Relationship between cognition and age at onset of first-episode psychosis: comparative study between adolescents, young adults, and adults

November 4, 2021

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Publicated to: EUROPEAN CHILD & ADOLESCENT PSYCHIATRY. 32 (4): 639-649 - 2023-04-01 32(4), DOI: 10.1007/s00787-021-01901-8

Authors:

De la Serna, E; Puig, O; Mezquida, G; Moreno-Izco, L; Merchan-Naranjo, J; Amoretti, S; Ruiz, P; Gonzalez-Pinto, A; Molina-Garcia, M; Corripio, I; Vieta, E; Baeza, I; Berge, D; Penades, R; Sanchez-Torres, A; Cuesta, M J; Bernardo, M; Castro-Fornieles, J

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Affiliations

August Pi i Sunyer Biomedical Research Institute, IDIBAPS, Barcelona, Spain. - Author

Autonomous Univ Barcelona, Hosp Mar Med Res Inst IMIM, Neurosci Grp, Barcelona, Spain - Author

Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain. - Author

Biomed Res Network Ctr Mental Hlth CIBERSAM, Barcelona, Spain - Author

Biomedical Research Network Center for Mental Health (CIBERSAM), Barcelona, Spain. - Author

Biomedical Research Network Center for Mental Health (CIBERSAM), Barcelona, Spain. eserna@clinic.cat. - Author

Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic, Catalonia, Barcelona, Spain. - Author

Complejo Hosp Navarra, Dept Psychiat, Pamplona, Spain - Author

Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clinic of Barcelona, CIBERSAM, 2017SGR881, C/Villarroel, 170, 08036, Barcelona, Spain. - Author

Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clinic of Barcelona, CIBERSAM, 2017SGR881, C/Villarroel, 170, 08036, Barcelona, Spain. eserna@clinic.cat. - Author

Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. - Author

Department of Medicine and Psychiatry, Hospital Clínico Universitario and Instituto de Investigación Sanitaria (IIS), Universidad de Zaragoza, Aragón, Zaragoza, Spain. - Author

Department of Medicine, Neuroscience Institute, University of Barcelona, Barcelona, Spain. - Author

Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain. - Author

Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. - Author

Department of Psychiatry, UPV/EHU, BIOARABA, Vitoria, Spain. - Author

Hosp Clin Barcelona, CIBERSAM, Inst Clin Neurociencies, Dept Child & Adolescent Psychiat & Psychol, 2017SGR881,C Villarroel 170, Barcelona 08036, Spain - Author

Hosp Clin Barcelona, Dept Psychiat & Psychol, Bipolar & Depress Disorders Unit, Barcelona, Spain - Author

Hosp Clin Barcelona, Neurosci Inst, Barcelona Clin Schizophrenia Unit, Barcelona, Spain - Author

Hosp Clin Univ, Dept Med & Psychiat, Zaragoza, Spain - Author

IDIBAPS, August Pi & Sunyer Biomed Res Inst, Barcelona, Spain - Author

Navarra Inst Hlth Res, Complejo Hosp Navarra, Dept Psychiat, Pamplona IdiSNA, Pamplona, Spain - Author

Neuroscience group, Hospital del Mar Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain. - Author

NULL - Author

Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. - Author

School of Psychology, Complutense University, Madrid, Spain. - Author

Univ Autonoma Barcelona UAB, Psychiat Dept, Inst Invest Biomed St Pau IIB SANT PAU, Hosp Santa Creu & St Pau, Barcelona, Spain - Author

Univ Barcelona, Neurosci Inst, Dept Med, Barcelona, Spain - Author

Univ Basque Country, Dept Psychiat, BIOARABA, Vitoria, Spain - Author

Univ Complutense Madrid, Sch Psychol, Madrid, Spain - Author

Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon, Dept Child & Adolescent Psychiat, Hosp Gen, Madrid, Spain - Author

