News Reader.info

ABSTRACT 1st episode drug naïve patients with psychosis might be at higher risk for cardiometabolic disturbances which could affect the different cognitive, and executive functions and

domains of social cognition. This study aimed to study the metabolic parameters in 1st episode drug naïve patients with psychosis, to evaluate the relation of these cardiometabolic domains

to the cognitive, executive functions, and social cognition. Socio-demographic characteristics of 150 first episode drug naïve patients with psychosis and 120 matched healthy control groups

were collected. The current study also assessed the cardiometabolic profile and cognitive functions in both groups. Social cognition was examined by Edinburgh Social Cognition Test. The

study revealed a statistically significant difference in parameters of metabolic profile among the studied groups (p < 0.001*), the scores of cognitive and executive tests were

statistically significantly different (p < 0.001*). In addition, the patient's group has lowered scores of domains of social cognition (p < 0.001*). Also, the mean affective

theory of mind was negatively correlated with the conflict cost of the Flanker test (r = -.185* p value = .023). The total cholesterol level (r = − 0.241**, p value = .003) and level of

triglycerides (r = − 0.241**, p value = 0.003) were negatively correlated with the interpersonal domain of social cognition, the total cholesterol level is positively correlated to the total

score of social cognition (r = 0.202*, p value = 0.013). Patients with 1st episode drug naïve psychosis showed disturbed cardiometabolic parameters which have deleterious effects on

cognitive functions and social cognition. SIMILAR CONTENT BEING VIEWED BY OTHERS METABOLIC DISTURBANCES, HEMOGLOBIN A1C, AND SOCIAL COGNITION IMPAIRMENT IN SCHIZOPHRENIA SPECTRUM DISORDERS

Article Open access 06 June 2022 MEDICATION ADHERENCE AND COGNITIVE PERFORMANCE IN SCHIZOPHRENIA-SPECTRUM AND BIPOLAR DISORDER: RESULTS FROM THE PSYCOURSE STUDY Article Open access 25 March

2023 SOCIAL COGNITION ACROSS THE SCHIZOPHRENIA–BIPOLAR DISORDER SPECTRUM Article 24 January 2024 INTRODUCTION First-episode psychosis (FEP) is a severe disabling psychiatric disorder

characterized by psychotic and negative manifestations with cognitive dysfunctions. Its pathophysiology is not fully explained, metabolic abnormalities (MAs) are common comorbidities in

these patients leading to a higher burden of medical diseases and complications. The average life expectancy of men and women with psychosis is, respectively, 15 and 12 years shorter than

for those without psychosis1, in which metabolic and cardiovascular complications are considered crucial concerns2. FEP patients are at increased risk for metabolic and cardiovascular

diseases, including hypertension, type II diabetes mellitus, and coronary artery disease3,4, in which different MAs have been identified as high-risk factors. Moreover, MAs have been linked

to poorer functional consequences5, disturbing quality of life6,7, and non-compliance with psychotropic medications8 in these patients. Previous studies showed that first-episode patients

with psychosis on therapeutic or minimal psychotropic intake usually have a higher prevalence of MAs, including lipid profile dysregulation, reduced uric acid levels, and elevated

homocysteine and prolactin levels in comparison to the healthy population9,10. Studies showed an elevated risk of cardiovascular mortality, 2.5 times higher in individuals with First Episode

Psychosis (FEP) compared to age-matched healthy control11,12. These patients are also four to five times more likely to be smokers13 with a higher risk of developing obesity up to twice

those of the general population14. Also, patients on antipsychotic medications, particularly obesogenic agents such as Olanzapine and Clozapine, can increase weight and elevate blood glucose

and fasting triglycerides levels15,16. However, Zhang et al.17 showed glucose disturbances in first-episode drug-naïve patients with psychosis, concluding that psychotropic is not only the

contributing factor leading to these adverse consequences but also may combine with underlying psychopathology factors, particularly, disturbed glucose homeostasis18, glucose intolerance,

and insulin resistance19. Disturbance of cognitive functions has been commonly described in FEP including attention span20,21, psychomotor speed22,23 mental flexibility24,25, working

memory26,27, and other executive functions28,29. Cognitive dysfunctions are reported during the prodromal stage of psychosis. The previous studies confirmed impaired performance in drug

naïve patients with psychosis compared to healthy individuals including verbal memory, speed of processing, and working memory which were comparable to those reported in

antipsychotic-treated patients27. The researchers concluded that cognitive disturbances might determine the patient's consequences and also combine with prominent functional impairments

in different domains of life including social, occupational, and daily living activities30,31. On the contrary, normal cognitive function is highly associated with better clinical outcomes

in FEP. A systematic review found that cognitive disturbances are associated with negative and disorganized domains of psychotic features rather than positive and depressive ones32. Other

studies showed that patients who have higher cognitive performance might have less severe negative manifestations of a psychotic disorder33,34. In the same vein, there was a relation between

neurocognitive performance and cognitive reserve (CR) which affected the outcomes of FEP35,36,37,38. The evidence that 1st episode psychosis was associated with an activated immune system

is growing, so neuroinflammation has been considered a potential underlying cause of cognitive dysfunctions in those patients39. The researchers concluded that biological causes including

altered neural reward systems and shared genetic loci between diabetes and duration of 1st episode psychosis were evident40. Also, poor health domains including poor diet, sedentary

lifestyle, smoking, and substance use were common in antipsychotic naïve patients41. All the biological causes are associated with a higher rate of overweight/obesity42, higher insulin

resistance, and increased levels of total and low-density lipoprotein cholesterol, and triglycerides43. Social cognition has referred to a dimension including perception, interpretation, and

processing of information for adaptive social contexts44. It is composed of four subdomains: emotional processing which has been defined as the ability to perceive and experience inner

emotions. Theory of mind (ToM) has made the individual attribute and represent the mental states of other people. Social perception has included decoding and interpreting social contexts in

others, and attributional bias has referred to the generalized errors made when people evaluate or try to find reasons for their own and other's behaviors45. Patients with first-episode

psychosis (FEP) have deficits in social cognition46 and metacognition47,48 which include how to think about their own and others' mental experiences49,50. PATIENTS AND METHODS SETTINGS

