September 2022. They included original studies that reported data on cognitive function in antipsychotic drug-naive patients with FEP. Cognitive tasks were grouped according to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery and the domain of executive function.

Fifty studies met the inclusion criteria, encompassing data from 2625 individuals with FEP and 2,917 healthy controls. The participants’ cognitive performance was evaluated across various domains, including speed of processing, verbal learning, visual learning, working memory, attention, reasoning/problem-solving, and executive function.

The meta-analysis revealed that individuals with FEP exhibited significant cognitive impairments across all evaluated domains compared to healthy controls. Specifically, the effect sizes for cognitive deficits were substantial, with Hedges’ g values indicating strong impairment in areas such as speed of processing, verbal learning, and working memory.

Moreover, the study found that the variability in cognitive performance within the FEP group was significantly greater than that in the control group. This suggests a wider distribution of cognitive abilities among patients with FEP, indicating that while some individuals may experience severe cognitive difficulties, others may be relatively unaffected or even perform above average. This within-group variability was quantified using the coefficient of variation ratio (CVR), with values ranging from 1.34 to 1.92 across different cognitive domains.

The findings have important clinical implications. The considerable heterogeneity in cognitive function among patients with FEP highlights the need for individualised cognitive assessments. Clinicians are encouraged to consider these cognitive differences when developing treatment plans, as tailored interventions may be necessary to address the specific cognitive deficits of each patient effectively.

The study also supports the notion that cognitive impairment is a core feature of psychosis, evident even before the initiation of antipsychotic medication. This early impairment underscores the importance of early detection and intervention in psychosis, potentially improving long-term outcomes for patients.

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