Psychological Medicine

Original Articles

Neurocognitive functioning before and after the first psychotic episode: does psychosis result in cognitive deterioration?

H. E. Beckera1 c1, D. H. Niemana1, S. Wiltinka1, P. M. Dingemansa1, J. R. van de Flierta1, E. Velthorsta1, L. de Haana1, T. A. van Amelsvoorta1 and D. H. Linszena1

a1 Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands


Background Cognitive impairment is considered to be a core characteristic of schizophrenia. The relationship between psychosis and cognitive deterioration, however, remains unclear. This longitudinal study investigated the neuropsychological functioning of patients before and after their first psychotic episode. Cognitive functioning of participants who later developed a psychosis was compared to that of people at ultra-high risk (UHR) for psychosis who did not develop psychosis at follow-up and healthy controls.

Method Participants were 41 persons at UHR for psychosis (the UHR group), of whom 17 developed psychosis between the first and second assessment. Seventeen healthy controls were included in the study. Cognitive performance was assessed at intake (T0) and again after 18 months (T1). The areas of cognitive functioning assessed include verbal memory and learning, visuospatial working memory, executive function, sustained attention and motor speed.

Results The transition group did not perform significantly worse at the second assessment than at the first on any of the outcome measures. The UHR group performed better on a verbal learning and memory test at T1 compared to T0. At T0, the control group scored significantly better than the UHR group and the transition group on the verbal learning and memory test and the verbal fluency test.

Conclusions The results indicate that no cognitive deterioration occurs during the first psychotic episode. Problems in verbal memory may be present before the first episode of psychosis.

(Received March 05 2009)

(Revised December 17 2009)

(Accepted December 17 2009)

(Online publication February 05 2010)


c1 Address for correspondence: H. E. Becker, M.D., Academic Medical Centre, Department of Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. (Email: