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SO491

Reconceptualizing psychotic disorders within a cognition-first framework

RECONCEPTUALIZING PSYCHOTIC DISORDERS THROUGH A COGNITIVE-FIRST FRAMEWORK

Two independent meta-analyses of antipsychotic-naive patients show that cognitive impairment is present across all domains at the onset of psychosis, with consistent effect sizes, supporting the view that cognitive impairment is a core feature of the illness rather than an effect of medication.

The study aimed to compare two meta-analyses examining cognitive performance in antipsychotic-naive (drug-naive) patients to assess the consistency, magnitude, and domain-specific pattern of cognitive impairment at the onset of psychosis relative to healthy controls. The meta-analyses compared were Fatouros-Bergman and colleagues (2014), which focused on schizophrenia spectrum disorders, and Lee and colleagues (2024), which focused on first-episode psychosis. Study 1 synthesized 23 studies identified through searches of PubMed and PsycInfo up to November 2012, while Study 2 synthesized 50 PubMed-indexed studies published up to September 2022; the same search terms were used, results were organized according to MATRICS cognitive domains, and effects were quantified using standardized mean differences or Hedges’ g. Both meta-analyses showed significant impairment across all cognitive domains; the pattern and magnitude of impairments were highly consistent, with the most pronounced deficits observed in speed of processing, verbal memory, and working memory (effect sizes of approximately -1.0 or greater in magnitude). The figure in the poster presents the effect sizes from the two studies side by side for executive functioning, visual memory, attention, working memory, speed of processing, and verbal memory. The convergence of findings from research conducted across two different decades supports the view that cognitive impairment predates antipsychotic treatment and is a core feature of psychosis. In conclusion, cognition may be considered not merely a consequence of the illness but a primary dimension for staging, prognosis, and intervention; a cognition-first framework may pave the way for preventive strategies aimed at early identification and preserving functioning beyond symptom reduction.

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