This study was conducted in Hayat National Hospital, Psychiatry Department, Riyadh, Kingdom of Saudi Arabia. The study was conducted from September 2020 to December 2021. STUDY DESIGN This

current methodological design is a cross-sectional observational case–control study aimed to investigate the metabolic parameters in 1st episode drug naïve psychotic episode, also to study

if those metabolic domains have associations to the cognitive, executive, and social cognitive functions, also to assess the risks of developing the cognitive and social cognition

impairments in these patients. STUDY POPULATION This study was composed of 2 groups: * The case group: a convenience sample of 150 patients of 1st episode drug naïve psychotic disorders

including schizophrenia, schizophreniform, and brief psychotic disorder according to DSM 551. Two expert consultants’ psychiatrists confirmed the diagnosis of patients with psychosis. * A

healthy control group composed of 120 participants of the employees of the Hospital matched with the case group regarding age, educational level, and sex. INCLUSION AND EXCLUSION CRITERIA

All participants of both sexes, with an age range from 18 to 60 years, who can read and write to complete the scales were included in the study. Those that have a history of major

psychiatric disorders, or other serious general medical conditions or are under the effect of psychotropic medications were excluded from the study. METHODS _Sociodemographic and clinical

characteristics_ this included age, sex, residence educational level, marital status, smoking, duration since onset of psychosis, and family history of psychosis. _Positive and negative

symptoms scale_52: The PANSS is a 30-item clinician-administered rating scale. It adapted 12 items from the Psychopathology Rating Schedule (PRS) and 18 items from the Brief Psychiatric

Rating Scale (BPRS). It includes 3 subscales: Positive Scale, Negative Scale, and General Psychopathology Scale. Each item is rated with 1 to 7 points ranging from absent to extreme. The

range for the Positive and Negative Scales is 7–49, and the range for the General Psychopathology Scale is 16–112. _Cognitive and executive assessment_ The Psychology Experiment Building

Language53: The Psychology Experiment Building Language (PEBL) is a free, open-source software system that allows researchers and clinicians to design, run, and share behavioral tests. This

battery included up to 70 cognitive tests, this study used the following tests: A-Eriksen’s Flanker Test54: which was published in 1974, is a set of tests to assess selective attention,

reaction time, and inhibitory function. In this task, the target is positioned in the center and is flanked by nontarget stimuli. The individual is requested to press the left or right arrow

key according to the target’s direction. B-GO /and No-go Test: Go/No-Go testing55: is often used as a component of a behavioral neurological examination to assess inhibitory control,

reaction time, language processing, and selective attention. A classic example is to hold out two fingers, the index and middle fingers (palm down), and say to the examinee: “When I do this

(showing two fingers in the form of a “V”), you do this (showing only the index finger), and when I do this (showing the index finger only), you do this (showing two fingers in the form of a

“V”). C-Simon Test23: this is a task in which participants are required to respond to a non-spatial feature (e.g. color, shape) of a lateralized stimulus by pressing one of two response

buttons that are lateralized in the same spatial arrangement. Although stimulus position is irrelevant to task performance, the reaction time (RT) is longer when the response side is

spatially incompatible with the stimulus position (incompatible stimulus–response (S-R) mappings) than in trials that require an ipsilateral response relative to stimulus position

(compatible S-R mappings). D-Tower of London Test (TOL)56: In the computerized version of the ToL the goal state is presented in the upper field of the screen. To match the goal

configuration, the participants operate on the start state in the lower half of the screen by using a computer mouse to move the balls. Participants were told to transform the start state

into the goal state in a predetermined minimum number of moves while following three rules:1 only one ball may be moved at a time, (2) a ball in the lower row cannot be moved when another

ball is lying above, and (3) three balls may be placed on the tallest peg, two balls on the middle peg, and one ball on the shortest peg. TOL is used to assess strategy, problem-solving,

color processing, hand–eye coordination, and fine Motor Skills. _Social Cognitive assessment_ by the Edinburgh Social Cognition Test57, The Edinburgh Social Cognition Test (ESCoT) measures

four social cognitive abilities: cognitive Theory of Mind; affective Theory of Mind; interpersonal understanding of social norms, and intrapersonal understanding of social norms. It consists

of 11 dynamic, cartoon-style social interactions (each approximately 30 s long): 1 practice interaction, 5 interactions involving a social norm violation, and 5 portray everyday

interactions that do not involve social norm violations. Each animation has a different context and specific questions relating to that context. The animations will run on most media

players, but we recommend VLC due to ease of use. Each question is awarded a maximum of 3 points, resulting in a score of 12 points for each social interaction. The total maximum score for

each subtest is 30 while the total score is out of 120. _Laboratory assessment of metabolic markers_ This was done to both groups (patients and control) by enzyme-linked immunosorbent assay

(ELISA). We used the modified definition of the WHO criteria58, consisting of hyperinsulinemia (the upper fourth of the fasting insulin level among nondiabetic subjects) or hyperglycemia

(fasting glucose ≥ 110 mg/dl) in addition to at least two of the following: waist girth ≥ 94 cm, dyslipidemia (triglycerides ≥ 150 mg/dl or HDL cholesterol ˂40 mg/dl), or BP ≥ 140/90 mmHg or

taking BP medication. Waist circumference was measured by a tape at the central point between the lowest front rib and the highest front point of the pelvis on light clothing. The metabolic

profile was determined using routine standardized laboratory methods. Lipid profile, blood glucose, and HbA1C samples were taken after 12 h of fasting at 9 a.m. Also, the body mass index

was assessed by body weight in Kilograms divided by height on a meter square. ETHICAL CONSIDERATION * A) Institutional Review Board approval of the local ethical committee of Hayat National

Hospital, Riyadh, Kingdom of Saudi Arabia was taken to conduct this study and all the steps were in parallel with the Declaration of Helsinki (Reference No: HNH, 132-10-2020) * B) Informed

consent was obtained from all participants after a full explanation of the aim of the study. * C) Patients confirmed the confidentiality of their data collected and that they were able to

withhold from the study at any time without giving reasons. STATISTICAL ANALYSIS Data were fed to the computer and analyzed using SPSS59,60. Statistics for Windows, Version 22.0. Armonk, NY:

IBM Corp. Qualitative data were described using numbers and percentages. Quantitative data were described using median (minimum and maximum) and mean, and standard deviation for parametric

data after testing normality using the Kolmogrov-Smirnov test. The significance of the obtained results was judged at the (0.05) level. DATA ANALYSIS QUALITATIVE DATA Chi-Square and Monte

