A systematic review and narrative synthesis of data-driven studies in schizophrenia symptoms and cognitive deficits

Abstract

To tackle the phenotypic heterogeneity of schizophrenia, data-driven methods are often applied to identify subtypes of its symptoms and cognitive deficits. However, a systematic review on this topic is lacking. The objective of this review was to summarize the evidence obtained from longitudinal and cross-sectional data-driven studies in positive and negative symptoms and cognitive deficits in patients with schizophrenia spectrum disorders, their unaffected siblings and healthy controls or individuals from general population. Additionally, we aimed to highlight methodological gaps across studies and point out future directions to optimize the translatability of evidence from data-driven studies. A systematic review was performed through searching PsycINFO, PubMed, PsycTESTS, PsycARTICLES, SCOPUS, EMBASE and Web of Science electronic databases. Both longitudinal and cross-sectional studies published from 2008 to 2019, which reported at least two statistically derived clusters or trajectories were included. Two reviewers independently screened and extracted the data. In this review, 53 studies (19 longitudinal and 34 cross-sectional) that conducted among 17,822 patients, 8729 unaffected siblings and 5520 controls or general population were included. Most longitudinal studies found four trajectories that characterized by stability, progressive deterioration, relapsing and progressive amelioration of symptoms and cognitive function. Cross-sectional studies commonly identified three clusters with low, intermediate (mixed) and high psychotic symptoms and cognitive profiles. Moreover, identified subgroups were predicted by numerous genetic, sociodemographic and clinical factors. Our findings indicate that schizophrenia symptoms and cognitive deficits are heterogeneous, although methodological limitations across studies are observed. Identified clusters and trajectories along with their predictors may be used to base the implementation of personalized treatment and develop a risk prediction model for high-risk individuals with prodromal symptoms.

Fig. 1

PRISMA flow diagram illustrating the screening and selection of literature.

Fig. 2

Schizophrenia spectrum circle illustrating the schizophrenia symptoms and cognitive deficits (innermost circle), sample groups (inner circle), identified trajectories (outer circle) and predictors (outermost circle) in longitudinal studies. Findings are read and interpreted based on the line up in the circle.

Fig. 3

Schizophrenia spectrum circle illustrating the schizophrenia symptoms and cognitive deficits (innermost circle), sample groups (inner circle), identified clusters (outer circle) and correlates (outermost circle) in cross-sectional studies. Findings are read and interpreted based on the line up in the circle.

Fig. 4

A hypothetical model for driving big multidimensional data towards a personalized selection of treatments in schizophrenia spectrum disorders. GBTM: Group-based trajectory modeling; LCGA: Latent class growth analysis; CBT: Cognitive behavioural therapy.