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Prognostic value of cognitive functioning for global functional recovery in first-episode schizophrenia

  • C. González-Blanch (a1), R. Perez-Iglesias (a1), G. Pardo-García (a1), J. M. Rodríguez-Sánchez (a1), O. Martínez-García (a1), J. L. Vázquez-Barquero (a1) and B. Crespo-Facorro (a1)...



It has become widely accepted that cognitive deficits in schizophrenia are related to functional outcome. However, it remains to be seen whether these associations are relevant for predicting which cases will have a global functional recovery. In this study, we attempt to determine whether global functional recovery (integrating social and occupational outcomes) after first-episode schizophrenia (FES) can be predicted by cognitive variables.


A total of 131 FES patients with functional deficits (n=97) and functional recovery (n=34) as determined at 1-year follow-up were examined. Neuropsychological, sociodemographic, pre-morbid and clinical data at baseline were analysed using independent groups comparisons and a logistic regression method.


Sustained attention and negative symptoms emerged as significant predictors of good global functional outcome. Although the model revealed a high accuracy (91%) in the classification of patients with functional deficits, it was unacceptably low (26%) in the classification of patients with global functional recovery.


The limitations found in the prediction of a favourable global functional outcome may well be an indication for a need to address the role of other factors not commonly included in longitudinal studies of long-term outcomes in schizophrenia.


Corresponding author

*Address for correspondence: Dr C. González-Blanch, Hospital Universitario ‘Marqués de Valdecilla’, Unidad de Investigación en Psiquiatría de Cantabria, Planta 2a, Edificio 2 de Noviembre Avda, Valdecilla s/n, 39008, Santander, Spain. (Email:


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Andreasen, NC (1981). Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City, IA.
Andreasen, NC (1983). Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City, IA.
Birchwood, M, Todd, P, Jackson, C (1998). Early intervention in psychosis. The critical period hypothesis. The British Journal of Psychiatry 172, 5359.
Bowie, CR, Leung, WW, Reichenberg, A, McClure, MM, Patterson, TL, Heaton, RK, Harvey, PD (2008). Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures. Biological Psychiatry 63, 505511.
Bowie, CR, Reichenberg, A, Patterson, TL, Heaton, RK, Harvey, PD (2006). Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry 163, 418425.
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.
Carpenter, WT Jr., Strauss, JS (1991). The prediction of outcome in schizophrenia. IV: eleven-year follow-up of the Washington IPSS cohort. Journal of Nervous and Mental Disease 179, 517525.
Cegalis, J, Bowlin, J (1991). Vigil: Software for the Assessment of Attention. Forthought: Nashua, NH.
Crespo-Facorro, B, Perez-Iglesias, R, Ramirez-Bonilla, M, Martinez-Garcia, O, Llorca, J, Vazquez-Barquero, JL (2006). A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. Journal of Clinical Psychiatry 67, 15111521.
Dickerson, F, Boronow, JJ, Ringel, N, Parente, F (1999). Social functioning and neurocognitive deficits in outpatients with schizophrenia: a 2-year follow-up. Schizophrenia Research 37, 1320.
Fenton, WS, McGlashan, TH (1987). Prognostic scale for chronic schizophrenia. Schizophrenia Bulletin 13, 277286.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders. Biometrics Research Department, New York State Psychiatric Institute: New York.
Gaite, L, Vazquez-Barquero, JL, Herran, A, Thornicroft, G, Becker, T, Sierra-Biddle, D, Ruggeri, M, Schene, A, Knapp, M, Vazquez-Bourgon, J (2005). Main determinants of Global Assessment of Functioning score in schizophrenia: a European multicenter study. Comprehensive Psychiatry 46, 440446.
Gleeson, JF, Cotton, SM, Alvarez-Jimenez, M, Wade, D, Gee, D, Crisp, K, Pearce, T, Newman, B, Spiliotacopoulos, D, Castle, D, McGorry, PD (2009). A randomized controlled trial of relapse prevention therapy for first-episode psychosis patients. Journal of Clinical Psychiatry 70, 477486.
González-Blanch, C, Crespo-Facorro, B, Alvarez-Jiménez, M, Rodríguez-Sanchez, JM, Pelayo-Terán, JM, Pérez-Iglesias, R, Vázquez-Barquero, JL (2007). Cognitive dimensions in first-episode schizophrenia spectrum disorders. Journal of Psychiatric Research 41, 968977.
Gonzalez-Blanch, C, Crespo-Facorro, B, Alvarez-Jimenez, M, Rodriguez-Sanchez, JM, Pelayo-Teran, JM, Perez-Iglesias, R, Vazquez-Barquero, JL (2008). Pretreatment predictors of cognitive deficits in early psychosis. Psychological Medicine 38, 737746.
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321330.
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119136.
Green, MF, Kern, RS, Heaton, RK (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research 72, 4151.
Grube, BS, Bilder, RM, Goldman, RS (1998). Meta-analysis of symptom factors in schizophrenia. Schizophrenia Research 31, 113120.
Gumley, A, O'Grady, M, McNay, L, Reilly, J, Power, K, Norrie, J (2003). Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychological Medicine 33, 419431.
Harrow, M, Sands, JR, Silverstein, ML, Goldberg, JF (1997). Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study. Schizophrenia Bulletin 23, 287303.
Hofer, A, Baumgartner, S, Bodner, T, Edlinger, M, Hummer, M, Kemmler, G, Rettenbacher, MA, Fleischhacker, WW (2005). Patient outcomes in schizophrenia II: the impact of cognition. European Psychiatry 20, 395402.
Holthausen, EA, Wiersma, D, Cahn, W, Kahn, RS, Dingemans, PM, Schene, AH, van den Bosch, RJ (2007). Predictive value of cognition for different domains of outcome in recent-onset schizophrenia. Psychiatry Research 149, 7180.
Johnstone, EC, Macmillan, JF, Frith, CD, Benn, DK, Crow, TJ (1990). Further investigation of the predictors of outcome following first schizophrenic episodes. British Journal of Psychiatry 157, 182189.
Keefe, RS, Poe, M, Walker, TM, Harvey, PD (2006). The relationship of the Brief Assessment of Cognition in Schizophrenia (BACS) to functional capacity and real-world functional outcome. Journal of Clinical and Experimental Neuropsychology 28, 260269.
Killackey, E, Jackson, HJ, McGorry, PD (2008). Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. British Journal of Psychiatry 193, 114120.
Lasalvia, A, Bonetto, C, Cristofalo, D, Tansella, M, Ruggeri, M (2007). Predicting clinical and social outcome of patients attending ‘real world’ mental health services: a 6-year multi-wave follow-up study. Acta Psychiatrica Scandinavica 437 (Suppl.), S16S30.
Lezak, MD, Howieson, DB, Loring, W (2004). Neuropsychological Assessment. Oxford University Press: New York.
Mañá, S, Ivorra, J, Girón, M (1998). Adaptación y fiabilidad de la entrevista para la evaluación de la discapacidad social en pacientes psiquiátricos (OMS). Revista de Psiquiatría de la Facultad de Medicina de Barcelona 25, 4348.
Menezes, NM, Arenovich, T, Zipursky, RB (2006). A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36, 13491362.
Milev, P, Ho, BC, Arndt, S, Andreasen, NC (2005). Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. American Journal of Psychiatry 162, 495506.
Miller, IW, Bishop, S, Norman, WH, Maddever, H (1985). The Modified Hamilton Rating Scale for Depression: reliability and validity. Psychiatry Research 14, 131142.
Norman, RM, Malla, AK, Cortese, L, Cheng, S, Diaz, K, McIntosh, E, McLean, TS, Rickwood, A, Voruganti, LP (1999). Symptoms and cognition as predictors of community functioning: a prospective analysis. American Journal of Psychiatry 156, 400405.
Revheim, N, Schechter, I, Kim, D, Silipo, G, Allingham, B, Butler, P, Javitt, DC (2006). Neurocognitive and symptom correlates of daily problem-solving skills in schizophrenia. Schizophrenia Research 83, 237245.
Robinson, DG, Woerner, MG, McMeniman, M, Mendelowitz, A, Bilder, RM (2004). Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry 161, 473479.
Schretlen, D, Bobholz, J, Brandt, J (1996). Development and psychometric properties of the Brief Test of Attention. Clinical Neuropsychologist 10, 8089.
Spreen, O, Strauss, E (1998). A Compendium of Neuropsychological Test: Administration, Norms, and Commentary. Oxford University Press: New York.
Swartz, MS, Perkins, DO, Stroup, TS, Davis, SM, Capuano, G, Rosenheck, RA, Reimherr, F, McGee, MF, Keefe, RS, McEvoy, JP, Hsiao, JK, Lieberman, JA (2007). Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. American Journal of Psychiatry 164, 428436.
Twamley, EW, Doshi, RR, Nayak, GV, Palmer, BW, Golshan, S, Heaton, RK, Patterson, TL, Jeste, DV (2002). Generalized cognitive impairments, ability to perform everyday tasks, and level of independence in community living situations of older patients with psychosis. American Journal of Psychiatry 159, 20132020.
van Winkel, R, Myin-Germeys, I, de Hert, M, Delespaul, P, Peuskens, J, van Os, J (2007). The association between cognition and functional outcome in first-episode patients with schizophrenia: mystery resolved? Acta Psychiatrica Scandinavica 116, 119124.
Velligan, DI, Mahurin, RK, Diamond, PL, Hazleton, BC, Eckert, SL, Miller, AL (1997). The functional significance of symptomatology and cognitive function in schizophrenia. Schizophrenia Research 25, 2131.
Verdoux, H, Liraud, F, Assens, F, Abalan, F, van Os, J (2002). Social and clinical consequences of cognitive deficits in early psychosis: a two-year follow-up study of first-admitted patients. Schizophrenia Research 56, 149159.
Wechsler, D (1999). Wechsler Adult Intelligence Scale-III. TEA Ediciones: Madrid.
Zarate, CA Jr., Tohen, M, Land, ML (2000). First-episode schizophreniform disorder: comparisons with first-episode schizophrenia. Schizophrenia Research 46, 3134.
Zhang, M, Wang, M, Li, J, Phillips, MR (1994). Randomised-control trial of family intervention for 78 first-episode male schizophrenic patients. An 18-month study in Suzhou, Jiangsu. British Journal of Psychiatry 24 (Suppl.), S96–S102.


Prognostic value of cognitive functioning for global functional recovery in first-episode schizophrenia

  • C. González-Blanch (a1), R. Perez-Iglesias (a1), G. Pardo-García (a1), J. M. Rodríguez-Sánchez (a1), O. Martínez-García (a1), J. L. Vázquez-Barquero (a1) and B. Crespo-Facorro (a1)...


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