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Psychotic episodes and the effect of cognitive functioning over time

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Amanda Wattenburg, college student, Ashford University


Objectives: Mental disorders are concerning in today’s society. Various psychotic disorders such as schizophrenia exist and are associated with psychosis. Psychosis occurs in individuals who mentally experience a reality disconnection (Boychuk, Lysaght & Stuart, 2018). While experiences and symptoms vary, common symptoms include hallucinations, delusions, unorganized thinking, disorderly behaviors, and negative symptoms (Boychuk, Lysaght & Stuart, 2018). Psychosis may lead to additional occurrences of psychotic experiences or may indicate signs of a mental health disorder. Individuals who experience a psychotic episode for the first time is known as first-episode psychosis. It is important to examine the impact psychosis has on cognitive functioning as cognitive functions relates to how mental knowledge is acquired and how individuals respond and view various aspects (Nieto et al., 2012). Gaining knowledge on this topic would provide a better understanding of psychosis and the impact it has on cognitive functioning. It may also provide a better understanding of the importance of treatment in hopes of decreasing the chances of psychosis leading to a mental disorder.
Method: Psychotic experiences typically occur in three phases. The first phase of psychosis is known as the prodrome phase, followed by the acute phase, and finally the recovery phase. The very first psychotic episode that occurs in an individual is referred to as first-episode psychosis. Several studies have given insight to the impact psychosis has on cognitive functioning. Zaytseva, Korsokava, Agius, & Gurovich (2013) and Bora & Murray (2014) discovered altered cognitive functioning exists prior to onset or before the prodrome stage. Similarly, Popolo, Vinci, & Balbi (2010) conducted a year-long longitudinal study on neurocognitive functioning amongst children and adolescent participants who have encountered first-episode psychosis. The results indicated that cognitive impairment occurs prior to psychosis onset and is present during the prodrome stage. The results of the cognitive assessments also indicated that adolescents with first-episode psychosis (FEP) have continued neurocognitive impairments in the first year, but psychotic patient’s cognitive deficiencies do not decline over the course of the psychotic disorder. However, according to the article Neurocognitive functioning before and after the first psychotic episode: does psychosis result in cognitive deterioration, (2010) the results indicated that there is no decline in cognitive functioning during the first psychotic episode. Thus, research indicates that cognitive functioning impairment occurs somewhere prior to first-episode onset however, there is varying research that indicates the impact on cognitive functioning over time. Nieto et al. (2012) organized a study which was cross-sectional observational consisting of 96 adults who were acute psychotic. Within the study, cognitive functioning was examined as it relates to the insight of the patients as well as the symptoms that are related to the patient. It was discovered that more than half of the patients had moderate or severe cognitive impairment. Finally, a study conducted by Bora, Lin, Wood, Yung, McGorry & Pantelis (2014) conducted a meta-analysis of cognitive deficits amongst adolescents. The results of the study concluded that cognitive impairment occurs over time, but the timing of the cognitive decline is unknown.
Results: Several studies have indicated cognitive functioning decline in the prodrome stage of psychosis. Thus, health care may be able to design and implement effective treatment options.
Conclusions: Psychosis is a health concern that affects the lives of individuals. Cognitive functioning is important to study and gain a better understanding of potential causes for decline. Gaining information and knowledge may assist individuals with treatment options as well as guide health professionals. Additional knowledge is essential in this area of psychosis and cognitive functioning in order to be able to assist individuals enhance their health and well-being.
Implications: The understanding that cognitive functioning declining in the prodrome stage of psychosis will provide knowledge for individuals experiencing psychosis, health care professionals, and mental health providers. This knowledge provides an understanding that treatment during the prodrome stage of psychosis is critical in hopes of preventing the decline in cognitive functioning. This information is important for research as it provides additional information on the topic and allows for continuous research in hopes of gathering the most current and accurate information.


Bora, E., & Murray, R. M. (2014). Meta-analysis of Cognitive Deficits in Ultra-high Risk to Psychosis and First-Episode Psychosis: Do the Cognitive Deficits Progress Over, or After, the Onset of Psychosis?. Schizophrenia Bulletin, 40(4), 744.
Bora, E., Lin, A., Wood, S. J., Yung, A. R., McGorry, P. D., & Pantelis, C. (2014). Cognitive deficits in youth with familial and clinical high risk to psychosis: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 130(1), 1-15. doi:10.1111/acps.12261
Boychuk, C., Lysaght, R., & Stuart, H. (2018). Career Decision-Making Processes of Young Adults With First-Episode Psychosis. Qualitative Health Research, 28(6), 1016. doi:10.1177/1049732318761864
Neurocognitive functioning before and after the first psychotic episode: does psychosis result in cognitive deterioration?. (2010). Psychological medicine, (10), 1599. doi:10.1017/s0033291710000048
Nieto, L., Cobo, J., Pousa, E., Blas-Navarro, J., García-Parés, G., Palao, D., & Obiols, J. E. (2012). Insight, symptomatic dimensions, and cognition in patients with acute-phase psychosis. Comprehensive Psychiatry, 53502-508. doi:10.1016/j.comppsych.2011.08.008
Popolo, R., Vinci, G., & Balbi, A. (2010). Cognitive function, social functioning and quality of life in first-episode psychosis: A 1-year longitudinal study. International Journal Of Psychiatry In Clinical Practice, 14(1), 33-40. doi:10.3109/13651500903282881
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