Carlo tests for comparison of 2 or more groups. QUANTITATIVE DATA BETWEEN GROUPS PARAMETRIC TESTS Student t-test was used to compare 2 independent groups. SPEARMAN'S CORRELATION

Spearman's rank-order correlation is used to determine the strength and direction of a linear relationship between two non-normally distributed continuous variables and/or ordinal

variables. _Binary stepwise logistic regression_ analysis was used for the prediction of independent variables of a binary outcome. Significant predictors in the Univariate analysis were

entered into the regression model using the forward Wald method /Enter. Adjusted odds ratios and their 95% confidence interval were calculated. _Linear regression analysis_ was used for the

prediction of independent variables of the continuous parametric outcome. Significant predictors in the correlation were entered into the regression model with the calculation of R2 the

quantity effect of combined variables on the desired outcome and the prediction equation (Y = β + a*x). INFORMED CONSENT Informed consent was obtained from all participants after a full

explanation of the aim of the study. APPROVAL OF THE RESEARCH PROTOCOL BY THE INSTITUTIONAL REVIEWER BARD Institutional Review Board approval was taken to conduct this study and all the

steps were in parallel with the Declaration of Helsinki (Reference No: HNH,132-10-2020). RESULTS The sociodemographic and clinical characteristics are illustrated in Table 1 in which the

number of cases was 150 while the control group was 120, the mean age of the cases was (31.86 SD ± 9.06), 103 (68.7%) of the cases were males while 47 (31.3%) were females. the mean age of

the control was (33.79 ± 8.77), 85 (70.8) of the control group were males while 35 (29.2) were females. There was a statistically significant difference between the studied groups regarding

the employment status (p < 0.001), also the smoking status was of significant difference between the cases and control groups (p < 0.001). The family history of psychosis was in 73

cases (48.7%). The results of the PANSS test for the studied cases group were illustrated in the Table 2 in which the mean positive domain was 41.96 SD ± 3.28, the mean negative domain of

PANSS was 43.73 ± 3.21, while the mean general domain was 97.16 ± 7.46 and the mean global score ± SD, it was 182.85 ± 9.16. Physical findings and cardiometabolic parameters in the studied

groups: The physical findings and the cardiometabolic parameters between the studied groups were illuminated in a Table 3 in which all findings were of statistical significance (p˂0.001).

BMI (t = 17.71. p < 0.001) and mean waist circumference (t = 16.70, p < 0.001) were of statistical significance. Also, both SBP (t = 20.88, p < 0.001) and DBP (t = 22.14, p < 

0.001) were of statistically significant difference. Total cholesterol, TGS, LDL, and HDL were evident as shown in Table 3. The cases had higher levels of RBG (t = 26.38, p < 0.001) and

HBA1C (t = 14.40 p < 0.001) than the control group. Table 4 illustrated the cognitive and executive tests in which all its compared items were of statistical significance (p < 0.001),

the flanker test in which the cases have more total errors than the control group (t = 33.6 p < 0.001). Go/and No go test including all domains was significant between studied groups (p 

< 0.001), Fewer correct answers of the Simon test was in the cases group than in control one (t = 40.18 p < 0.001), and more incorrect answers (t = 40.30 p < 0.001). The patients

had slow total moves (t = 34.76 p < 0.001) and total time(t = 16.15 p < 0.001) of Tower of London. The domains of social cognition of the studied groups were described in Table 5.in

which the cases group has the defective cognitive theory of mind (t = 56.91 p < 0.001), and impaired affective theory of mind (t = 65.48 p < 0.001). The cases group had more impaired

interpersonal (t = 68.81 p < 0.001) than the control group. The intrapersonal understanding of social norms was significant in the studied groups (t = 69.71 p < 0.001). Table 6 showed

that the mean affective theory of mind is negatively correlated with the conflict cost of the Flanker test (r = − 0.185* p value = 0.023). Table 7 illustrated that the elevated levels of

total cholesterol (r = − 0.241**, p value = 0.003), and triglycerides (r = − 0.207*, p value = 0.011) had a negative correlation to the score of the interpersonal domain of social cognition

Also, the elevated total cholesterol is positively correlated to the total score of social cognition (r = 0.202*, p value = 0.013). The binary logistic regression was illustrated in the

Table 8 in which the prediction of the risk factors in the studied cases of 1st episode psychosis in which unemployment (β = 1.049, p-value < 0.001*, odds ratio (95% CI) 2.85 (1.69–4.80),

smoking (β = 1.11, p-value < 0.001*, odds ratio (95% CI) 3.03 (1.79–5.12) were associated with the outcome. BMI (kg/m2) (β = 0.440, p-value 0.005*odds ratio (95% CI) 1.55 (1.14–2.11),

Waist circumference/cm (β = 0.352, P-value 0.006*odds ratio (95% CI) 1.42 (1.10–1.83) which were 2 parameters of metabolic assessment represent predictive factors of social cognition in

those patients. In the same vein, Diastolic Blood Pressure (mm/HG) (β = 0.301, p-value 0.015* odds ratio (95% CI) 1.35 (1.06–1.72), total cholesterol (β = 0.219, p-value 0.003* odds ratio

(95% CI) 1.24 (1.08–1.44), Low-Density Lipoprotein (β = 0.189, p-value 0.01* odds ratio (95% CI) 1.20 (1.04–1.39) were predictors of social cognition in 1st episode patients with psychosis.

Also, the reaction times of the Simon test (β = 0.002, p-value 0.998, odds ratio (95% CI) 1.002), the total score of Social cognition (β = − 0.722, p-value 1.0, odds ratio (95% CI) 0.486),

the total reaction time of Tower of London (β = 0.004, p-value 1.0, odd ratio (95% CI) 1.004) and total errors of Flanker test (β = 0.209, p-value 1.0, odds ratio (95% CI) 1.232) were

predictive factors of social cognition in the cases group. DISCUSSION This study aimed to evaluate the metabolic parameters in patients with 1st episode psychotic disorders and the

relationship between these parameters and cognitive, executive functions, and social cognition. Laboratory evaluation was done for assessment of the lipid profile, glycemic status, central

obesity, and blood pressure among the patients with psychotic features and the healthy control group. This study revealed that smoking was common in the patients with 1st episode psychosis

which was in parallel with61,62 who noted the smoking prevalence in their studies samples was (55%) and, in another study it was smoking was 47% observed in FEP63, but is considerably lower

than the more recent, Gaughran et al.64 and Manzella et al.65 studies which revealed much higher rates of cigarette smoking (76.8% and 78% respectively) in FEP patients. These higher rates

of smoking in FEP were compared to rates of 19%– 21% in the age-matched general population. The patients with 1st episode psychosis had a higher level of BMI/central obesity, abdominal

adiposity, elevated blood pressure, and higher lipid profile including cholesterol, TGS, LDL, and lower HDL which reflected the cardiometabolic parameters in 1st episode psychosis66,67.

