L’insight neurocognitif dans la schizophrénie

Objectives

Given the extent, magnitude and functional significance of the neurocognitive deficits of schizophrenia, growing attention has been paid recently to patients’ self-awareness of their own deficits. Thus far, the literature has shown either that patients fail to recognize their cognitive deficits or that the association between subjective and objective cognition is weak in schizophrenia. The reasons for this lack of consistency remain unexplained but may have to do, among others, with the influence of potential confounding clinical variables and the choice of the scale used to measure self-awareness of cognitive deficits. In the current study, we sought to examine the relationships between subjective and objective cognitive performance in schizophrenia, while controlling for the influence of sociodemographic and psychiatric variables.

Depressive and negative symptoms in schizophrenia: different effects on clinical features

Objective

The primary aim of this study was to investigate whether depressive symptoms were significantly associated with functional outcome measures in a clinically stable group of outpatients with schizophrenia. We also analyzed whether depressive and negative symptoms presented different patterns of predictors.

Method

Seventy-eight consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for schizophrenia in the stable period were enrolled in this cross-sectional study. Assessment were performed using the Calgary Depression Scale for Schizophrenia, Positive and Negative Syndromes Scale (PANSS), Clinical Global Impression Scale-severity, Social and Occupational Functioning Assessment Scale, Sheehan Disability Scale, and Quality of Life Scale. A neuropsychologic battery including the vocabulary and block design subtests of the Wechsler Adult Intelligence Scale-Revised, Wechsler Memory Scale, Wisconsin Card Sorting Test, and Continuous Performance Test was also administered to the patients. Two multiple regressions were performed testing demographic and clinical factors, rating scales, and cognitive measures as independent variables and Calgary Depression Scale for Schizophrenia and PANSS-negative subscale scores as dependent variables.

Results

Four variables were predictors of depressive symptoms in our sample of schizophrenic patients: 2 outcome measures (Sheehan Disability Scale and Quality of Life Scale), gender, and Continuous Performance Test reaction time. Predictors of negative symptoms were the measures of severity of psychopathology (Clinical Global Impression Scale-severity and PANSS-general psychopathology subscale) and the cognitive tests Wechsler Adult Intelligence Scale-Revised block design and Wechsler Memory Scale.

Conclusion

We found that depressive symptoms in schizophrenia are mainly a function of the level of social adjustment and quality of life, whereas negative symptoms constitute an indicator of severity of schizophrenia. The 2 symptom dimensions showed also distinct cognitive correlates.     

A randomised, double-blind, placebo-controlled trial of tropisetron in patients with schizophrenia

Background

Cognitive deficits in schizophrenia are associated with psychosocial deficits that are primarily responsible for the poor long-term outcome of this disease. Auditory sensory gating P50 deficits are correlated with neuropsychological deficits in attention, one of the principal cognitive disturbances in schizophrenia. Our studies suggest that the α7 nicotinic acetylcholine receptor (α7 nAChR) agonist tropisetron might be a potential therapeutic drug for cognitive deficits in schizophrenia. Therefore, it is of particular interest to investigate the effects of tropisetron on the cognitive deficits in patients with schizophrenia.

Methods

A randomised, placebo-controlled trial of tropisetron in patients with schizophrenia was performed. A total of 40 patients with chronic schizophrenia who had taken risperidone (2 to 6 mg/day) were enrolled. Subjects were randomly assigned to a fixed titration of tropisetron (n = 20, 10 mg/day) or placebo (n = 20) in an 8-week double-blind trial. Auditory sensory gating P50 deficits and Quality of Life Scale (QLS), Cambridge Neuropsychological Test Automated Battery (CANTAB), and Positive and Negative Syndrome Scale (PANSS) scores were measured.

Results

In all, 33 patients completed the trial. Tropisetron was well tolerated. Administration of tropisetron, but not placebo, significantly improved auditory sensory gating P50 deficits in non-smoking patients with schizophrenia. The score on the rapid visual information processing (sustained visual attention) task of CANTAB was significantly improved by tropisetron treatment. Total and subscale scores of PANSS were not changed by this trial. QLS scores in the all patients, but not non-smoking patients, were significantly improved by tropisetron trial.

Conclusions

This first randomised, double-blind, placebo-controlled trial supports the safety and efficacy of adjunctive tropisetron for treatment of cognitive deficits in schizophrenia.     

