Cognitive presentation at psychosis onset through premorbid deterioration and exposure to environmental risk factors

Ferraro, Laura, Di Forti, Marta, La Barbera, Daniele, La Cascia, Caterina, Morgan, Craig, Tripoli, Giada, Jongsma, Hannah, Seminerio, Fabio, Sartorio, Crocettarachele, Sideli, Lucia, Tarricone, Ilaria, Carloni, Anna Lisa, Szoke, Andrei, Pignon, Baptiste, Bernardo, Miguel, de Haan, Lieuwe, Arango, Celso, Velthorst, Eva, Gayer-Anderson, Charlotte, Kirkbride, James, Rutten, Bart P.F, Lasalvia, Antonio, Tosato, Sarah, Del Ben, Cristina Marta, Menezes, Paulo Rossi, Bobes, Julio, Arrojo, Manuel, Tortelli, Andrea, Jones, Peter, Selten, Jean-Paul, van Os, Jim, Murray, Robin, Quattrone, Diego and Vassos, Evangelos 2025. Cognitive presentation at psychosis onset through premorbid deterioration and exposure to environmental risk factors. Psychological Medicine 55 , e12. 10.1017/S0033291724003507

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Abstract

Background Previous studies identified clusters of first-episode psychosis (FEP) patients based on cognition and premorbid adjustment. This study examined a range of socio-environmental risk factors associated with clusters of FEP, aiming a) to compare clusters of FEP and community controls using the Maudsley Environmental Risk Score for psychosis (ERS), a weighted sum of the following risks: paternal age, childhood adversities, cannabis use, and ethnic minority membership; b) to explore the putative differences in specific environmental risk factors in distinguishing within patient clusters and from controls. Methods A univariable general linear model (GLS) compared the ERS between 1,263 community controls and clusters derived from 802 FEP patients, namely, low (n = 223) and high-cognitive-functioning (n = 205), intermediate (n = 224) and deteriorating (n = 150), from the EU-GEI study. A multivariable GLS compared clusters and controls by different exposures included in the ERS. Results The ERS was higher in all clusters compared to controls, mostly in the deteriorating (β=2.8, 95% CI 2.3 3.4, η2 = 0.049) and the low-cognitive-functioning cluster (β=2.4, 95% CI 1.9 2.8, η2 = 0.049) and distinguished them from the cluster with high-cognitive-functioning. The deteriorating cluster had higher cannabis exposure (meandifference = 0.48, 95% CI 0.49 0.91) than the intermediate having identical IQ, and more people from an ethnic minority (meandifference = 0.77, 95% CI 0.24 1.29) compared to the high-cognitive-functioning cluster. Conclusions High exposure to environmental risk factors might result in cognitive impairment and lower-than-expected functioning in individuals at the onset of psychosis. Some patients’ trajectories involved risk factors that could be modified by tailored interventions.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Publisher:	Cambridge University Press
ISSN:	0033-2917
Date of First Compliant Deposit:	6 March 2025
Date of Acceptance:	16 December 2024
Last Modified:	14 Mar 2025 15:23
URI:	https://orca.cardiff.ac.uk/id/eprint/176684

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