Also, of the patients with FEP, 58% of them had dyslipidemia, 40% had hypertriglyceridemia, and 30% of participants met the criteria of metabolic syndrome, also high triglycerides, typically

elevated in FEP, are a precursor for T2DM67. Hypertension and blood glucose harm the immediate and recognition memory domains of cognitive functions68. Waist circumference as a parameter of

assessment of obesity per se was negatively correlated with impairment in different cognitive domains including processing speed, attention, working memory, and reasoning which was noted in

a previous similar study69. The patients of 1st episode psychotic disorders had worse scores on multiple cognitive tests which were in line with previous studies that noted cognitive

impairments in the drug naïve patients with psychosis70,71,72. In the same vein, the results of the study are in parallel with the studies73 that found a significant negative correlation

between cognitive functions and triglycerides which was associated with poorer working memory in FEP. Also, the cognitive performance of a patient with first-episode psychotic features

particularly cognitive flexibility, attention, memory, and current IQ was negatively associated with the domains of physical health, including body mass index (BMI) and waist

circumference74,75. On the other hand, the metabolic changes were more commonly reported in chronic schizophrenic patients than in 1st episode psychotic ones which were attributed to the

metabolic derangements caused by the effects of antipsychotic medications on the metabolic profiles and glycemic status76. As other authors have illustrated, cognitive functions may not be

associated with cardiometabolic parameters, and the impairment of cognitive functions occurred only with severe disturbance of glucose metabolism and predisposition to diabetes mellitus77.

On the contrary, other studies78 revealed no relation between cognitive performance including working memory, attention, strategic planning, and the different metabolic parameters especially

the random blood glucose and HBA1C which represented crucial determinants of Diabetes Mellitus. Previous studies concluded that FEP patients showed impairments in different domains of

social cognitive functions including TOM, and interpersonal and intrapersonal understanding79,80,81. Also, the results of82,83 confirmed our results that lower scores of domains of social

cognition were positively correlated to deteriorated performance on cognitive and neuropsychological tests which reflected on attention, memory, planning, decision-making, and mental

flexibility. The scores of social cognitions in patients with psychosis including the theory of mind, interpersonal domain, and the total score were inversely correlated to HBA1C and random

blood glucose84. The level of triglycerides, cholesterol, BMI, and waist circumference as metabolic parameters were negatively correlated to the different domains of social cognition

including TOM which were in line with a similar study but it was conducted on the schizophrenia spectrum disorders85. On the other point of view, other studies86,87,88 found no statistically

significant differences between the mean scores of different subdomains of social cognitive battery in FEP patients and healthy controls. On the contrary89, found in their studies that

there was no correlation between the different domains of the metabolic profile including waist circumference, lipid profile, blood pressure, and glycemic status with the subdomains of

social cognition. A multiple linear regression analysis was conducted and showed that cognitive tests and social cognition were correlated with BMI, waist circumference total cholesterol,

DBP, and TG. These findings were in line with previous studies that random blood glucose and blood pressure levels were significantly associated with cognitive and social cognition

disturbance in processing speed, verbal learning, visual learning, and executive ability in 1st episode patients with psychosis90,91,92. CONCLUSIONS In conclusion, the metabolic profile in

1st episode patients with psychosis showed disturbance of physical health, lipid profile, blood pressure, and glycemic status. Also, the cardiometabolic parameters have an association with

cognitive and social cognition. STUDY LIMITATIONS The study needs a greater number of cases for generalization of the results, also the assessment was done once at the initial phase of the

disorder, more frequent evaluation will be needed after initiation of the medication and implementation of a healthy lifestyle to assess their effects on cognitive functions and social

cognition. DATA AVAILABILITY The data are available upon request from the corresponding author. ABBREVIATIONS * APA: American Psychiatric Association * BMI: Body mass index * BPRS: Brief

Psychiatric Rating Scale * CR: Cognitive reserve * DBP: Diastolic blood pressure * ELIZA: Enzyme-linked immunosorbent assay * ESCoT: Edinburgh Social Cognition Test * FEP: First episode

psychosis * HDL: High-density lipoprotein * LDL: Low-density lipoprotein * MAs: Metabolic abnormalities * PANSS: Positive and negative symptoms scale * PRS: Psychopathology Rating Schedule *

RBG: Random blood glucose * SBP: Systolic blood pressure * TGs: Triglycerides * TOL: Tower of London * TOM: Theory of mind REFERENCES * Crump, C., Winkleby, M. A., Sundquist, K. &

Sundquist, J. Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. _Am. J. Psychiatry_ 170, 324–333. https://doi.org/10.1176/appi.ajp.2012.120505992-

(2013). Article  PubMed  Google Scholar  * Casey, D. E. Metabolic issues and cardiovascular disease in patients with psychiatric disorders. _Am. J. Med. Suppl._ 118, 15–22.

https://doi.org/10.1016/j.amjmed.2005.01.046 (2005). Article  Google Scholar  * Mitchell, A. J. _et al._ Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and

related disorders: A systematic review and meta-analysis. _Schizophr. Bull._ 39, 306–318. https://doi.org/10.1093/schbul/sbr148 (2013). Article  PubMed  Google Scholar  * Vancampfort, D. _et

al._ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: A systematic review and

meta-analysis. _World Psychiatry_ 14, 339–347. https://doi.org/10.1002/wps.20252 (2015). Article  PubMed  PubMed Central  Google Scholar  * Vancampfort, D. _et al._ Association of the

metabolic syndrome with physical activity performance in patients with schizophrenia. _Diabetes Metab._ 37, 318–323. https://doi.org/10.1016/j.diabet.2010.12.007 (2011). Article  CAS  PubMed

  Google Scholar  * De Hert, M. _et al._ Body weight and self-esteem in patients with schizophrenia evaluated with B-WISE R. _Schizophr. Res._ 88, 222–226.

https://doi.org/10.1016/j.schres.2006.07.025 (2006). Article  PubMed  Google Scholar  * Vancampfort, D. _et al._ Lack of physical activity during leisure time contributes to an impaired

health related quality of life in patients with schizophrenia. _Schizophr. Res._ 129, 122–127. https://doi.org/10.1016/j.schres.2011.03.0 (2011). Article  PubMed  Google Scholar  * Weiden,

P. J., Mackell, J. A. & McDonnell, D. D. Obesity as a risk factor for antipsychotic noncompliance. _Schizophr Res._ 66, 51–57. https://doi.org/10.1016/S0920-9964(02)00498-X (2004).

