The relationship between neurocognitive course and clinical and functional outcomes in psychosis is not well known, especially in the long term.

The aim of the study was to examine the clinical and neuropsychological course of first psychotic episode patients at 5 follow-up years and analyze the relationship between cognitive performance and clinical and functional outcome.

The five follow-up years was conducted with 26 (58%) of patients recruited who met inclusion criteria and provided informed consent to participate. Psychotic symptoms were measured by Positive and Negative Symptom Scale, manic and depressive symptoms by Young Mania Rating Scale and Hamilton Depression Rating Scale respectively, and psychosocial functioning by Functioning Assessment Short Test. We used repeated measures analysis, Kruskal Wallis and linear regression models (SPSS 18.0).

Patients experienced symptomatic improvement in the follow up except in negative psychotic symptoms (F = .149; p < .862). There was also improvement in most cognitive domains: executive functions (F = 9,368; p = .006), logic memory (F = 12.091; p = .002), attention (F = 4,967; p = .035) and abstract reasoning (F = 14.816; p = .001), except in working memory (F = .337; p = .567) and processing speed (F = 2.463; p = .130). in linear regression analysis working memory was significantly related with psychotic negative symptoms (B = −4.722; p = .035) and with the psychosocial functioning (B = −5.396; p = .053).

There was improvement in most cognitive domains and a symptomatic and functional recovery in first psychotic episode patients in the long term. Working memory impairment was associated with negative psychotic symptoms and functional outcomes, so effective therapeutic interventions could improve outcome of patients.