Community dysfunction in schizophrenia: rate-limiting factors

The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.     

Cognitive functioning and negative symptoms in first episode schizophrenia: Different patterns of correlates

Negative symptoms of schizophrenia have been related to disturbances of executive functions, memory, attention and motor functioning. The executive functions dimension comprises a variety of cognitive subprocesses, including speed of processing, flexibility and working memory. We independently analysed the relationship between different cognitive tasks and clinical symptoms (negative, positive and disorganized) in a sample of 126 first-episode patients with schizophrenia spectrum disorders. Negative symptoms were significantly associated with performance on executive-functions and motor coordination tasks. Within the executive functions domain only those tests that required speeded performance showed a significant association with the negative dimension. The widely described relationship between negative symptoms and executive impairments in schizophrenia appears to be mediated by likely dysfunctions in the speed of processing instead of by working memory impairment.     

Independence and overlap among neurocognitive correlates of community functioning in schizophrenia

Existing literature on the neurocognitive correlates of community functioning in schizophrenia has not adequately focused on the relationships among the correlated variables. In a sample of 40 outpatients with schizophrenia and related disorders, we studied two sets of variables that we expected to be related to broad ratings of community functioning: (1) the Wechsler Adult Intelligence Scale-III (WAIS-III) index scores for verbal comprehension, perceptual organization, working memory, and processing speed; and (2) positive, negative, disorganized and affective symptom variables. Of the WAIS-III index scores, working memory and processing speed entered a stepwise regression, together accounting for substantial variance in functional ratings (R(2)=0.37). However, only processing speed remained significantly associated with community functioning after controlling for the other indexes. In relation to community functioning, the remaining indexes appeared to be overlapping markers of general cognitive ability, rather than specific measures of discrete cognitive domains. Addition of positive and negative symptom variables in a further analysis greatly increased the explained functional variance (R(2)=0.65). Processing speed overlapped substantially with negative symptoms in predicting functioning, while the other WAIS-III indexes were independent of symptomatology. Results illustrate the importance of (1) knowing which neurocognitive variables have specific relationships to community functioning and which reflect the influence of more general cognitive ability in daily life, and (2) appreciating areas of overlap and independence among classes of correlates of functioning, such as neurocognitive and symptom variables. This improved understanding has implications for predictive models of community functioning, for cognitive rehabilitation and deficit compensation strategies, and for assessment practice.     

Daily activities, cognition and community functioning in persons with schizophrenia

OBJECTIVE: This cross-sectional study explored the relationships between daily activity performance, attention, memory, executive functions and community functioning in people with schizophrenia. More specifically, this study attempted to verify the hypothesis that functional limitations in the performance of daily activities negatively affect community functioning in people with schizophrenia. METHODS: Eighty-two individuals with schizophrenia living in the community were recruited for the study. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis was used to assess participants' functional capacity during a meal preparation task. Visuo-spatial associative memory, spatial working memory, planning, visuo-motor coordination, and selective attention were evaluated as well. Community functioning was assessed with the Independent Living Skills Survey (ILSS) and the Multnomah Community Ability Scale (MCAS). RESULTS: Correlations revealed significant associations between functional capacity and visuo-spatial associative learning, spatial working memory, planning and negative symptoms. Planning skills during meal preparation were found to be associated with MCAS. After regression analyses, only visuo-spatial memory, negative symptoms, education and familiarity with meal preparation explained variation in functional capacity. CONCLUSIONS: The findings of the current study suggest that visuo-spatial associative learning, negative symptoms, education and familiarity with task are among the important factors for functional capacity. Planning skills necessary for efficient task performance were also found to be those most determinant for community functioning. Rehabilitation interventions should consider these underlying strength and deficits when developing strategies to help people with schizophrenia build functional skills essential for community living.     

