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The British Journal of Psychiatry (2005) 187: 516-522
© 2005 The Royal College of Psychiatrists

Cognitive heterogeneity in first-episode schizophrenia

Eileen M. Joyce, MA, PhD, MRCP, FRCPsych

Division of Neuroscience and Mental Health, Imperial College and Institute of Neurology, London

Sam B. Hutton, BA, DPhil

Department of Psychology, University of Sussex

Stanley H. Mutsatsa, BSc, MSc, RMN and Thomas R. E. Barnes, MD, FRCPsych, DSc

Division of Neuroscience and Mental Health, Imperial College London,UK

Correspondence: Dr Eileen Joyce, Institute of Neurology, University College London, Box 19, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. E-mail: e.joyce{at}ion.ucl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Studies of chronic schizophrenia suggest that there are subgroups with different profiles of cognitive impairment.

Aims To determine whether such heterogeneityis present at illness onset and any relationship to clinical variables.

Method Ninety-three community patients with first-episode schizophrenia and 50 healthy volunteers were assessed for premorbid (Revised National Adult ReadingTest) and current IQ, memory and executive function.

Results Half of those with schizophrenia had preserved IQ in the normal range but there was evidence of a specific impairment in spatial working memory even in those with high/average IQ; 37 out of 93 (40%) had generalised cognitive decline. Those with low premorbid IQ were significantly younger atillness onset. For the entire group, age at onset correlated positively with premorbid but not current IQ.

Conclusions At illness onset, cognitive heterogeneityis present in people with schizophrenia, with a high proportion having undergone general cognitive decline. However, working memory impairment may be a common feature. Lower premorbid IQ is a risk factor for an earlier onset.


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