Article  PubMed  Google Scholar  * Misiak, B. _et al._ Lipid profile disturbances in antipsychotic-naive patients with first-episode non-affective psychosis: A systematic review and

meta-analysis. _Schizophr. Res._ 190, 18–27. https://doi.org/10.1016/j.schres.2017.03.031 (2017). Article  PubMed  Google Scholar  * González-Blanco, L. _et al._ Prolactin concentrations in

antipsychotic-naive patients with schizophrenia and related disorders: A meta-analysis. _Schizophr. Res._ 174, 156–160. https://doi.org/10.1016/j.schres.2016.03.018 (2016). Article  PubMed 

Google Scholar  * Brown, S., Kim, M., Mitchell, C. & Inskip, H. Twenty-five year mortality of a community cohort with schizophrenia. _Br. J. Psychiatry_ 196, 116–121.

https://doi.org/10.1192/bjp.bp.109.067512 (2010). Article  PubMed  PubMed Central  Google Scholar  * Westman, J. _et al._ Increased cardiovascular mortality in people with schizophrenia: A

24-year national register study. _Epidemiol. Psychiatr. Sci._ 27(5), 519–527. https://doi.org/10.1017/S2045796017000166 (2018). Article  CAS  PubMed  Google Scholar  * Myles, N. _et al._

Tobacco use before, at, and after first-episode psychosis: A systematic meta-analysis. _J. Clin. Psychiatry_ 73, 468–475. https://doi.org/10.4088/JCP.11r07222 (2012). Article  PubMed  Google

Scholar  * De Hert, M. _et al._ Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the

European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). _Eur. Psychiatry._ 24(6), 412–424. https://doi.org/10.1016/j.eurpsy.2009.01.005 (2009).

Article  PubMed  Google Scholar  * Curtis, J. _et al._ Metabolic abnormalities in an early psychosis service: A retrospective, naturalistic crosssectional study. _Early Interv. Psychiatry._

5, 108–114. https://doi.org/10.1111/j.1751-7893.2011.00262.x (2011). Article  PubMed  Google Scholar  * De Hert, M., Detraux, J., van Winkel, R., Yu, W. & Correll, C. U. Metabolic and

cardiovascular adverse effects associated with antipsychotic drugs. _Nat. Rev. Endocrinol._ 8, 114–126. https://doi.org/10.1038/nrendo.2011.156 (2012). Article  CAS  Google Scholar  * Zhang,

X. Y. _et al._ Glucose disturbances in first-episode drug-naïve schizophrenia: Relationship to psychopathology. _Psychoneuroendocrinology_ 62, 376–438.

https://doi.org/10.1016/j.psyneuen.2015.09.005 (2015). Article  CAS  PubMed  Google Scholar  * Pillinger, T., Beck, K., Stubbs, B. & Howes, O. D. Cholesterol and triglyceride levels in

first-episode psychosis: Systematic review and meta-analysis. _Br. J. Psychiatry_ 211(6), 339–349. https://doi.org/10.1192/bjp.bp.117.200907 (2017). Article  PubMed  PubMed Central  Google

Scholar  * Perry, B. I., McIntosh, G., Weich, S., Singh, S. & Rees, K. The association between firstepisode psychosis and abnormal glycaemic control: Systematic review and meta-analysis.

_Lancet Psychiatry_ 3(11), 1049–1058. https://doi.org/10.1016/S2215-0366(16)30262-0 (2016). Article  PubMed  Google Scholar  * Lee, J. _et al._ The effects of age and sex on cognitive

impairment in schizophrenia: Findings from the consortium on the genetics of schizophrenia (COGS) study. _PLoS ONE_ 15, e0232855 (2020). Article  CAS  PubMed  PubMed Central  Google Scholar

  * Atake, K. _et al._ The impact of aging, psychotic symptoms, medication, and brain-derived neurotrophic factor on cognitive impairment in Japanese chronic schizophrenia patients. _Front.

Psychiatry_ 9, 232 (2018). Article  PubMed  PubMed Central  Google Scholar  * Li, A. W. Y. _et al._ Gender differences in correlates of cognition in first-episode psychosis. _Psychiatry

Res._ 271, 412–420 (2019). Article  PubMed  Google Scholar  * Leuthold, H. The Simon effect in cognitive electrophysiology: A short review. _Acta Psychol._ 136, 203–211 (2011). Article 

Google Scholar  * Navarra-Ventura, G. _et al._ Gender differences in social cognition: A crosssectional pilot study of recently diagnosed patients with schizophrenia and healthy subjects.

_Can. J. Psychiatr._ 63, 538–546 (2018). Article  Google Scholar  * Green, M. F., Horan, W. P. & Lee, J. Nonsocial and social cognition in schizophrenia: Current evidence and future

directions. _World Psychiatry_ 18, 146–161 (2019). Article  PubMed  PubMed Central  Google Scholar  * Guo, J. Y., Ragland, J. D. & Carter, C. S. Memory and cognition in schizophrenia.

_Mol. Psychiatry_ 24, 633–642. https://doi.org/10.1038/s41380-018-0231-1 (2019). Article  CAS  PubMed  Google Scholar  * Fatouros-Bergman, H., Cervenka, S., Flyckt, L., Edman, G. &

Farde, L. Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. _Schizophr. Res._ 158, 156–162. https://doi.org/10.1016/j.schres.2014.06.034 (2014). Article 

PubMed  Google Scholar  * Sheffield, J. M., Karcher, N. R. & Barch, D. M. Cognitive deficits in psychotic disorders: A lifespan perspective. _Neuropsychol. Rev._ 28, 509–533.

https://doi.org/10.1007/s11065-018-9388-2 (2018). Article  PubMed  PubMed Central  Google Scholar  * Dickson, H. _et al._ Academic achievement and schizophrenia: A systematic meta-analysis.