Univ Zaragoza, Inst Invest Sanitaria IIS, Zaragoza, Spain - Author

Abstract

Psychotic disorders typically manifest from late adolescence to early adulthood, and an earlier onset might be associated with greater symptom severity and a worse long-term prognosis. This study aimed to compare the cognitive characteristics of patients with first-episode psychosis (FEP) by their age at onset. We included 298 patients diagnosed with FEP and classified them as having an early onset (EOS), youth onset (YOS), or adult onset (AOS) based on age limits of ≤ 18 years (N = 61), 19-24 years (N = 121), and ≥ 25 years (N = 116), respectively. Socio-demographic and clinical variables included age at baseline, gender, socio-economic status, antipsychotic medication, DSM-IV diagnoses assessed by clinical semi-structured interview, psychotic symptom severity, and age at onset. Neuropsychological assessment included six cognitive domains: premorbid intelligence, working memory, processing speed, verbal memory, sustained attention, and executive functioning. The EOS group had lower scores than the YOS or AOS groups in global cognition, executive functioning, and sustained attention. Although the scores in the YOS group were intermediate to those in the EOS and AOS groups for most cognitive factors, no statistically significant differences were detected between the YOS and AOS groups. Age at onset results in specific patterns of cognitive interference. Of note, impairment appears to be greater with EOS samples than with either YOS or AOS samples. A longitudinal study with a larger sample size is needed to confirm our findings.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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Keywords

1st episodeadolescentsadultsaffective-disorderschildrencognitionexecutive functionindividualsperformancepsychotic disordersriskschizophreniasocioeconomic-statusAdolescentAdolescentsAdultAdultsAge of onsetCognitionHumansLongitudinal studiesNeuropsychological testsOf-onsetPsychotic disordersYoung adult

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal EUROPEAN CHILD & ADOLESCENT PSYCHIATRY due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 6/186, thus managing to position itself as a Q1 (Primer Cuartil), in the category Pediatrics. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 6.85. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Weighted Average of Normalized Impact by the Scopus agency: 5.38 (source consulted: FECYT Mar 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-11, the following number of citations:

WoS: 17
Scopus: 7
Europe PMC: 3

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Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (de la Serna Gómez, Elena) .

the author responsible for correspondence tasks has been de la Serna Gómez, Elena.

