Neuropsychological (NP) functioning in first episode (FE) schizophrenia: A 2-year follow-up study (original) (raw)
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European Archives of Psychiatry and Clinical Neuroscience, 2002
To investigate the temporal stability, or progressivity, of neuropsychological (NP) impairment in schizophrenia, 50 patients with first episode (FE) schizophrenia and 50 healthy controls were given a battery of tests at the outset of the study and after a two-year interval. Both patient and control groups were balanced with respect to age, gender, education and parental socioeconomic status. Summary rating scales for semantic memory (SEM), visual memory (VIM), verbal learning (VBL), visual-motor processing and attention (VSM) and abstraction/flexibility (ABS) were constructed. FE schizophrenics showed improvement in VBL, stability of function in SEM, VSM and ABS and absence of improvement in VIM.While performance in VSM and VIM is influenced by medication status, SEM seems to be trait-related and stable; VBL, however, seems to be staterelated. Our data suggest that there is no proof for the assumption of progressive deterioration in NP functioning during the first few years of illness.
Neuropsychological profile of cognitively impaired patients with schizophrenia
Comprehensive Psychiatry, 2006
Objective: Our purpose in undertaking the present study was to explore the existence of specific areas of cognitive deficits within the context of generalized poor performance in a group of Greek patients with schizophrenia. We also sought to identify any patients who might be cognitively normal. Method: Participants were 70 patients with schizophrenia and 42 healthy control subjects. The 2 groups were matched on age and male-female ratio but differed in their level of education. A battery of neuropsychological tests was selected to assess executive functions/abstraction, fluency, verbal and spatial working memory, verbal and nonverbal memory, attention, visuospatial ability, and psychomotor speed. Results: Patients with schizophrenia performed more poorly than healthy control subjects, when we controlled for differences in level of education, on executive functions, working memory, verbal memory, nonverbal memory, fluency, visuospatial ability, and attention. In contrast, no significant differences were found between the 2 groups on psychomotor speed. Patients showed a more pronounced deficit on executive functions, verbal and visual memory, and visuospatial ability. Overall, 13% to 62% of the patients with schizophrenia scored within 1 SD of the mean z scores of healthy control group depending on the cognitive domains examined. In the entire sample of patients with schizophrenia, however, no individual scored within 1 SD of the mean z scores of the control group in all cognitive domains. Conclusions: We found a generalized deficit in cognitive functioning in a group of patients with schizophrenia. We failed to find any individual patients who were healthy across all cognitive areas. The current neuropsychological profile, indicating widespread impairment, is comparable to that reported in the international literature and thus appears to be characteristic of schizophrenia. Our findings of increased difficulties with executive functions, verbal and visual memory, and visuospatial ability support previous suggestions of generalized brain dysfunction in the pathophysiology of schizophrenia. D
Generalized Cognitive Deficits in Schizophrenia
Archives of General Psychiatry, 1999
Background: Cognitive impairment is recognized as a core characteristic of schizophrenia. There has always been a debate about the nature, selectivity, and time of onset of these deficits in relationship to the onset of illness and treatment factors. To our knowledge, the present study represents the largest sample of mostly neurolepticnaive patients with first-episode schizophrenia that has been reported to date.
Malaysian Journal of Medicine and Health Sciences
Introduction: Poor neuro-cognitive performance in patients with schizophrenia has been described as a core symptom of the illness and is shown to be associated with poor psycho-social functioning. Management of schizophrenia has shifted its focus to treat this deficit apart from only emphasising on positive and negative symptoms, as it will subsequently improve patient functioning and outcome. Objective: The study aims to determine the proportion of neuro-cognitive impairment in patients with schizophrenia in a psychiatric clinic in Hospital Universiti Kebangsaan Malaysia and factors that are likely to be associated with the impairment. Method: A cross-sectional study design was conducted in this hospital-based study and subjects were randomly chosen from the psychiatric clinic. Rey Auditory Verbal Learning Test (RAVLT), Digit Forward and Backward (DF and DB), Trail Making Test (TMT) and Verbal Fluency Test (VF) were used to assess subjects' neuro-cognitive performance that measured their verbal memory and executive functioning of the brain. Results: The proportion of neuro-cognitive impairment is estimated at about 80% in patients with schizophrenia in this hospital-based study. A higher percentages of respondents had abnormal scores for RAVLT1, RAVLT5 and RAVLTB tests (75.6%, 68.3% and 82.9% respectively). The majority of respondents had normal scores for DF, VF tests (80.5% and 73.2% respectively), and about 51.2% of respondents had normal scores for DB test. For TMT, overall performance of respondents in Set A and B was poor. The mean duration of time taken to complete both sets was longer than that of a normal population based on age group: (age group: 18-39 years; TMT A 68.98 vs 40 seconds; TMT B 174.09 vs 90 seconds and age group: 40-49 years; TMT A 58.57 vs 45 seconds; TMT B 162.43 vs 100 seconds). There was a significant association between duration of illness and scores of RAVLT1 and between age of onset of illness and RAVLTB scores (p<0.05). There was no significant association between scores of all tests with the type of treatment received by respondents. Conclusion: The proportion of neuro-cognitive impairment in patients with schizophrenia is very high (80%) and has major implications on the current management of schizophrenia in which this core symptom should also be a focus of treatment. The significant association between clinical factors and neuro-cognitive impairment highlights the importance of modifying those factors in order to minimise the deficit in patients with schizophrenia.