_Psychol. Med._ 50, 1949–1965. https://doi.org/10.1017/S0033291720002354 (2020). Article  PubMed  Google Scholar  * Carrion, R. E. _et al._ From the psychosis prodrome to the first-episode

of psychosis: No evidence of a cognitive decline. _J. Psychiatr. Res._ 96, 231–238 (2018). Article  PubMed  Google Scholar  * van Winkel, R. _et al._ The association between cognition and

functional outcome in frst-episode patients with schizophrenia: Mystery resolved?. _Acta Psychiatr. Scand._ 116(2), 119–124 (2007). Article  PubMed  Google Scholar  * Hall, M. H., Holton, K.

M., Ongür, D., Montrose, D. & Keshavan, M. S. Longitudinal trajectory of early functional recovery in patients with frst episode psychosis. _Schizophr. Res._ 209, 234–244 (2019).

Article  PubMed  PubMed Central  Google Scholar  * Dominguez, M. G., Viechtbauer, W., Simons, C. J., van Os, J. & Krabbendam, L. Are psychotic psychopathology and neurocognition

orthogonal? A systematic review of their associations. _Psychol. Bull._ 135(1), 157–171 (2009). Article  PubMed  Google Scholar  * Allott, K., Liu, P., Profftt, T. M. & Killackey, E.

Cognition at illness onset as a predictor of later functional outcome in early psychosis: Systematic review and methodological critique. _Schizophr. Res._ 125(2–3), 221–235 (2011). Article 

PubMed  Google Scholar  * Rodríguez-Sanchez, J. M. _et al._ Course of cognitive defcits in frst episode of non-affective psychosis: A 3-year follow-up study. _Schizophr. Res._ 150(1),

121–128 (2013). Article  PubMed  Google Scholar  * De la Serna, E. _et al._ Cognitive reserve as a predictor of two year neuropsychological performance in early onset frst-episode

schizophrenia. _Schizophr. Res._ 143(1), 125–131 (2013). Article  PubMed  Google Scholar  * Anaya, C. _et al._ Cognitive reserve in bipolar disorder: Relation to cognition, psychosocial

functioning and quality of life. _Acta Psychiatr. Scand._ 133(5), 386–398 (2016). Article  CAS  PubMed  Google Scholar  * Amoretti, S. _et al._ The impact of cognitive reserve in the outcome

of first episode psychoses: 2-year follow-up study. _Eur. Neuropsychopharmacol._ 26(10), 1638–1648 (2016). Article  CAS  PubMed  Google Scholar  * Fourrier, C., Singhal, G. & Baune, B.

T. Neuroinflammation and cognition across psychiatric conditions. _CNS Spectr._ 24, 4–15 (2019). Article  PubMed  Google Scholar  * Foley, D. L. & Morley, K. I. Systematic review of

early cardiometabolic outcomes of the first treated episode of psychosis. _Arch. Gen. Psychiatry_ 68(6), 609–616 (2011). Article  PubMed  Google Scholar  * Shah, P. _et al._ Alterations in

body mass index and waist-to-hip ratio in never and minimally treated patients with psychosis: A systematic review and meta-analysis. _Schizophr. Res._ 208, 420–429 (2019). Article  PubMed 

Google Scholar  * Kolenic, M. _et al._ Obesity, dyslipidemia and brain age in firstepisode psychosis. _J. Psychiatr. Res._ 99, 151–158 (2018). Article  PubMed  Google Scholar  * Keinanen, J.

_et al._ Low-grade inflammation in first-episode psychosis is determined by increased waist circumference. _Psychiatry Res._ 270, 547–553 (2018). Article  PubMed  Google Scholar  *

Amoretti, S. _et al._ Cognitive reserve as an outcome predictor: First-episode affective versus nonaffective psychosis. _Acta Psychiatr. Scand._ 138(5), 411–455 (2018). Article  Google

Scholar  * Green, M. F., Horan, W. P. & Lee, J. Nonsocial and social cognition in schizophrenia: current evidence and future directions. _World Psychiatry_ 18, 146 (2019). Article 

PubMed  PubMed Central  Google Scholar  * Tikka, D. L., Singh, A. R. & Tikka, S. K. Social cognitive endophenotypes in schizophrenia: A study comparing first episode schizophrenia

patients and individuals at clinical- and familial- ‘at-risk’ for psychosis. _Schizophr. Res._ 215, 157–166 (2020). Article  PubMed  Google Scholar  * Healey, K. M., Bartholomeusz, C. F.

& Penn, D. L. Deficits in social cognition in first episode psychosis: A review of the literature. _Clin. Psychol. Rev._ 50, 108–137 (2016). Article  PubMed  Google Scholar  * Vohs, J.

L. _et al._ Metacognition, social cognition, and symptoms in patients with first episode and prolonged psychoses. _Schizophr. Res._ 153, 54–59 (2014). Article  CAS  PubMed  Google Scholar  *

Moritz, S. & Lysaker, P. H. Metacognition research in psychosis: Uncovering and adjusting the prisms that distort subjective reality. _Schizophr. Bull._ 45, 17–18 (2018). Article 

PubMed  PubMed Central  Google Scholar  * Lysaker, P. H. _et al._ Depression and insight in schizophrenia: Comparisons of levels of deficits in social cognition and metacognition and

internalized stigma across three profiles. _Schizophr. Res._ 148, 18–23 (2013). Article  PubMed  Google Scholar  * American Psychiatric Association. _Diagnostic and Statistical Manual of

Mental Disorder_ 5th edn. (American Psychiatric Association, 2013). Book  Google Scholar  * Kay, S. R., Fiszbein, A. & Opler, L. A. The positive and negative syndrome scale (PANSS) for

schizophrenia. _Schizophr. Bull._ 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261 (1987). Article  CAS  PubMed  Google Scholar  * Mueller, S. T. & Piper, B. J. The psychology

experiment building language (PEBL) and PEBL test battery. _J. Neurosci. Methods_ 222, 250–259. https://doi.org/10.1016/j.jneumeth.2013.10.024 (2014). Article  PubMed  Google Scholar  *