Neuropsychologic profile of college students with schizotypal traits

Background

This study investigated the neuropsychologic functioning in nonclinical individuals with schizotypal traits using a comprehensive battery of neuropsychologic tests.

Method

We measured the neuropsychologic functioning of individuals with psychometrically defined nonclinical schizotypy (n = 28) and healthy controls (n = 31) for verbal memory (the Korean version of the California Verbal Learning Test), nonverbal memory (the Rey-Osterrieth Complex Figure Test), executive function (the Wisconsin Card Sorting Test), and attention (the d2 Test, Trail Making Test, and Controlled Oral Word Association Test).

Results

The schizotypal trait group committed significantly more total and perseverative errors and completed fewer categories on the Wisconsin Card Sorting Test than the control group. Performance on the other neuropsychologic tests did not differ between groups.

Conclusions

The nonclinical individuals with schizotypal traits demonstrated executive dysfunction, showing decreased ability in conceptualization, use of cues, and mental flexibility. Furthermore, these results indicate that the cognitive deficits observed in schizophrenia are also a characteristic of nonclinical individuals with schizotypal traits.     

Poor insight in schizophrenia: links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness

Objective

Many persons with schizophrenia experience poor insight or reflexive unawareness of the symptoms and consequences of their illness and, as a result, are at risk for treatment nonadherence and a range of negative outcomes. One recent theory regarding the origins of poor insight in schizophrenia has suggested that it may result, in part, from deficits in metacognitive capacity, or the ability to think about thinking, both one's own and the thinking of others.

Methods

Participants were 65 adults with a schizophrenia spectrum disorder in a postacute phase of illness living in the community. For all participants, we obtained measures of three domains of metacognition, including self-reflectivity, mastery, and perspective taking, using the Metacognitive Assessment Scale and the hinting test and three domains of insight, which were awareness of symptoms, treatment need, and consequences of illness, using the Scale to Assess Unawareness of Mental Disorder. Measures of neurocognition were also collected for potential use as covariates.

Results

Univariate correlations followed by stepwise multiple regressions, which controlled for neurocognition, indicated that self-reflectivity was significantly linked with awareness of symptoms, mastery with treatment need, and mastery and perspective taking were linked with awareness of consequences of illness.

Conclusions

Results suggest that metacognition may be linked to insight in persons with schizophrenia independent of concurrent impairments in neurocognition.     

Effects of atypical antipsychotics on neurocognition in euthymic bipolar patients

Background

Different factors may influence cognitive functioning in bipolar disorder such as the effect of subsyndromal symptoms, the history of psychotic symptomatology or substance abuse, negative symptomatology, chronicity, sleep disturbances, and hormonal factors. The effect of pharmacologic treatment on cognition is still uncertain because of an insufficient number of studies examining this issue.

Objective

The aims of this study were to compare neuropsychologic performance of treated bipolar patients with that of controls, including unmedicated patients and healthy subjects, as well as to evaluate possible neurocognitive differences among 3 different atypical antipsychotics.

Research Design and Methods

A total of 119 subjects were included in the study. Of 79 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition euthymic bipolar patients, 68 were treated with one atypical antipsychotic, quetiapine (n = 12), olanzapine (n = 26), or risperidone (n = 30). Sixteen patients were drug-free. The 4 groups were compared with a sample of drug-naïve patients and a healthy control group (n = 35) on several clinical and neuropsychologic variables, especially on the domains of attention, verbal memory, and executive functions. Euthymia was defined by a score of 6 or less at the Young Mania Rating Scale and a score of 8 or less at the Hamilton Depression Rating Scale for at least 6 months.

Results

The 5 groups did not differ in age, years of education, sex distribution, or estimated premorbid IQ. The 4 patients groups did not differ in chronicity, age of onset, total number of episodes, and number of hospitalizations. No differences were found regarding antipsychotic dosages between the groups. Bipolar patients performed poorly on most neuropsychologic measures as compared with healthy controls. After controlling for Hamilton Depression Rating Scale symptoms, no significant change in the results was observed. Because many patients with antipsychotic treatment had a history of psychotic symptoms, we performed multivariate analysis of covariance controlling for this variable. Bipolar patients taking 1 of the 3 antipsychotics presented with dose-independent significant deficits in most cognitive tasks compared with healthy controls. After several head-to-head group comparisons, the patients receiving quetiapine showed a better performance in learning task, short-term memory, and recognition task assessed with the California Verbal Learning Test and verbal fluency (P < .05).

