Relationship of Cognition to Clinical Response in First-Episode Schizophrenia Spectrum Disorders

Schizophr Bull. 2015 Nov;41(6):1237-47. doi: 10.1093/schbul/sbv120. Epub 2015 Sep 25.


First-episode schizophrenia (FES) spectrum disorders are associated with pronounced cognitive dysfunction across all domains. However, less is known about the course of cognitive functioning, following the first presentation of psychosis, and the relationship of cognition to clinical course during initial treatment. The present longitudinal study examined the magnitude of neurocognitive impairment, using the MATRICS Consensus Cognitive Battery, in patients experiencing their first episode of psychosis at baseline and after 12 weeks of randomized antipsychotic treatment with either aripiprazole or risperidone. At baseline, FES patients evidenced marked impairments in cognitive functioning. Notably, performance on the mazes task of planning and reasoning significantly predicted the likelihood of meeting stringent criteria for positive symptom remission during the first 12 weeks of the trial. Performance on indices of general cognitive function, working memory, and verbal learning improved over time, but these improvements were mediated by improvements in both positive and negative symptoms. We did not detect any differential effects of antipsychotic medication assignment (aripiprazole vs risperidone) on cognitive functioning. Our results suggest that a brief paper-and-pencil measure reflecting planning/reasoning abilities may index responsivity to antipsychotic medication. However, improvements in cognitive functioning over time were related to clinical symptom improvement, reflecting "pseudospecificity."

Keywords: aripiprazole; cognition; general cognitive function; planning; psychosis; risperidone.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antipsychotic Agents / administration & dosage
  • Antipsychotic Agents / pharmacology*
  • Aripiprazole / administration & dosage
  • Aripiprazole / pharmacology
  • Cognition Disorders* / drug therapy
  • Cognition Disorders* / etiology
  • Cognition Disorders* / physiopathology
  • Female
  • Humans
  • Male
  • Outcome Assessment, Health Care / methods*
  • Psychotic Disorders* / complications
  • Psychotic Disorders* / drug therapy
  • Psychotic Disorders* / physiopathology
  • Remission Induction
  • Risperidone / administration & dosage
  • Risperidone / pharmacology
  • Schizophrenia* / complications
  • Schizophrenia* / drug therapy
  • Schizophrenia* / physiopathology
  • Young Adult


  • Antipsychotic Agents
  • Aripiprazole
  • Risperidone