Eriksen, B. A. & Eriksen, C. W. Effects of noise letters upon identification of a target letter in a non-search task. _Percept. Psychophys._ 16, 143–149 (1974). Article  Google Scholar 

* Gomez, P., Ratcliff, R. & Perea, M. A model of the go/no-go task. _J. Exp. Psychol. Gen._ 136(3), 389–413. https://doi.org/10.1037/0096-3445.136.3.389 (2007). Article  PubMed  PubMed

Central  Google Scholar  * Unterrainer, J. M. _et al._ Planning abilities and the Tower of London: Is this task measuring a discrete cognitive function?. _J. Clin. Exp. Neuropsychol._ 26(6),

846–856. https://doi.org/10.1080/13803390490509574 (2004). Article  CAS  PubMed  Google Scholar  * Baksh, R. A., Abrahams, S., Auyeung, B. & MacPherson, S. E. The Edinburgh Social

Cognition Test (ESCoT): Examining the effects of age on a new measure of theory of mind and social norm understanding. _PLoS ONE_ 13(4), e0195818 (2018). Article  PubMed  PubMed Central 

Google Scholar  * Parikh, R. M. & Mohan, V. Changing definitions of metabolic syndrome. _Indian J. Endocrinol. Metab._ 16(1), 7–12. https://doi.org/10.4103/2230-8210.91175 (2012).

Article  PubMed  PubMed Central  Google Scholar  * Corp, I. B. M. _IBM SPSS Statistics for Windows. Version 22.0_ (IBM Corp, 2013). Google Scholar  * Balkau, B. & Charles, M. A. Comment

on the provisional report from the WHO consultation: European Group for the Study of Insulin Resistance (EGIR) (Letter). _Diabet. Med._ 16, 442–443 (1999). Article  CAS  PubMed  Google

Scholar  * Hahn, L. A. _et al._ Counting up the risks: How common are risk factors for morbidity and mortality in young people with psychosis?. _Early Interv. Psychiatry_ 12(6), 1045–1051.

https://doi.org/10.1111/eip.12406 (2018). Article  PubMed  Google Scholar  * Lally, J. _et al._ Tobacco smoking and nicotine dependence in first episode and established psychosis. _Asian J.

Psychiatr._ 43, 125–131. https://doi.org/10.1016/j.ajp.2019.05.002 (2019). Article  PubMed  Google Scholar  * Mitchell, A. J., Vancampfort, D., DeHerdt, A., Yu, W. & De Hert, M. Is the

prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated andtreated patients. _Schizophr. Bull._

39, 295–305. https://doi.org/10.1093/schbul/sbs082 (2013). Article  PubMed  Google Scholar  * Gaughran, F. _et al._ Effect of lifestyle, medication and ethnicity on cardiometabolic risk in

the year following the first episode of psychosis: prospective cohort study. _Br J Psychiatry_ 215(6), 712–719. https://doi.org/10.1192/bjp.2019.159 (2019). Article  PubMed  PubMed Central 

Google Scholar  * Manzella, F., Maloney, S. E. & Taylor, G. T. Smoking in schizophrenic patients: A critique of the self-medication hypothesis. _World J. Psychiatry._ 5, 35–46.

https://doi.org/10.5498/wjp.v5.i1.35 (2015). Article  PubMed  PubMed Central  Google Scholar  * Health Survey for England 2015. _Adult and Overweight and Obesity_. NHS Digital.

https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/health-survey-for-england-2015 (Accessed December 30, 2021) * Vancampfort, D. _et al._ Risk of

metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: A systematic review and meta-analysis.

_World Psychiatry_ 14(3), 339–347. https://doi.org/10.1002/wps.20252 (2015). Article  PubMed  PubMed Central  Google Scholar  * Lindenmayer, J. P. _et al._ Relationship between metabolic

syndrome and cognition in patients with schizophrenia. _Schizophr Res._ 142, 171–176 (2012). Article  PubMed  Google Scholar  * Pillinger, T. _et al._ Impaired glucose homeostasis in

first-episode schizophrenia: A systematic review and meta-analysis. _JAMA Psychiat._ 74(3), 261–269. https://doi.org/10.1001/jamapsychiatry.2016.3803 (2017). Article  Google Scholar  *

Zhang, X. _et al._ Glucose disturbances, cognitive deficits and white matter abnormalities in first-episode drug-naive schizophrenia. _Mol. Psychiatry_ 25, 3220–3230.

https://doi.org/10.1038/s41380-019-0478-1 (2019). Article  CAS  PubMed  Google Scholar  * Heald, A. _et al._ Lifestyle factors and the metabolic syndrome in schizophrenia: A cross-sectional

study. _Ann. General Psychiatry._ 16, 12 (2017). Article  Google Scholar  * Zilliox, L. A., Chadrasekaran, K., Kwan, J. Y. & Russell, J. W. Diabetes and cognitive impairment. _Curr.

Diab. Rep._ 16, 87. https://doi.org/10.1007/s11892-016-0775-x (2016). Article  CAS  PubMed  PubMed Central  Google Scholar  * Lystad, J. U. _et al._ The MATRICS consensus cognitive battery

(MCCB): Performance and functional correlates. _Psychiatry Res._ 220, 1094–1101 (2014). Article  PubMed  Google Scholar  * McCleery, A. _et al._ Cognitive functioning in first-episode

schizophrenia: MATRICS consensus cognitive battery (MCCB) profile of impairment. _Schizophr. Res._ 157, 33–39 (2014). Article  CAS  PubMed  PubMed Central  Google Scholar  *

Rodriguez-Jimenez, R. _et al._ MCCB cognitive profile in spanish first episode schizophrenia patients. _Schizophr. Res._ 211, 88–92 (2019). Article  CAS  PubMed  Google Scholar  * Dye, L.,

Boyle, N. B., Champ, C. & Lawton, C. The relationship between obesity and cognitive health and decline. _Proc. Nutr. Soc._ 76(4), 443–454 (2017). Article  PubMed  Google Scholar  * Gray,

J. C., Schvey, N. A. & Tanofsky-Kraff, M. Demographic, psychological, behavioural, and cognitive correlates of BMI in youth: Findings from the adolescent brain cognitive development

