Longitudinal clinical and functional outcome in distinct cognitive subgroups of first-episode psychosis: a cluster analysis

Priscilla P. Oomen*, Marieke J. H. Begemann, Bodyl A. Brand, Lieuwe de Haan, Wim Veling, Sanne Koops, Jim van Os, Filip Smit, P. Roberto Bakker, Nico van Beveren, Nynke Boonstra, Sinan Guloksuz, Martijn Kikkert, Joran Lokkerbol, Machteld Marcelis, Bram-Sieben Rosema, Franciska de Beer, Shiral S. Gangadin, Chris N. W. Geraets, Erna van't HagYudith Haveman, Inge van der Heijden, Alban E. Voppel, Elske Willemse, Therese van Amelsvoort, Maarten Bak, Albert Batalla, Agaath Been, Marinte van den Bosch, Truus van den Brink, Gunnar Faber, Koen P. Grootens, Martin de Jonge, Rikus Knegtering, Jorg Kurkamp, Amrita Mahabir, Gerdina H. M. Pijnenborg, Tonnie Staring, Natalie Veen, Selene Veerman, Sybren Wiersma, Ellen Graveland, Joelle Hoornaar, Iris E. C. Sommer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes.
Methods 204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up.
Results Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present. Conclusions Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.
Original languageEnglish
Pages (from-to)2317-2327
Number of pages11
JournalPsychological Medicine
Volume53
Issue number6
Early online date19 Oct 2021
DOIs
Publication statusPublished - 19 Apr 2023

Bibliographical note

Funding Information:
The HAMLETT study is funded by ZonMW in the Netherlands (grant number 80-84800-98-41015). The funders have no role in the study design, collection, management, analysis and interpretation of data, writing the report, or the decision to submit the report for publication.

Publisher Copyright:
Copyright © The Author(s), 2021. Published by Cambridge University Press.

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