Abstract
History of adversity is associated with subsequent psychosis, and with a spectrum of cognitive alterations in individuals with psychosis. These cognitive features go from neurocognitive aspects as working memory and attention, to complex social cognitive processes as theory of mind and emotional perception. Difficulties in these domains impact patients' social and occupational functioning, which has been shown to be more impaired in those previously exposed to childhood trauma. However, the interplay between adversity, neurocognition, and functioning is yet poorly understood. This narrative review aims to explore the evidence on whether deficits in neurocognitive and social cognitive domains may act as possible putative mechanism linking adversity with functioning in people with psychosis. We show available evidence supporting the link between adversity and poorer functioning in psychosis, especially in chronic stages; and replicated evidence suggesting associations of social cognition and, to a lesser extent, neurocognition with impairment in functioning in patients; although there is still an important gap in the literature testing particularly deficits in social cognition as mediator of the link between adversity and functional decline in psychosis. Targeting interventions focusing on neurocognition and social cognition in individuals with adversity and psychosis seems important, given the severe deterioration of these patients in these domains, although more research is needed to test whether such treatments can specifically improve functioning in individuals with psychosis and adversity. Literature aiming to understand the determinants of functional outcome should consider the pervasive impact of childhood adversity, and its related effects on cognition.
Highlights
Psychotic disorders are among the leading causes of disability worldwide [1] with recovery rates in terms of functional level below 15% of the patients with schizophrenia [2]
As it has been shown in this review and as it can be illustrated in Figure 1, there is consistent evidence suggesting a link between adversity and functioning; between neurocognition, social cognition and functioning, with suggestions that deficits in neurocognition may precede those in social cognition; and some emerging studies suggesting that adversity may be associated with social cognitive deficits in patients
There are solid grounds to suggest that individuals with psychosis and a history of adversity have poorer neurocognitive functions than those without histories of adversity, with emerging evidence suggesting a link between abuse, neglect, and various social cognitive domains in patients with psychosis
Summary
Psychotic disorders are among the leading causes of disability worldwide [1] with recovery rates in terms of functional level below 15% of the patients with schizophrenia [2]. Finding potentially treatable determinants of functional outcome is one of the main goals in schizophrenia research [7, 8] Both Neurocognition and Social Cognition are very important domains in psychosis [9,10,11,12], and such deficits account for the diversity of functional outcomes in the disorder, more effectively than symptoms [7, 13, 14]. A recent systematic review has shown that negative schemas about the self, the world and others mediate considerably the adversity-psychosis association [25] These works have not covered which potential mechanisms may operate on the link between adversity and functional decline in those with psychotic disorder. We will discuss potential clinical implications of current research, as well as methodological issues and gaps in the literature (section Discussion, Future Directions, and Implications)
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