Cognitive deficits in recent-onset and chronic schizophrenia
Journal of Psychiatric Research, 2010
Although cognitive dysfunction is a primary characteristic of schizophrenia, only recently have investigations begun to pinpoint when the dysfunction develops in the individual afflicted by the disorder. Research to date provides evidence for significant cognitive impairments prior to disorder onset. Less is known about the course of cognitive dysfunction from onset to the chronic phase of schizophrenia. Although longitudinal studies are optimal for assessing stability of cognitive deficits, practice effects often confound assessments, and large and representative subject samples have not been followed over long periods of time. We report results of a cross-sectional study of cognitive deficits early and late in the course of schizophrenia carried out at four different geographic locations to increase sample size and generalizability of findings. We examined a broad set of cognitive functions in 41 recent-onset schizophrenia patients and 106 chronic schizophrenia patients. The study included separate groups of 43 matched controls for the recent-onset sample and 105 matched controls for the chronic schizophrenia sample in order to evaluate the effects of cohort (i.e., age) and diagnosis (i.e., schizophrenia) on cognitive functions. All measures of cognitive function showed effects of diagnosis; however, select time-based measures of problem solving and fine motor dexterity exhibited interactions of diagnosis and cohort indicating that these deficits may progress beyond what is expected with normal aging. Also, worse recall of material in episodic memory was associated with greater length of illness. Nevertheless, findings indicate that nearly all cognitive deficits are comparably impaired across recent-onset and chronic schizophrenia.
Course of neurocognitive deficits in the prodrome and first episode of schizophrenia
Neuropsychology, 2010
Understanding the trajectory of cognitive changes in the development of schizophrenia may shed light on the neurodevelopmental processes in the beginning stage of illness. Subjects at risk for psychosis (AR, n=48), patients in their first episode of schizophrenia (FE, n=20) and normal comparison subjects (NC, n=29) were assessed on a neurocognitive battery at baseline and at a 6month follow-up. There were significant group differences across all cognitive domains as well as a significant group by time interaction in the verbal learning domain. After statistically controlling for practice effects and regression to the mean, a high proportion of FE subjects showed an improvement in verbal learning, while a significant number of AR subjects improved in general intelligence. Moreover, a higher than expected percentage of FE subjects, as well as AR subjects who later converted to psychosis, showed a deterioration in working memory and processing speed. These inconsistent trajectories suggest that some domains may improve with stabilization in the early stages of psychosis, while others may decline with progression of the illness, indicating possible targets for cognitive remediation strategies and candidate vulnerability markers for future psychosis.
Cognitive impairment and outcome in schizophrenia
2003
Objectives: The main focus of this study was the investigation of cognitive dysfunction in schizophrenia, specifically memory and executive impairment, and the link this has with outcome in the illness. The hypotheses being that both memory impairment and executive dysfunction would be demonstrated and that cognitive dysfunction would be linked to outcome. An attempt was also made to replicate Liddle et al's (1987) finding of three syndromes of schizophrenic symptoms (Psychomotor Poverty, Reality Distortion and Disorganisation) and linking two of these factors to executive dysfunction. Design: A group of 70 patients with schizophrenia at varying stages of the Rehabilitation process completed a neuropsychological battery of assessments including tests of memory and executive function. Correlational analyses were carried out on results. A between group comparison of "successful" versus "unsuccessful" outcome in schizophrenia with 15 patients in each group was a...