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Neurocognitive skills and vulnerability for psychosis in depression and across the psychotic spectrum: findings from the PRONIA Consortium

Published online by Cambridge University Press:  17 October 2023

Carolina Bonivento
Scientific Institute, IRCCS E. Medea, Pasian di Prato, Udine, Italy
Lana Kambeitz-Ilankovic
Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; and Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Germany
Eleonora Maggioni
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
Stefan Borgwardt
Translational Psychiatry Unit, Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
Rebekka Lencer
Institute for Translational Psychiatry, Münster University, Germany
Eva Meisenzahl
Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Germany
Joseph Kambeitz
Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; and Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Germany
Stephan Ruhrmann
Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
Raimo K. R. Salokangas
Department of Psychiatry, University of Turku, Finland
Alessandro Bertolino
Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Italy
Alexandra Stainton
Orygen, Melbourne, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
Julian Wenzel
Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Australia
Stephen J. Wood
Orygen, Melbourne, Australia; School of Psychology, University of Birmingham, UK; and Centre for Youth Mental Health, University of Melbourne, Australia
Rachel Upthegrove
School of Psychology, University of Birmingham, UK; Institute for Mental Health, University of Birmingham, UK; and Centre for Human Brain Health, University of Birmingham, UK
Nikolaos Koutsouleris
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Germany; Max Planck Institute for Psychiatry, Germany; and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Paolo Brambilla*
Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Italy
Correspondence: Paolo Brambilla. Email:



Neurocognitive deficits are a core feature of psychosis and depression. Despite commonalities in cognitive alterations, it remains unclear if and how the cognitive deficits in patients at clinical high risk for psychosis (CHR) and those with recent-onset psychosis (ROP) are distinct from those seen in recent-onset depression (ROD).


This study was carried out within the European project ‘Personalized Prognostic Tools for Early Psychosis Management’, and aimed to characterise the cognitive profiles of patients with psychosis or depression.


We examined cognitive profiles for patients with ROP (n = 105), patients with ROD (n = 123), patients at CHR (n = 116) and healthy controls (n = 372) across seven sites in five European countries. Confirmatory factor analysis identified four cognitive factors independent of gender, education and site: speed of processing, attention and working memory, verbal learning and spatial learning.


Patients with ROP performed worse than healthy controls in all four domains (P < 0.001), whereas performance of patients with ROD was not affected (P > 0.05). Patients at CHR performed worse than healthy controls in speed of processing (P = 0.001) and spatial learning (P = 0.003), but better than patients with ROP across all cognitive domains (all P ≤ 0.01). CHR and ROD groups did not significantly differ in any cognitive domain. These findings were independent of comorbid depressive symptoms, substance consumption and illness duration.


These results show that neurocognitive abilities are affected in CHR and ROP, whereas ROD seems spared. Although our findings may support the notion that those at CHR have a specific vulnerability to psychosis, future studies investigating broader transdiagnostic risk cohorts in longitudinal designs are needed.

Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

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Joint first authors.


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