(ABCD) study. _Psychol. Med._ 50(9), 1539–1547 (2020). Article  PubMed  Google Scholar  * Steenbergen, L. & Colzato, L. S. Overweight and cognitive performance: High body mass index is

associated with impairment in reactive control during task switching. _Front. Nutr._ 4, 51 (2017). Article  PubMed  PubMed Central  Google Scholar  * Chen, D. _et al._ Impaired glucose

tolerance in first-episode drug-naive patients with schizophrenia: Relationships with clinical phenotypes and cognitive deficits. _Psychol. Med._ 46(15), 3219–3230 (2016). Article  CAS 

PubMed  Google Scholar  * Rocca, P. _et al._ Social cognition in people with schizophrenia: A cluster-analytic approach. _Psychol. Med._ 46, 2717–2729 (2016). Article  CAS  PubMed  Google

Scholar  * Etchepare, A. _et al._ What are the specificities of social cognition in schizophrenia? A cluster-analytic study comparing schizophrenia with the general population. _Psychiatry

Res._ 272, 369–379 (2019). Article  PubMed  Google Scholar  * Uren, J., Cotton, S. M., Killackey, E., Saling, M. M. & Allott, K. Cognitive clusters in first-episode psychosis: Overlap

with healthy controls and relationship to concurrent and prospective symptoms and functioning. _Neuropsychology_ 31, 787–797 (2017). Article  PubMed  Google Scholar  * Hajdúk, M., Harvey, P.

D., Penn, D. L. & Pinkham, A. E. Social cognitive impairments in individuals with schizophrenia vary in severity. _J. Psychiatr. Res._ 104, 65–71 (2018). Article  PubMed  Google Scholar

  * Oliver, L. D. _et al._ Social cognitive networks and social cognitive performance across individuals with schizophrenia spectrum disorders and healthy control participants. _Biol.

Psychiatry Cogn. Neurosci. Neuroimaging_ 6, 1201–1214 (2021). Google Scholar  * Boyer, L. _et al._ Association of metabolic syndrome and inflammation with neurocognition in patients with

schizophrenia. _Psychiatry Res._ 210, 381–386 (2013). Article  PubMed  Google Scholar  * Kurtz, M. M., Gopal, S., John, S. & Thara, R. Cognition, social cognition and functional

disability in early-stage schizophrenia: A study from southern India. _Psychiatry Res._ 265, 231–237 (2018). Article  PubMed  Google Scholar  * Lim, K., Lee, S.-A., Pinkham, A. E., Lam, M.

& Lee, J. Evaluation of social cognitive measures in an Asian schizophrenia sample. _Schizophr. Res. Cogn._ 20, 100169 (2020). Article  PubMed  Google Scholar  * Stone, W. S. _et al._

Association between the duration of untreated psychosis and selective cognitive performance in community-dwelling individuals with chronic untreated schizophrenia in rural China. _JAMA

Psychiat._ 77, 1116–1126 (2020). Article  Google Scholar  * Wu, S. & Chen, W. L. Longitudinal trajectories of metabolic syndrome on different neurocognitive domains: A cohort study from

the Taiwan biobank. _Aging_ 13(11), 15400–15412. https://doi.org/10.18632/aging.203099 (2021). Article  CAS  PubMed  PubMed Central  Google Scholar  * Goughari, A. S., Mazhari, S.,

Pourrahimi, A. M., Sadeghi, M. M. & Nakhaee, N. Associations between components of metabolic syndrome and cognition in patients with schizophrenia. _J. Psychiatr. Pract._ 21, 190–197

(2015). Article  PubMed  Google Scholar  * Sabayan, B. _et al._ Association of visit-to-visit variability in blood pressure with cognitive function in old age: Prospective cohort study.

_BMJ_ 347, f4600 (2013). Article  PubMed  Google Scholar  * Tsai, C. K. _et al._ Increased risk of cognitive impairment in patients with components of metabolic syndrome. _Medicine

(Baltimore)_ 95, e4791 (2016). Article  CAS  PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS The authors would like to acknowledge all the participants in this study. AUTHOR

INFORMATION Author notes * Samir El Sayed, Sarah Gomaa & Dalia Khalil Present address: , Riyadh City, Riyadh, Kingdom of Saudi Arabia AUTHORS AND AFFILIATIONS * Department of Psychiatry,

Faculty of Medicine, Mansoura University, Mansoura, Egypt Samir El Sayed * Mansoura University Students’ Hospital, Mansoura University, Mansoura, Egypt Sarah Gomaa * Department of

Psychiatry, Hayat National Hospital, Riyadh, Kingdom of Saudi Arabia Alaa Alhazmi * Faculty of Medicine, Mansoura University, Mansoura, Egypt Ibrahem ElKalla * Faculty of Medicine, Zagazig

University, Zagazig, Egypt Dalia Khalil Authors * Samir El Sayed View author publications You can also search for this author inPubMed Google Scholar * Sarah Gomaa View author publications

You can also search for this author inPubMed Google Scholar * Alaa Alhazmi View author publications You can also search for this author inPubMed Google Scholar * Ibrahem ElKalla View author

publications You can also search for this author inPubMed Google Scholar * Dalia Khalil View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS

S.E.S. (corresponding author): Conceptualization, interviewing the patients, data collection, and writing the manuscript. A.A.: Clinical interviewing, psychometric assessment. S.G.: a

collection of patients’ data and editing of manuscript and revision of the manuscript. I.H.: data reviewing, manuscript writing. D.M.K.: conceptualization, manuscript writing, and revision.

CORRESPONDING AUTHOR Correspondence to Samir El Sayed. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER'S NOTE

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS OPEN ACCESS This article is licensed under a

Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit

to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are

included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons

licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of

this licence, visit http://creativecommons.org/licenses/by/4.0/. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Sayed, S.E., Gomaa, S., Alhazmi, A. _et al._ Metabolic profile

in first episode drug naïve patients with psychosis and its relation to cognitive functions and social cognition: a case control study. _Sci Rep_ 13, 5435 (2023).

https://doi.org/10.1038/s41598-023-31829-9 Download citation * Received: 12 July 2022 * Accepted: 17 March 2023 * Published: 03 April 2023 * DOI: https://doi.org/10.1038/s41598-023-31829-9

SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to

clipboard Provided by the Springer Nature SharedIt content-sharing initiative