Relative contributions of psychiatric symptoms and neuropsychological functioning to quality of life in first-episode psychosis


  • Signy Wegener,

  • Marie Antoinette Redoblado-Hodge,

  • Sara Lucas,

  • Dianne Fitzgerald,

  • Anthony Harris,

  • John Brennan

  • The Department of Child, Adolescent and Family Psychiatry, Westmead Hospital, PO Box 533, Wentworthville, New South Wales 2145, Australia. Email:

  • Sara Lucas, Clinical Neuropsychologist

  • Department of Medical Psychology, Westmead Hospital, Sydney, Australia

  • Anthony Harris, Psychiatrist

  • Discipline of Psychological Medicine, Brain Dynamics Centre, University of Sydney and the Department of Psychiatry, Westmead Hospital, Sydney, Australia

Signy Wegener, Research Psychologist; Marie Antoinette Redoblado-Hodge, Clinical Neuropsychologist (Correspondence); Dianne Fitzgerald, Clinical Psychologist; John Brennan, Child and Adolescent Psychiatrist


Objective: To report on the relationship between quality of life (QOL), psychiatric symptoms and neuropsychological functioning in a sample of young people who have experienced a first episode of psychosis 2–3 years following initial presentation.

Method: Fifty-one participants aged 15–27 years old completed the short form of the World Health Organization Quality of Life scale (WHOQOL-Brèf), a self-report instrument assessing physical, psychological, social and environmental aspects of QOL. A comprehensive neuropsychological battery was administered. Measures of psychiatric symptoms including depression (as assessed by the Calgary Depression Scale), positive, negative and general psychopathology (as assessed by the Positive and Negative Syndrome Scale) were obtained.

Results: Multiple regression analyses were used to evaluate the ability of neuropsychological measures and psychiatric symptoms to predict QOL. When neuropsychological variables were considered on their own, cognitive flexibility, verbal fluency, verbal ability and sustained attention explained up to 28% of the variance in the four domains of QOL. However, in the presence of psychiatric symptoms, neuropsychological variables were no longer significant predictors for physical and psychological QOL; depression, general psychopathology and negative symptoms together explained up to 43% of the variance in QOL, with neuropsychological variables remaining significant for social and environmental QOL.

Conclusions: In young people with their first episode of psychosis, QOL is more strongly related to levels of psychopathology, particularly depression, than neuropsychological deficits. This finding replicates previous studies in chronic schizophrenia that have suggested QOL is more strongly related to levels of psychopathology than the presence of neuropsychological deficits.