Background: Changes in cognitive impairments and their relationship with psychopathological symptoms during treatment in schizophrenia remain debatable. Especially, there is few studies specifically focusing on female patients. Further exploration of the characteristics of female schizophrenia patients can offer valuable sex-related considerations for clinicians in diagnosis and interventions. Methods: Our study involved 94 female patients with drug-naïve or drug-withdrawal schizophrenia who received antipsychotic drug for 8 weeks, along with 71 age-matched female healthy controls. The MATRICS Consensus Cognition Battery was used to assess cognition in the healthy controls at baseline and in the schizophrenia patients before and after 8 weeks of treatment. The Positive and Negative Syndrome Scale (PANSS) was employed to evaluate the psychopathological symptoms of the patients before and after 8 weeks of treatment. Results: After antipsychotic treatment, 90.43% of the patients showed a reduction rate of more than 25% in their PANSS scores. Psychopathological symptoms and overall cognitive functioning improved significantly (p < 0.05), with the exception of verbal learning and social cognition (p > 0.05). Most cognitive dimensions were negatively correlated with positive symptoms, negative symptoms, and general psychopathological symptoms (p < 0.05, Bonferroni correction), while verbal learning and social cognition were only correlated with negative symptoms (p < 0.05, Bonferroni correction). Multivariate linear regression analysis revealed that improvements in positive symptoms and negative symptoms can predict the improvement in visual learning (p < 0.05) and overall cognitive composite scores (p < 0.05), improved positive symptoms can predict the improvement in the speed of processing (p < 0.05), reasoning and problem-solving(p < 0.05), and improvement in negative symptoms can predict the improvement in attention/vigilance (p < 0.05). Conclusions: Verbal learning and social cognition may serve as core independent cognitive impairments in female schizophrenia. Improvements in the overall cognitive function, along with most cognitive dimensions, appeared to be secondary to the improvement in positive and negative symptoms during the acute stages of antipsychotic treatment. Trial registration: ClinicalTrials.gov Identifier: NCT03451734. [ABSTRACT FROM AUTHOR]

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