Conclusions

Our results confirm the findings of previous studies of cognitive deficits in bipolar disorder. Untreated euthymic patients showed better cognitive performance than did patients on atypical antipsychotics. Some iatrogenic-pharmacologic effect, therefore, cannot be excluded, but quetiapine seemed to be less associated with impairment in measures of verbal memory than olanzapine or risperidone. We suggest to use drugs in bipolar disorder with a lower risk of cognitive adverse effects. However, randomized controlled trials are urgently needed to give a definite answer to this critical problem.     

Insight in obsessive-compulsive disorder: a comparative study of insight measures in an Israeli clinical sample

Background and objectives

Attempts to identify the characteristics of OCD patients with poor insight have not produced a coherent picture. This may be related to the wide variety of the available insight assessment tools. The study aimed to compare five principal measure for assessing insight in OCD and to investigate the relationships between insight and central demographic and clinical variables.

Methods

Sixty outpatients diagnosed with OCD (36 men, 24 women) were assessed with the following insight measures: DSM-IV insight criterion, Over-Valued Ideas Scale (OVIS), Item 11 of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Brown Assessment of Beliefs Scale (BABS) and Beck Cognitive Insight Scale (BCIS).

Results

Correlation coefficients indicated high correspondence between all insight measures with the exception of the BCIS. At the same time, the relations of the various insight measures with demographic and clinical variables were distinctive and in some cases measure-specific. The most robust correlation was between insight and current medical treatment, so that medicated participants showed higher insight levels on most insight measures compared to non-medicated participants. Some insight measures were correlated with co-morbidity, onset age and gender. Insight levels did not correlate with OCD symptom severity.

Limitations

Limitations of this study include its cross-sectional design, modest sample size and an incomplete representation of the available insight measures.

Conclusions

The diversity of measures used in previous studies cannot account for the inconsistent findings on the role of insight in OCD.     

Relationship of cognitive function in patients with schizophrenia in remission to disability: a cross-sectional study in an Indian sample

Background

Cognitive deficits in various domains have been consistently replicated in patients with schizophrenia. Most studies looking at the relationship between cognitive dysfunction and functional disability are from developed countries. Studies from developing countries are few. The purpose of the present study was to compare the neurocognitive function in patients with schizophrenia who were in remission with that of normal controls and to determine if there is a relationship between measures of cognition and functional disability.

Methods

This study was conducted in the Psychiatric Unit of a General Hospital in Mumbai, India. Cognitive function in 25 patients with schizophrenia in remission was compared to 25 normal controls. Remission was confirmed using the brief psychiatric rating scale (BPRS) and scale for the assessment of negative symptoms (SANS). Subjects were administered a battery of cognitive tests covering aspects of memory, executive function and attention. The results obtained were compared between the groups. Correlation analysis was used to look for relationship between illness factors, cognitive function and disability measured using the Indian disability evaluation and assessment scale.

Results

Patients with schizophrenia showed significant deficits on tests of attention, concentration, verbal and visual memory and tests of frontal lobe/executive function. They fared worse on almost all the tests administered compared to normal controls. No relationship was found between age, duration of illness, number of years of education and cognitive function. In addition, we did not find a statistically significant relationship between cognitive function and scores on the disability scale.

Conclusion

The data suggests that persistent cognitive deficits are seen in patients with schizophrenia under remission. The cognitive deficits were not associated with symptomatology and functional disability. It is possible that various factors such as employment and family support reduce disability due to schizophrenia in developing countries like India. Further studies from developing countries are required to explore the relationship between cognitive deficits, functional outcome and the role of socio-cultural variables as protective factors.     

Pertinence clinique du calcul d’un score global à l’échelle de Conscience des Troubles Mentaux (SUMD)

Introduction

Since 1990 rating scales assessing clinical insight have become the standard for empirical studies of lack of awareness in psychotic disorders. One of them, the Scale to assess Unawareness of Mental Disorder–SUMD is a semi-structured interview based on a dimensional and quantitative approach of clinical insight. The SUMD is founded on a modality specific view of insight that is to say that a patient can acknowledge the presence of some symptoms (e.g. anhedonia) but not others (e.g. blunted affect). However, presently, patients cannot be compared to each other based on the SUMD subscales total scores. In order to do so, patients would have to present the exact same symptoms.