Neurocognitive complaints in HIV-infection and their relationship to depressive symptoms and neuropsychological functioning

We examined the degree to which depressive symptoms, clinical staging of HIV disease, and neuropsychological (NP) functioning were related to neurocognitive complaints in HIV-infection. One hundred adults with HIV-infection (12 asymptomatic, 41 mildly symptomatic, and 47 with AIDS) were administered NP tests of attention and working memory, language, psychomotor speed, verbal memory, and conceptual problem-solving, the Beck Depression Inventory, and the Patient's Assessment of Own Functioning Inventory (Chelune, Heaton & Lehman, 1986), a subjective neurocognitive complaint questionnaire where patients rated their problems with memory, language and communication, sensory-motor skills, and higher-level cognitive and intellectual functions. Neurocognitive complaints (regardless of specific type) were correlated significantly with depressive symptoms and with NP measures of attention and working memory, psychomotor skills, and learning efficiency. However, multiple regression analyses revealed that depressive symptoms accounted for the majority of variance explained in neurocognitive complaints with psychomotor efficiency generally predicting the remaining variance. Neurocognitive complaints did not differ according to HIV clinical staging.     

Processing speed and executive functions predict real-world everyday living skills in adolescents with early-onset schizophrenia

Cognition and clinical variables are known to be among the most predictive factors of real-world social functioning and daily living skills in adult-onset schizophrenia. Fewer studies have focused on their impact in adolescents with early-onset schizophrenia (EOS). The aim of this study is to examine the relationships and the predictive value of cognition and clinical variables on real-world daily living skills in a sample of adolescents with EOS. Cognitive, clinical and real-world everyday living skills measures were administered to 45 clinically and pharmacologically stabilized adolescent outpatients with EOS and 45 healthy control subjects matched by age and sex. Multi-variant analyses to compare cognitive and real-world functioning profiles between patients and controls and regression analysis to identify predictors of real-world functioning scores in patients were used. Adolescents with EOS showed a generalized cognitive and real-world daily living skills dysfunction. Several cognitive and clinical variables significantly correlated with real-world daily living skills functioning but only the processing speed and executive functions emerged as independent predictors of everyday living skills scores, explaining 25.1% of the variance. Slowness in processing information and executive dysfunction showed a significant impact on real-world daily living skills in EOS, independently from clinical symptoms and other cognitive variables. Nevertheless, much of the variance in the daily living skills measure remained unaccounted for, suggesting that other factors were involved as well in this young population.     

Verbal memory, problem-solving skills and community status in schizophrenia

Neuropsychological deficits have been associated with poor community functioning in individuals with schizophrenia. Previous research suggests that verbal memory capacity is related to functional capacity. The purpose of this study was to investigate the relationship between verbal memory, problem-solving skills and community functioning, as measured by treatment status (inpatient vs. outpatient) in people with schizophrenia spectrum disorders. Evaluations were done on 162 individuals with schizophrenia or schizoaffective disorder, seen in inpatient (n=87) and outpatient settings (n=75). Verbal memory was assessed using narrative recall and list recall measures. Problem-solving skills for independent living were assessed using a social reasoning measure and a daily problem-solving skills measure. Better verbal memory performance was associated with better problem solving for independent living. However, inpatient vs. outpatient status was best determined by problem-solving skills for independent living rather than verbal memory performance. The results reveal the importance of daily problem-solving skills for community status in schizophrenia. Although verbal memory performance is associated with problem-solving skills for independent living, predictive probability of community status does not improve when memory performance is taken into account.     

Spatial working memory deficit correlates with disorganization symptoms and social functioning in schizophrenia

Both spatial working memory deficit and disorganization symptoms have been considered significant components of schizophrenic impairment involved with the dorsolateral prefrontal cortex. The purpose of the present study was to investigate the relationships among spatial working memory, psychiatric symptoms including disorganization symptoms, and social functioning in schizophrenia. Fifty clinically stable patients with schizophrenia and 34 healthy controls participated in the study. Patients were rated with the Brief Psychiatric Rating Scale and the Rehabilitation Evaluation Hall and Baker. The Advanced Trail Making Test was used to evaluate spatial working memory. Patients demonstrated significantly reduced spatial working memory compared to that of healthy controls. Spatial working memory in patients correlated significantly with social functioning such as self-care skills, community skills and speech disturbance, and with disorganization symptoms. Disorganization symptoms also correlated with these aspects of social functioning. In conclusion it is suggested that both spatial working memory deficit and disorganization symptoms, which are impairments involved with the dorsolateral prefrontal cortex dysfunction, can serve as effective predictors of social functioning.     

Convergent validity and neuropsychological correlates of the schedule for the assessment of negative symptoms (SANS) attention subscale

Cognitive deficits have come to be viewed as a hallmark feature of schizophrenic illness. Although laboratory based assessment of patients' cognitive deficits has been well investigated, few studies to date have examined the utility of clinical ratings of cognitive symptoms using the Schedule for the Assessment of Negative Symptoms (SANS) attention subscale. In this report, we examined the convergence between clinical ratings of cognitive impairment using the SANS attention subscale and performance on a variety of neurocognitive tests designed to measure attentional impairment, as well as other cognitive constructs such as working memory and executive functioning. A total of 56 acute schizophrenic inpatients were clinically rated with the SANS and completed the Continuous Performance Test, Digit Span Distraction Test, Wisconsin Card Sorting Task, and the Trailmaking Test. A series of correlational and regression analyses were conducted to test the concurrent and discriminant validity of the SANS attention subscale. Performance measures of attention, but not working memory or executive functioning, were significantly correlated with and moderately predicted the severity of SANS rated inattention. Additionally, the attention subscale was discriminated from the other SANS negative symptom subscales in predicting a laboratory measure of attentional functioning. The SANS attention subscale demonstrated both concurrent and discriminant validity. These data indicate that attentional dysfunction in schizophrenia can be meaningfully rated and interpreted using the SANS.     

The relationships of positive and negative symptoms with neuropsychological functioning and their ability to predict verbal memory in psychotic major depression

Neuropsychological functioning, in relation to positive and negative symptoms in psychotic major depression (PMD), has not been as thoroughly studied as it has been in schizophrenia. Thus, the current study investigated the associations between positive and negative symptoms with cognitive functioning, with an emphasis on verbal memory in PMD. Attention, working memory, and the executive functioning domains were analyzed among 49 PMD participants. Positive symptoms did not correlate significantly with any measures of verbal memory but did correlate with one measure of attention, working memory, and executive functioning. Negative symptoms correlated significantly with two California Verbal Learning Test-II (CVLT-II) measures of verbal memory and three measures of executive function. Hierarchical regressions were conducted to determine if negative symptoms could predict verbal memory performance after controlling for depression. Of the two verbal memory measures, negative symptoms significantly explained additional variance for CVLT Recognition, but not for CVLT Trials 1-5 total score. Our results provide some evidence that, consistent with the schizophrenia literature, negative symptoms contributed more to verbal memory deficits in PMD than positive symptoms, regardless of depression severity.     

Neurocognitive Complaints in HIV-Infection and Their Relationship to Depressive Symptoms and Neuropsychological Functioning

We examined the degree to which depressive symptoms, clinical staging of HIV disease, and neuropsychological (NP) functioning were related to neurocognitive complaints in HIV-infection. One hundred adults with HIV-infection (12 asymptomatic, 41 mildly symptomatic, and 47 with AIDS) were administered NP tests of attention and working memory, language, psychomotor speed, verbal memory, and conceptual problem-solving, the Beck Depression Inventory, and the Patient's Assessment of Own Functioning Inventory (Chelune, Heaton & Lehman, 1986), a subjective neurocognitive complaint questionnaire where patients rated their problems with memory, language and communication, sensory-motor skills, and higher-level cognitive and intellectual functions. Neurocognitive complaints (regardless of specific type) were correlated significantly with depressive symptoms and with NP measures of attention and working memory, psychomotor skills, and learning efficiency. However, multiple regression analyses revealed that depressive symptoms accounted for the majority of variance explained in neurocognitive complaints with psychomotor efficiency generally predicting the remaining variance. Neurocognitive complaints did not differ according to HIV clinical staging.     

Decision-making capacity for research participation among individuals in the CATIE schizophrenia trial

OBJECTIVE: Uncertainty regarding the degree to which persons with schizophrenia may lack decision-making capacity, and what the predictors of capacity may be led us to examine the relationship between psychopathology, neurocognitive functioning, and decision-making capacity in a large sample of persons with schizophrenia at entry into a clinical trial. METHOD: In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial, a clinical trial sponsored by the National Institute of Mental Health designed to compare the effectiveness of antipsychotic drugs, subjects were administered the MacArthur Competence Assessment Tool-Clinical Research (MacCAT-CR) and had to demonstrate adequate decision-making capacity before randomization. The MacCAT-CR, the Positive and Negative Syndrome Scale (PANSS), and an extensive neurocognitive battery were completed for 1447 study participants. RESULTS: The neurocognitive composite score and all 5 neurocognitive subscores (verbal memory, vigilance, processing speed, reasoning, and working memory) were positive correlates of the MacCAT-CR understanding, appreciation, and reasoning scales at baseline. Higher levels of negative symptoms, but not positive symptoms, were inversely correlated with these three MacCAT-CR scales. Linear regression models of all three MacCAT-CR scales identified working memory as a predictor; negative symptoms made a small contribution to the understanding and appreciation scores. CONCLUSIONS: Negative symptoms and aspects of neurocognitive functioning were correlated with decision-making capacity in this large sample of moderately ill subjects with schizophrenia. In multiple regression models predicting performance on the MacCAT-CR scales, working memory was the only consistent predictor of the components of decision-making capacity. Individuals with schizophrenia who have prominent cognitive dysfunction, especially memory impairment, may warrant particular attention when participating in research.     

Negative symptoms and specific cognitive impairments as combined targets for improved functional outcome within cognitive remediation therapy

Negative symptoms and poor cognition are both associated with poor functional outcome in schizophrenia. This poor functional outcome has been attributed to poor cognition rather than any independent contribution from symptoms. Identifying target cognitive processes and mechanisms that predict community function, and possible moderator effects of negative symptoms, will allow the development of cognitive remediation programs that are successful in improving functional outcome. A referred sample of 53 in- and outpatients with schizophrenia with general cognitive impairment (including 28 with severe negative symptoms) and 22 healthy controls, balanced for premorbid IQ, were compared cross sectionally on measures of community shopping skills, executive function, and working memory. Across the groups, there were direct relationships between community functioning and specific executive functions, and there were interactions between group membership and the types of associations found. Working memory was independently associated with accurate community functioning only in people with schizophrenia and negative symptoms. This association was not due to the sole presence of working memory impairment or just to negative symptoms. Poor community function is predicted both by specific cognitive impairments that are prominent in people with negative symptoms and through the moderating effect of negative symptoms on the working memory-community function relationship. This may reflect a synergistic association between symptoms and cognition: negative symptoms arise from cognitive impairment but also impact detrimentally on working memory functioning. Both cognitive processes and negative symptoms should be targeted in cognitive remediation to effect the greatest change in community functions.     

Relationship between psychopathology and cognitive functioning in schizophrenia

The purpose of this study was to delineate the relationship between positive, negative, cognitive, depressive, and excitement symptom dimensions of schizophrenia and cognitive functioning. Fifty-eight patients with schizophrenia (DSM-IV criteria) were assessed using the Positive and Negative Syndrome Scale (PANSS) and a battery of neuropsychological tests (executive function/abstraction, verbal and spatial working memory, verbal and nonverbal memory/learning, attention, visuospatial ability, and psychomotor speed). The cognitive symptom dimension correlated with executive functions, attention, verbal memory, and spatial ability. Severity of the negative symptom dimension was related to impairment in the structure of the semantic knowledge system, verbal memory, and auditory attention. In contrast, severity of the positive symptom dimension correlated only with impairment in the structure of the semantic knowledge system, and psychomotor speed. Finally, severity of the depressive and excitement symptom dimension was not associated with cognition. Correlations between symptom dimensions and cognitive measures were at best modest. Severity of cognitive and negative symptoms was mainly correlated with deficits on executive functions, semantic memory, and verbal memory, while positive symptoms only with semantic memory. These correlations were modest, suggesting that psychopathology and cognitive deficits in schizophrenia are caused, at least partially, by distinct pathophysiological processes.     

Neuropsychological substrates and everyday functioning implications of prospective memory impairment in schizophrenia

Individuals with schizophrenia demonstrate impairment in prospective memory (ProM), which describes the multifaceted ability to execute a future intention. Despite its clear implications for everyday functioning, the neuropsychological substrates and functional correlates of ProM impairment in schizophrenia remain poorly understood. In this study, the Memory for Intentions Screening Test (MIST), a standardized measure of ProM, was administered to 72 outpatients with schizophrenia or schizoaffective disorder as part of a comprehensive neuropsychological and psychiatric research evaluation. Results showed that ProM was positively correlated with standard clinical tests of attention, working memory, processing speed, learning, and executive functioning, but not delayed recall. In the context of multiple neuropsychological predictors, learning ability was the only domain that independently contributed to ProM. Importantly, better ProM was predictive of higher functional capacity (as measured by the UCSD Performance-Based Skills Assessment-Brief Version), above and beyond the variability explained by demographic and disease factors. Analysis of component processes revealed that event-based ProM, as well as no response (i.e., omission) and task substitution errors were the strongest predictors of everyday functioning. Overall, these findings suggest that ProM impairment in schizophrenia is associated with multiple cognitive substrates, particularly episodic learning deficits, and plays an important role in everyday living skills. Studies regarding the potential effectiveness of ProM-based remediation strategies to improve functional outcomes in schizophrenia are indicated.     

Does the ability to sustain attention underlie symptom severity in schizophrenia?

An association between deficits in executive control, particularly inhibitory control, and more severe negative and disorganised symptoms of schizophrenia has been widely reported. The importance of more basic aspects of attention, often referred to as 'vigilant' or 'sustained' attention, to this relationship remains unclear. This study examined the contribution of sustained attention to symptom severity using the Sustained Attention to Response Task (SART) in 69 patients with schizophrenia. We found that negative and disorganised symptom severity scores were correlated with sustained attention, working memory, and psychomotor speed. The ability to sustain attention significantly predicted variance in negative symptom severity but not disorganised symptoms, which were instead predicted by working memory performance. These data suggest that this component of attention at least partly explains variance in negative symptoms.     

精神分裂症患者综合职业技能相关因素的横断面评估(英文)

背景国外一些研究显示职业技能训练能提高精神分裂症患者的社会功能,改善生活质量。国内对精神分裂症患者职业技能与功能状态关系的研究相对较少。目的以综合职业技能评定量表(Comprehensive Occupational Therapy Evaluation Scale,COTE)评估住院以及刚出院的精神分裂症患者的职业功能,评价患者综合职业技能与人口学特征、临床症状及认知功能的关系。方法由经过培训的临床医生对64例精神分裂症患者(35例住院患者、29刚出院的门诊患者)进行评估,评估工具包括COTE,阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)以及包括威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)、注意力持续操作测验(Continuous Perfomance Test,CPT),成人韦氏智力测验(Wechsler Adult Intelligence Scale,WAIS)中的数字符号项目,连线测验A和连线测验B在内的成套神经心理测验。结果患者的COTE 总分及一般行为、人际交往和任务行为3个维度的因子分与PANSS总分及其阳性症状分、阴性症状分和一般病理分均相关(秩相关系数范围为0.40~0.90)。COTE各指标与PANSS阴性症状分的相关性比其与PANSS阳性症状分的相关性强。COTE评分也与CPT的评分相关,并与WAIS中的数字符号项目得分,和WCST的部分项目结果相关。逐步回归分析显示,反映患者职业技能的4个COTE指标主要与PANSS总分或阴性症状分相关,其次与完成连线测验B所用时间、CPT漏报次数以及患者的受教育程度相关。结论住院及刚出院精神分裂症患者的职业技能与其精神症状的严重程度密切相关,也与患者的认知功能和受教育年限有一定关系。     

Persistent cognitive impairment in depression: the role of psychopathology and altered hypothalamic-pituitary-adrenocortical (HPA) system regulation.

BACKGROUND: Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system and cognitive impairment are consistent findings in depression. This study examines the associations between HPA system regulation, cognitive functioning, and psychopathology in depressed inpatients on admission and at discharge. METHODS: The HPA system dysregulation was evaluated with the dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test. Cognitive assessment included speed of information processing, divided and selective attention, as well as short-term and working memory. Psychopathology was evaluated with the Hamilton Rating Scale for Depression (HAMD). Data from 75 depressed inpatients are reported, 51 (68%) of them achieved remission. RESULTS: Despite a significant reduction of depressive symptoms between admission and discharge, a high rate of patients remained cognitively impaired. Selective attention improved significantly in remitters and nonremitters, while speed of information processing increased only in remitters. The cortisol response to the DEX/CRH test decreased significantly only in remitters, which was uncorrelated with cognitive performance. In nonremitters, severity of depression was significantly correlated with information processing time while improvement in short-term memory was negatively associated with the cortisol response at discharge. CONCLUSIONS: Our data support the assumption that psychopathological symptoms and the HPA system dysregulation can be dissociated in their impact on cognitive functioning in depressed patients.     

The crucial role of sustained attention in community functioning in outpatients with schizophrenia

The aim was to explore the pattern of associations between visual cognitive performance and community functioning in a sample of outpatients with schizophrenia participating in a rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performances in 88 subjects. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. Our results showed that the sustained attention score was significantly associated with the global community functioning score and with two specific dimensions: "adjustment to living" and "behavioral problems". No association was found between other cognitive indices and MCAS scores. Since the sustained attention task mainly involves the executive component of working memory, these findings suggest that attentional control processes are limiting factors for community functioning in schizophrenia outpatients. Measures of such processes could serve as key indices of disability in clinical practice. Attention and working memory training may be helpful to improve community functioning in subjects with schizophrenia.     

Clinical and neurocognitive course in early-onset psychosis: a longitudinal study of adolescents with schizophrenia-spectrum disorders

Aim: Adolescents with psychotic disorders show deficits in IQ, attention, learning and memory, executive functioning, and processing speed that are related to important clinical variables including negative symptoms, adaptive functioning and academics. Previous studies have reported relatively consistent deficits with varying relationships to illness status and symptoms. The goals of this study were to examine these relationships in a larger sample at baseline, and also to examine the longitudinal course of these deficits in a smaller subset of adolescents. Method: Thirty‐six subjects, aged 10 to 17 years, were included at baseline. All had Diagnostic and Statistical Manual‐Fourth Edition diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder and psychosis – not otherwise specified, as determined by Kiddie‐Schedule for Affective Disorders and Schizophrenia for School‐Age Children structured interviews. Patients were administered a neuropsychological battery, and Positive and Negative Syndrome Scale ratings were completed at baseline and again at 1 year (n = 14). Most participants were inpatients at baseline, and 13 of 14 were on atypical antipsychotic medication during both sessions. Results: At baseline, the patients demonstrated impairments in working memory, processing speed, executive function and verbal learning. No significant cognitive change was detected at 1‐year follow‐up. In contrast, clinical symptoms were variable across 1 year, with an improvement in positive symptoms at 1 year. No relationships between clinical and cognitive symptoms were observed, with the exception of baseline IQ predicting negative symptoms at 1 year. Conclusions: Young patients with schizophrenia‐spectrum disorders displayed neurocognitive impairments at baseline. Despite measurable fluctuations in clinical symptoms over the year, no significant changes were measured in cognition. Lower IQ at baseline was predictive of more negative symptoms at 1 year.