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Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment

Published online by Cambridge University Press:  12 March 2021

Eric J. Tan*
Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
Susan L. Rossell
Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
Kenneth L. Subotnik
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Joseph Ventura
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Keith H. Nuechterlein
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA UCLA Department of Psychology, Los Angeles, CA, USA
Author for correspondence: Eric J. Tan, PhD, E-mail:



Patients with schizophrenia spectrum disorders have been increasingly recognised to form cognitive subgroups with differential levels of impairment. Using cluster analytical techniques, this study sought to identify cognitive clusters in a sample of first-episode psychosis (FEP) patients and examine clinical and developmental differences across the resultant groups.


In total, 105 FEP patients in the University of California Los Angeles Aftercare Research Program were assessed for cognition, symptoms and premorbid developmental adjustment. Hierarchical cluster analysis with Ward's method and squared Euclidean distance was conducted, confirmed by discriminant function analysis and optimised with k-means clustering. The stability of the solution was evaluated through split-sample (random, 80 and 70% samples) and alternate method (average linkage method) replication via Cohen's κ analysis. Controlling for multiple comparisons, one-way analysis of variances examined group differences in symptom severity and premorbid adjustment.


Three groups were identified: severely impaired (n = 27), moderately impaired (n = 41) and relatively intact (n = 37). There were no significant differences in symptom severity across the groups. Significant differences were observed for scholastic performance at three different developmental stages: childhood, early adolescence and late adolescence, with the relatively intact group demonstrating significantly better scholastic performance at all three stages than both the moderately impaired and severely impaired groups (who did not significantly differ from each other).


The findings add to growing evidence that cognitive clusters in FEP mirror that of later-stage schizophrenia. They also suggest that premorbid scholastic performance may not just be a risk factor for developing schizophrenia, but is also related to cognitive impairment severity and potentially to prognosis.

Original Article
Copyright © The Author(s), 2021. Published by Cambridge University Press

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