Objective

The aim of this study is to make the use of the SUMD simpler and more clinically useful.

Method

This study involved 76 adult inpatients, diagnosed with schizophrenia (DSM-IV-TR criteria).

Results

Calculating SUMD Global Scores of the SUMD general items (items 1; 2 and 3) allowed us to reduce intra-individual variations and to compare patients’ level of insight.

Conclusions

Until now, the SUMD has proven to be a useful instrument to assess insight into schizophrenia for individual patients whereas our new statistical approach of the SUMD allows clinicians to compare level of insight between patients.     

La conscience des troubles (insight) dans la schizophrénie : une revue critique: Partie I : insight et schizophrénie, caractéristiques cliniques de l’insight

Introduction

Schizophrenia is the psychiatric disorder in which the awareness of pathology (or insight) is most frequently altered.

Literature findings

A review of the literature shows that between 50 and 80% of patients with schizophrenia do not believe they have a disorder. Studies published on this subject over the two last decades stressed the specificity of this phenomenon in schizophrenic patients, taking into account both its prevalence and its clinical consequences comparatively to other mental disorders. If in bipolar disorders a lack of insight is linked with the intensity and acuteness of symptomatology, there is only a limited relationship between these factors in schizophrenia, thus making lack of insight a trait rather than a state-related symptom.

Discussion

Though defined for a very long time as a dichotomic phenomenon, the recent interest on insight in psychosis and the development of assessment tools for its evaluation have made it possible to underline its multifactorial and dynamic characteristics. Although lack of insight related to pathologies may vary across time in bipolar disorders, the results of clinical studies suggest that this phenomenon remains stable in schizophrenia.

Conceptual proposals

In this review, we will reconsider the evolution of this concept in psychiatry and its definition. The clinical characteristics, which are specifically associated with the lack of insight in schizophrenia will be outlined. We will describe more specifically the model of Amador and Strauss and their assessment tool: the Scale to Assess Unawareness of Mental Disorder (SUMD). This model developed since the 1990s takes into account the time-related evolution of insight, and can be applied both to bipolar and psychotic disorders.

Assessment tools

The SUMD has six general items and four subscales. The general items estimate the three most widely used definitions of insight: awareness of having a mental disorder, awareness of the achieved effects of medication and awareness of the social consequences of having a mental disorder, and include assessment of both current and past-time periods. Four other subscales, each composed of 17 items, assess awareness and attribution of specific current and retrospective symptoms as well as deficits associated with severe mental disorders. Insight, thus, appears as a multidimensional and continuous phenomenon, since patients’ awareness may apply only to part of their symptoms and vary over time. In this article, we will review existing scales assessing insight in schizophrenia. The deficiency of available scales validated in French limits the number of scientific publications concerning this important aspect of the clinical evaluation of schizophrenic patients.

Therapeutical aspects

Finally, interventions to improve insight in patients with schizophrenia are presented. Recent studies have shown cognitive behavioural therapy (CBT) to be of benefit in the treatment of poor insight in schizophrenia.

Conclusion

Evidence suggests that early diagnosis and treatment of schizophrenia leads to better prognosis. An important suggestion from theses studies may be that psychosocial therapy needs to focus on explanations that are in tune with the culture, rather than focus on diagnostic labels.     

Improved insight affects social outcomes in involuntarily committed psychotic patients: A longitudinal study in the Netherlands

Background

Lack of insight in schizophrenia is associated with negative social outcomes mediated by symptom severity, but longitudinal studies show contradicting findings.

Method

After commencement of court-ordered admission, adult patients were enrolled in a prospective study. A relatively homogeneous group of 133 patients with schizophrenia or related psychotic disorders was selected to evaluate the impact of illness insight and symptom severity on social outcomes. Interviews at baseline and after 6 and 12 months included objective and subjective indicators of insight and social outcomes. Multilevel analyses were used to estimate the effect of insight and change in social outcomes controlling for symptom severity.

