Investigating cognitive performance and functional outcomes in early psychosis: measurement, screening, and prediction
Cowman, Megan
Cowman, Megan
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Publication Date
2025-03-29
Type
doctoral thesis
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Abstract
Many individuals with psychosis experience difficulties with social and occupational function. Given the economic, social and personal costs associated with psychosis, it is important to gain a better understanding of factors that are associated with functional recovery. While current pharmacological treatments are effective for ameliorating positive symptoms, there is little evidence that they benefit negative or cognitive symptoms of psychosis, both of which are likely to be associated with functional outcomes. As a potentially modifiable predictor of function, cognitive performance has the potential to inform new and better treatments.
The overall aim of this thesis was to better characterise the relationship between cognitive and social cognitive performance and functional outcomes in early psychosis. Specifically, we aimed to estimate the association between cognitive domains and functional outcomes, and to identify cognitive and clinical subgroups in a cohort of individuals with first-episode psychosis. To enhance the clinical utility of this work, we aimed to investigate how cognitive impairment can be screened for, and how functioning can be better assessed.
The findings of this thesis build on the evidence that treatments that successfully target cognitive deficits are likely to be important for improving functional outcomes in psychosis. In terms of measuring functional outcomes, findings suggest that more specific measures of social function are better able to detect changes in function over time and in response to treatment compared to more commonly used global measures. Cognitive and clinical cluster analyses suggest those with greater cognitive impairments and higher negative symptom severity are at highest risk for functional disability. In terms of cognitive screening, our findings suggest that cognitive functioning can be assessed quickly in a clinical setting using measures of memory. Overall, these findings highlight the value of assessing cognition as part of routine care, and the need for more tailored, cognitively focused interventions to optimise longer-term outcomes.
Funder
Health Research Board
Publisher
University of Galway
Publisher DOI
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International