Cognitive Correlates of Functional Disruption at Psychosis Onset: Unique Relevance of Visual Cognition

<b>Background</b>: Cognitive impairment is a common feature of schizophrenia spectrum disorders and has been associated with functional disruption preceding the onset of psychosis. Understanding how cognitive deficits interact with clinical symptoms and functioning in early psychosis remains challenging. In this study, we aim to investigate whether a distinct "cognitive signature" characterizes functional disruption at the onset of psychosis. <b>Material and Methods</b>: Clinical, cognitive, and functional data were collected from 101 first episode psychosis patients at their first hospitalization. Stepwise regression models were used to identify predictors of global functioning and symptom severity at the time of onset, as well as diagnostic outcomes at discharge. Path analysis was used to explore the relationship among symptom severity, cognition, and functional outcomes. <b>Results</b>: Deficits in visual memory were selectively predictive of lower functioning and higher global symptom severity at the time of psychosis onset. Reduced visual-spatial abilities were also associated with unemployment at the time preceding hospitalization and predicted a non-affective schizophrenia spectrum diagnosis at discharge. Path analysis found that visual memory fully mediated the relationship between negative symptoms and level of functioning. <b>Conclusions</b>: Impairment in visual cognition seems to be uniquely associated with functional impairment and global symptom severity at the onset of psychosis and to mediate the relationship between negative symptoms and functioning. The results might indicate a primary relevance of visual cognitive aspects in marking functional disruption and symptom exacerbation at psychosis onset. This might have implications for early detection and inform treatment plans.