Results

In 12-month follow-up, patients involuntarily hospitalized showed improvement in illness insight, symptom level, and social functioning, and had stable quality of life scores. Illness insight was associated with change in outcomes, independent from symptom severity. Results of the change analyses suggest that in time the association between insight and functioning becomes stronger. In contrast, insight scores were negatively associated with self-report quality of life ratings and markedly ill patients had a more negative perception of their quality of life.

Conclusions

Improvement in illness insight was associated with improvement in social functioning, but this was not reflected in improved self-perceived quality of life. Illness insight could result in worrying about relationships, living situation, health and finances. For severely mentally ill patients additional strategies must be found to improve social outcomes. Researchers should be more aware of varying effects for researcher-rated versus self-report indicators of insight and social outcome.     

Children’s Perceived Competence Scale: reevaluation in a population of Japanese elementary and junior high school students

Background

It is important for children to maintain high self-perceived competence and self-esteem, and there are few measures to evaluate them through elementary to junior high school days in Japan. To evaluate psychometric properties of the Children’s Perceived Competence Scale (CPCS).

Methods

Data were collected from 697 elementary school and 956 junior high school students. Some of these students completed measures for construct validity, whereas others repeated the CPCS.

Results

The results demonstrated the three-factor structure of the CPCS: cognitive (nine items), social (eight items) and physical (nine items). Factorial invariance was confirmed between elementary and junior high school students, as well as between boys and girls. Construct validity was excellent. Scores on the cognitive, physical and general self-worth domains declined with increasing age. Boys scored significantly higher than girls on physical and general self-worth domains.

Conclusions

The CPCS is a valid and reliable measure of perceived competence in Japanese children aged 6–15 years. The CPCS may be applied to students from elementary through junior high school days as a measure of self-perceived and psychological state in Japan.

     

The social brain network in 22q11.2 deletion syndrome: a diffusion tensor imaging study

Background

Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a neurogenetic disorder that is associated with a 25-fold increase in schizophrenia. Both individuals with 22q11.2DS and those with schizophrenia present with social cognitive deficits, which are putatively subserved by a network of brain regions that are involved in the processing of social cognitive information. This study used two-tensor tractography to examine the white matter tracts believed to underlie the social brain network in a group of 57 young adults with 22q11.2DS compared to 30 unaffected controls.

Results

Results indicated that relative to controls, participants with 22q11.2DS showed significant differences in several DTI metrics within the inferior fronto-occipital fasciculus, cingulum bundle, thalamo-frontal tract, and inferior longitudinal fasciculus. In addition, participants with 22q11.2DS showed significant differences in scores on measures of social cognition, including the Social Responsiveness Scale and Trait Emotional Intelligence Questionnaire. Further analyses among individuals with 22q11.2DS demonstrated an association between DTI metrics and positive and negative symptoms of psychosis, as well as differentiation between individuals with 22q11.2DS and overt psychosis, relative to those with positive prodromal symptoms or no psychosis.

Conclusions

Findings suggest that white matter disruption, specifically disrupted axonal coherence in the right inferior fronto-occipital fasciculus, may be a biomarker for social cognitive difficulties and psychosis in individuals with 22q11.2DS.

     

The Portuguese version of the Personal and Social Performance Scale (PSP): reliability, validity, and relationship with cognitive measures in hospitalized and community schizophrenia patients

Purpose

Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables. In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning.

Methods

One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed, and verbal memory.

Results

Convergent validity with the GAF in the four domains of the PSP varied from 0.357 to 0.899. Reliability was found to be satisfactory, with a Cronbach’s alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP?<?70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared with high-functioning patients (PSP?≥?70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance.

Conclusions

The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.     

Untreated illness and recovery in clients of an early psychosis intervention program: a 10-year prospective cohort study

Purpose

To investigate whether duration of untreated psychosis (DUP) and duration of untreated illness (DUI) are associated with measures of both subjective and objective recovery 10 years after a first episode of psychosis.

Methods

A cohort of 65 clients from an early psychosis intervention program completed a battery of outcome measures 10 years following initial treatment for first-episode psychosis (FEP). The outcomes of interest were self-perceived recovery scores (Maryland Assessment of Recovery in People with Serious Mental Illness Scale) and occupational activity, defined as engagement in work and/or school on a full/part-time basis. Multiple linear and logistic regression analyses were used to estimate the associations between DUP and DUI with each measure of recovery, adjusting for potential confounding factors.