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Awards linked to the item

The authors are extremely grateful to all participants. PEPs Study is coordinated by MB and is part of the coordinatedmulticenter project, funded by the Ministerio de Economia y Competitividad (PI08/0208; PI11/00325; PI14/00612), Instituto de Salud Carlos III -Fondo Europeo de Desarrollo Regional. Union Europea. Una manera de hacer Europa, Centro de Investigacion Biomedica en Red de salud Mental, CIBERSAM, by the CERCA Program/Generalitat de Catalunya And Secretaria d'Universitats i Recerca del Departament d'Economia I Coneixement (2017SGR1355, 2017SGR1365; 2017SGR881). Departament de Salut de la Generalitat de Catalunya, Pla Estrategic de Recerca i Innovacio en Salut (PERIS) 2016-2020, modalitat Projectes de recerca orientats a l'atencio primaria, amb el codi d'expedient SLT006/17/00345. MB is also grateful for the support of the Institut de Neurociencies, Universitat de Barcelona. PEPs Group Members-Santiago Madero: Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain, Department of Medicine, Institut de Neurociencies, Universitat de Barcelona, Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, August Pi I Sunyer Biomedical Research Institute-IDIBAPS), Barcelona, Spain; Gerard Anmella: Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain, Department of Medicine, Institut de Neurociencies, Universitat de Barcelona, Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, August Pi I Sunyer Biomedical Research Institute-IDIBAPS), Barcelona, Spain; Renzo Abregu: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Child and Adolescent Psychiatry. Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Maranon, IiSGM; Marta Rapado-Castro: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Child and Adolescent Psychiatry. Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Maranon, IiSGM, School of Medicine, Universidad Complutense; Anna Alonso-Solis: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Psychiatry Department, Institut d'Investigacio BiomedicaSant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autonoma de Barcelona (UAB), Barcelona, Spain; Eva Grasa: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Psychiatry Department, Institut d'Investigacio Biomedica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autonoma de Barcelona (UAB), Barcelona, Spain; Inaki Zorrilla: BIOARABA. Department of Psychiatry. UPV/EHU. Vitoria, Spain; Itxaso Gonzalez-Ortega: BIOARABA. Department of Psychiatry. UPV/EHU. Vitoria, Spain; Pedro Saz: Department of Medicine and Psychiatry. Zaragoza University. Instituto de Investigacion Sanitaria Aragon (IIS Aragon), Zaragoza; Concepcion De-la-Camara: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Medicine and Psychiatry. Zaragoza University. Instituto de Investigacion Sanitaria Aragon (IIS Aragon), Zaragoza; Jose Escarti: Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Psychiatry, Hospital Clinico Universitario de Valencia. Biomedical Research Institute INCLIVA, Valencia, Spain, School of Medicine, Universidad de Valencia, Valencia, Spain; Jon-Inaki Etxeandia-Pradera: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Psychiatry, Hospital Clinico Universitario de Valencia. Biomedical Research Institute INCLIVA, Valencia, Spain; Laura Martinez: Hospital del Mar, Department of Psychiatry; Teresa Legido: Hospital del Mar, Department of Psychiatry, Medical Research Institute (IMIM), Neuroscience group; Maria SagueVilavella: Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic, Barcelona, Catalonia, Spain; Laura Montejo: Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic, Barcelona, Catalonia, Spain; Gisela Sugranyes: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, August Pi I Sunyer Biomedical Research Institute-IDIBAPS), Barcelona, Spain, Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociencies, Hospital Clinic Universitari, Barcelona, Spain. 2017SGR881; Patricia Camprodon-Boadas: Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociencies, Hospital Clinic Universitari, Barcelona, Spain. 2017SGR881, Fundacio Clinic per a la Recerca Biomedica, Barcelona, Spain; Fernando Contreras: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Bellvitge Biomedical Research Institute IDIBELL, Department of Psychiatry-Bellvitge University Hospital, Hospitalet de Llobregat-Barcelona, Spain; Cristina Saiz-Masvidal: Bellvitge Biomedical Research Institute IDIBELL, Department of Psychiatry-Bellvitge University Hospital, Hospitalet de Llobregat-Barcelona, Spain, University of Barcelona, Department of Clinical Sciences-School of Medicine, Barcelona, Spain; Elisa Seijo: Unidad de Hospitalizacion Infanto-Juvenil. Hospital Universitario Central de Asturias (HUCA). Servicio de Salud del Principado de Asturias (SESPA). Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA); Teresa Bobes: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Centro de Salud Mental II de Oviedo, Servicio de Salud del Principado de Asturias (SESPA). Universidad de Oviedo. Instituto de Investigacion Sanitaria del Prin-cipado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (IN-EUROPA); Miguel Gutierrez: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Araba University Hospital, Bioaraba Research Institute, University of the Basque Country (UPV/EHU) Vitoria, Spain; Arantzazu Zabala: Barcelona, Spain. Biomedical Research Networking Center for Mental Health NetworkCIBERSAM, Barcelona, Spain, University of the Basque Country (UPV/EHU), Department of Neurosciences. BioCruces Health Research Institute. Vizcaya, Spain; Roberto Rodriguez-Jimenez: Barcelona, Spain.; Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain, CogPsy Group, Universidad Complutense de Madrid (UCM), Madrid, Spain; Jusdith Usall: Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona; Anna Butllosa: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Institut de Recerca Sant Joan de Deu, Esplugues del Llobregat, Barcelona, Spain; Luis Sanchez-Pastor: Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Salvador Sarro: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain; Edith Pomarol: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain; Angela Ibanez: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Department of Psychiatry, Hospital Universitario Ramon y Cajal, IRYCIS. Universidad de Alcala, Madrid, Spain; Ruth Lorente-Omena: IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Vicente Balanza: Barcelona, Spain. Biomedical Research Networking Center for Mental Health Network-CIBERSAM, Barcelona, Spain, Universidad de Valencia, Valencia, Spain.

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