Cognitive intervention in early psychosis - preserving abilities versus remediating deficits

•Evidence that some areas of cognition are preserved at psychosis onset but deteriorate over time.•A developmental perspective that takes account of early versus late brain maturation is needed.•Cognitive abilities with different developmental trajectories require different intervention strategies.•Deficits present at illness onset generally do not appear to be ameliorated through cognitive remediation.•Strengths-based cognitive training may be useful in preserving areas of cognition that are unimpaired at illness onset.

Remediation strategies have focused on a deficits model to plan restorative interventions, with inconsistent results. Here, we propose that different trajectories require different approaches to optimise outcomes and prevent disability for individuals with psychoses. We propose that for functions that are preserved in early psychosis, targeted approaches focusing on strengths and factors conferring resilience are needed. Alternatively, for deficits apparent from illness onset, other approaches such as cognitive adaptation may be necessary. Based on the limited evidence to date, this also implies that treatments aiming to preserve functions must be instigated at the earliest prodromal stage of psychosis. Below, we examine the evidence for these approaches as they might apply to these notions and highlight recent studies of particular interest.