Results

We did not find a statistically significant association between DUP and either occupational activity (OR?=?1.26, 95% CI 0.81–1.95) or self-perceived recovery score (β = ??0.73, 95% CI ??2.42 to 0.97). However, we found a significant negative association between DUI and self-perceived recovery score (β = ??0.52, 95% CI ??0.87 to ??0.16).

Conclusions

Our findings suggest that DUI may have a stronger influence than DUP on recovery from FEP at 10-year follow-up. This suggests the potential value in targeted interventions for people with a long DUI to increase the likelihood of achieving recovery after the first episode of psychosis.

     

L’insight et les croyances relatives aux médicaments influencent l’observance médicamenteuse dans la schizophrénie

Background

Even effective drugs are useless when not taken. The aim of this study is to assess whether attitudes toward treatment were a better predictor of compliance than insight in schizophrenia.

Methods

Ninety-eight inpatients diagnosed with schizophrenia were evaluated within 1 week after being admitted to a psychiatric ward.

Results

Forty-nine percent of patients were non-compliant. Assessing jointly DAI and insight scores optimized the prediction of compliance to antipsychotic medication: results from a logistic regression indicated that compliance is better predicted by DAI factor 2 score “patient's assessment of need for medications” combined to SUMD G1 insight score “insight into mental disorder” (ROC AUC = 0.776).

Discussion

It is possible that there is a conceptual overlap between patient's assessment of need for medication and clinical insight.

Conclusion

Clinical insight and attitudes toward treatment are stronger predictors of compliance when combined.     

Triiodothyronine may be possibly associated with better cognitive function and less extrapyramidal symptoms in chronic schizophrenia

Objective

Many chronic inpatients with schizophrenia demonstrate enduring psychiatric symptoms and various side effects of antipsychotic drugs. Several biological markers such as prolactin, thyroid hormones and brain-derived neurotrophic factor (BDNF) are reportedly associated with psychiatric symptoms and/or antipsychotic side effects in patients with schizophrenia but to date findings are inconsistent. The objective of the present study was to comprehensively investigate the association of psychiatric and extrapyramidal symptoms with hormones and BDNF in chronic schizophrenia.

Methods

In this study, 93 chronic inpatients with schizophrenia were comprehensively investigated in order to examine the association of psychiatric and extrapyramidal symptoms with prolactin, thyroid hormones (free triiodothyronine (T₃), free thyroxine (T₄), thyroid stimulating hormone), cortisol and BDNF. Symptoms were assessed via the Positive and Negative Syndrome Scale (PANSS), Mini-Mental State Examination (MMSE), and drug-induced extrapyramidal symptoms scale (DIEPSS).

Results

Multiple regression analyses revealed that antipsychotic dose was the only variable that predicted significant variance in PANSS positive subscale scores, that BDNF and free T₃ predicted significant variance in MMSE scores, and that prolactin and free T₃ predicted significant variance in DIEPSS scores.

Conclusion

These findings suggest that BDNF, free T₃, and prolactin may be associated with cognitive function and/or extrapyramidal symptoms in patients with chronic schizophrenia. Notably, free T₃ may be possibly associated with better cognitive function and less extrapyramidal symptoms, although our cross-sectional study could not reveal a causal relationship.     

Stratégies de résolution de problèmes et attention sélective dans la schizophrénie : critères typologiques et multidimensionnels de la Positive and Negative Syndrome Scale (PANSS)

Introduction

The Positive and Negative Syndrome Scale (PANSS) is one of the most widespread diagnostic scales of psychoses, in particular for Schizophrenia. The scale distinguishes between positive and negative subtypes. A consequent number of researches explored the cognitive dysfunction in schizophrenia by distinguishing these negative and positive subtypes. However, findings are inconsistent. On the other hand, multidimensional diagnostic criteria show the specificity of cognitive disorders within the different spheres of schizophrenia.

Literature findings

Studies show that principal components analyze applied to PANSS's 30 items attain from three to nine components. Therefore, psychotic, negative and disorganized dimensions were regularly obtained. Every one of these dimensions has specific neuropsychological and cognitive correlations.

Objectives

Our purpose was to explore cognitive disorders related to the negative and positive subtypes as defined by typological criteria and negative, disorganised and psychotic dimensions defined by multidimensional criteria. Our particular interest was selective attention and problem-solving abilities.

