In addition to psychotic symptoms, first-episode schizophrenia (FES) is characterized by profound difficulties in cognition and social and emotional functions.
We examined whether cognitive markers predict real-world functional outcome in FES and whether this prediction is enhanced by social-cognitive markers. We also examined the relationship between these markers and lack of neural synchrony in FES, in the context of our integrative neuroscience model of impaired neural coordination of salient and task-relevant information in this condition.
We tested patients with FES (within 3 months of service contact) using the standardized Brain Resource International Database cognitive battery and tests of social and emotional function (including DASS, NEO-FFI). Neural synchrony was extracted from EEG recorded to corresponding tasks. Assessments of symptoms and functional outcome included PANSS, SOFAS, and World Health Organisation Quality of Life Scale.
General cognitive markers predicted negative symptom severity, with the greatest contribution from poor verbal function, then visuospatial executive functions. Poorer executive function also predicted poorer social and occupational outcome and quality of life. This predictive relationship was significantly improved by the addition ofthe social-cognitive marker, excessive negativity bias. These combined markers were also related to an excess of high-frequency neural synchrony in EEG recordings.
These findings show that 1) markers of general cognitive dysfunction predict real-world functional outcome in FES, 2) predictive power is enhanced by taking social and emotional aspects of cognition into account and 3) impairments in neural binding and coordination of salient stimuli may underlie these functional difficulties.