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European Archives of Psychiatry and Clinical Neuroscience

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Open Access 01-04-2022 | Schizophrenia | Original Paper

Characterising cognitive heterogeneity in individuals at clinical high-risk for psychosis: a cluster analysis with clinical and functional outcome prediction

Authors: Kate Haining, Ruchika Gajwani, Joachim Gross, Andrew I. Gumley, Robin A. A. Ince, Stephen M. Lawrie, Frauke Schultze-Lutter, Matthias Schwannauer, Peter J. Uhlhaas

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 3/2022

Abstract

Schizophrenia is characterised by cognitive impairments that are already present during early stages, including in the clinical high-risk for psychosis (CHR-P) state and first-episode psychosis (FEP). Moreover, data suggest the presence of distinct cognitive subtypes during early-stage psychosis, with evidence for spared vs. impaired cognitive profiles that may be differentially associated with symptomatic and functional outcomes. Using cluster analysis, we sought to determine whether cognitive subgroups were associated with clinical and functional outcomes in CHR-P individuals. Data were available for 146 CHR-P participants of whom 122 completed a 6- and/or 12-month follow-up; 15 FEP participants; 47 participants not fulfilling CHR-P criteria (CHR-Ns); and 53 healthy controls (HCs). We performed hierarchical cluster analysis on principal components derived from neurocognitive and social cognitive measures. Within the CHR-P group, clusters were compared on clinical and functional variables and examined for associations with global functioning, persistent attenuated psychotic symptoms and transition to psychosis. Two discrete cognitive subgroups emerged across all participants: 45.9% of CHR-P individuals were cognitively impaired compared to 93.3% of FEP, 29.8% of CHR-N and 30.2% of HC participants. Cognitively impaired CHR-P participants also had significantly poorer functioning at baseline and follow-up than their cognitively spared counterparts. Specifically, cluster membership predicted functional but not clinical outcome. Our findings support the existence of distinct cognitive subgroups in CHR-P individuals that are associated with functional outcomes, with implications for early intervention and the understanding of underlying developmental processes.

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Title: Characterising cognitive heterogeneity in individuals at clinical high-risk for psychosis: a cluster analysis with clinical and functional outcome prediction
Authors: Kate Haining
Ruchika Gajwani
Joachim Gross
Andrew I. Gumley
Robin A. A. Ince
Stephen M. Lawrie
Frauke Schultze-Lutter
Matthias Schwannauer
Peter J. Uhlhaas
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keyword: Schizophrenia
Published in: European Archives of Psychiatry and Clinical Neuroscience / Issue 3/2022
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI: https://doi.org/10.1007/s00406-021-01315-2

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Characterising cognitive heterogeneity in individuals at clinical high-risk for psychosis: a cluster analysis with clinical and functional outcome prediction

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