Materials and methods

Our sample incorporated 42 subjects responding to D.S.M.-IV criteria for schizophrenia (APA, 1994). The mean age was 40.58 ± 7.95 years, the mean years of education were 9.88 ± 2.74, the mean duration of illness was 12.26 ± 6.49 years and the number of hospitalisations was 4.41 ± 2.27. Clinical assessment was reached by using the Positive and Negative Symptoms Scale (PANSS). In order to define schizophrenic dimensions, the principal components analysis was performed with Varimax rotation. To assess problem-solving and selective attention, subjects were asked to complete the Wisconsin Card Sorting Test, the Parlor Game, the Stroop test and the Word Recognition Scale (ADAS-cog). Statistical significance was based on non-parametric measures: the Kruskal-Wallis test and the Spearman correlation test.

Results

Typological diagnostic criteria based on PANNS show no cognitive differences between positive, negative and mixed sub-types in selective attention and problem-solving ability. On the other hand, the principal component analysis applied to PANSS shows three components ; negative, psychotic and disorganisation. Clinical assessment: the negative component included blunted affect, lack of spontaneity and active social avoidance, the psychotic component included delusions, hallucinatory behaviour, grandiosity, suspiciousness and unusual thought content, and finally the disorganisation component comprised conceptual disorganisation, difficulty in abstract thinking, disorientation and poor attention. Cognitive assessment: the disorganisation dimension was associated with low performances in the Stroop test and in the Word Recognition Scale. Negative dimensions were correlated to low performances in the indicators of the Wisconsin Card Sorting Test (number of errors, number of perseverant errors, number of failures to maintain the set, number of trials to achieve the task and number of achieved categories) and the Parlor Game. However, no significant correlation was found between psychotic dimensions and cognitive dysfunctions.

Conclusion

Our study contributes to the comprehension of specific patterns of cognitive disorders of schizophrenics by using multidimensional criteria. Results are detailed and discussed.     

Adjunctive memantine therapy for cognitive impairment in chronic schizophrenia: a placebo-controlled pilot study

Objective

To investigate the effects of memantine, an N-methyl-d-aspartate (NMDA) receptor antagonist, on cognitive impairments in patients with chronic schizophrenia.

Methods

A 12-week, placebo-controlled trial was conducted to determine the effectiveness of memantine as an adjunctive treatment with conventional antipsychotic medications in 26 patients with chronic schizophrenia. The subjects were evaluated with the Korean version of the Mini-Mental State Examination (K-MMSE), the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HAM-D), and a standard neuropsychological screening test.

Results

Memantine treatment was not associated with significantly improved cognitive test scores compared with the placebo control treatment. An improvement in the scores on the PANSS negative subscale was noted with memantine, but it was not significant.

Conclusion

Adjunctive memantine treatment did not improve cognitive functioning or affect psychopathology in patients with chronic schizophrenia in the present study. Memantine, however, was tolerated well and did not exacerbate positive symptoms in patients with chronic schizophrenia.     

Depression and cognitive deficits in geriatric schizophrenia

Objective

Past reports have found patients with comorbid depression and schizophrenia spectrum disorders exhibit greater deficits in memory and attention compared to schizophrenia spectrum disorder patients without depressive symptoms. However, in contrast to younger schizophrenia patients, the few past studies using cognitive screens to examine the relationship between depression and cognition in inpatient geriatric schizophrenia have found that depressive symptomatology was associated with relatively enhanced cognitive performance. In the current study we examined the relationship between depressive symptoms and cognitive deficits in geriatric schizophrenia spectrum disorder patients (n = 71; mean age = 63.7) on an acute psychiatric inpatient service.

Method

Patients completed a battery of cognitive tests assessing memory, attention and global cognition. Symptom severity was assessed via the PANSS and Calgary Depression Scale for Schizophrenia.

Results

Results revealed that geriatric patients' depression severity predicted enhancement of their attentional and verbal memory performance. Patients' global cognitive functioning and adaptive functioning were not associated with their depression severity.

Conclusion

Contrary to patterns typically seen in younger patients and non-patient groups, increasing depression severity is associated with enhancement of memory and attention in geriatric schizophrenia spectrum disorder patients. Also, diverging from younger samples, depression severity was unassociated with patients adaptive and global cognitive functioning.