Abnormal subjective experiences in schizophrenia: its relationships with neuropsychological disturbances and frontal signs

Assessment of cognitive impairment in psychosis spectrum disorders through self-reported and interview-based measures

Self-reported and interview-based measures can be considered coprimary measures of cognitive performance. We aimed to ascertain to what extent cognitive impairment in psychotic disorders, as assessed with a neuropsychological battery, is associated with subjective cognitive complaints compared to difficulties in daily activities caused by cognitive impairment. We assessed 114 patients who had a psychotic disorder with a set of neuropsychological tests and two additional measures: the Cognitive Assessment Interview-Spanish version (CAI-Sp) and the Frankfurt Complaint Questionnaire (FCQ). Patients also underwent a clinical assessment. The CAI-Sp correlated significantly with all the clinical dimensions, while the FCQ correlated only with positive and depressive symptoms. The CAI-Sp correlated significantly with all cognitive domains, except for verbal memory and social cognition. The FCQ was associated with attention, processing speed and working memory. The combination of manic and depressive symptoms and attention, processing speed, working memory and explained 38-46% of the variance in the patients' CAI-Sp. Education and negative symptoms, in combination with attention, processing speed, and executive functions, explained 54-59% of the CAI-Sp rater's variance. Only negative symptoms explained the variance in the CAI-Sp informant scores (37-42%). Depressive symptoms with attention and working memory explained 15% of the FCQ variance. The ability to detect cognitive impairment with the CAI-Sp and the FCQ opens the possibility to consider these instruments to approximate cognitive impairment in clinical settings due to their ease of application and because they are less time-consuming for clinicians.

Cognitive, community functioning and clinical correlates of the Clinical Assessment Interview for Negative Symptoms (CAINS) in psychotic disorders

Negative symptoms are a core dimension of schizophrenia and other psychoses that account for a large degree of the poor functional outcomes related to these disorders. Newer assessment scales for negative symptoms, such as the Clinical Assessment Interview for Negative Symptoms (CAINS), provide evidence for separate dimensions of motivational and pleasure (MAP) and expression (EXP) dimensions. This study was aimed at extending the analysis of the clinical, functional and cognitive correlates of CAINS dimensions in a sample of patients with psychotic disorders (n = 98) and 50 healthy controls.A psychopathological evaluation was conducted by using the Comprehensive Assessment of Symptoms and History (CASH). To assess the extrapyramidal signs, the UKU scale was used. Community functioning was evaluated by means of real-world and functional attainment measures. Additionally, a full neuropsychological test battery was administered. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the influencing and predictive factors associated with the CAINS dimensions.The MAP and EXP dimensions showed strong associations with the Scale for the Assessment of Negative Symptoms (SANS) items and were not significantly associated with extra-pyramidal or cognitive deficits. The MAP and EXP CAINS dimensions revealed good predictive validity for real-world functioning and functional attainment measures.These findings suggest that the CAINS scale endorses good convergent validity for the assessment of negative symptoms and is very useful in the prediction of psychosocial functioning. In addition, the CAINS dimensions might provide advantages over old assessment scales on disentangling the complex associations between negative symptoms and cognitive impairment.

Movement disorder and sensorimotor abnormalities in schizophrenia and other psychoses - European consensus on assessment and perspectives

Over the last three decades, movement disorder as well as sensorimotor and psychomotor functioning in schizophrenia (SZ) and other psychoses has gained greater scientific and clinical relevance as an intrinsic component of the disease process of psychotic illness; this extends to early psychosis prediction, early detection of motor side effects of antipsychotic medication, clinical outcome monitoring, treatment of psychomotor syndromes (e.g. catatonia), and identification of new targets for non-invasive brain stimulation. In 2017, a systematic cooperation between working groups interested in movement disorder and sensorimotor/psychomotor functioning in psychoses was initiated across European universities. As a first step, the members of this group would like to introduce and define the theoretical aspects of the sensorimotor domain in SZ and other psychoses. This consensus paper is based on a synthesis of scientific evidence, good clinical practice and expert opinions that were discussed during recent conferences hosted by national and international psychiatric associations. While reviewing and discussing the recent theoretical and experimental work on neural mechanisms and clinical implications of sensorimotor behavior, we here seek to define the key principles and elements of research on movement disorder and sensorimotor/psychomotor functioning in psychotic illness. Finally, the members of this European group anticipate that this consensus paper will stimulate further multimodal and prospective studies on hypo- and hyperkinetic movement disorders and sensorimotor/psychomotor functioning in SZ and other psychotic disorders.

Dimensional structure and diagnostic specificity of the Frankfurt Complaint Questionnaire

The Frankfurt Complaint Questionnaire (FCQ) is a widely used method to investigate non-psychotic subjective experiences of schizophrenics. Less is known about its dimensional structure. Therefore, principal components analyses (PCA) were conducted with the FCQ data of 505 schizophrenics and 187 alcoholics. Furthermore, results of a former analysis using item-to-item comparisons between schizophrenics and alcoholics were examined. PCA yielded two factors called ‘dysphoric concomitants of severe illness particularly impairing concentration’ and ‘subjective experiences of perceptual uncertainties’. Neither of the factors was specific to schizophrenia. The item comparisons suggest that only a group of eight FCQ items (subscale ‘FCQ-S’) is specific to schizophrenia while ten items (‘FCQ-A’) are related more to alcoholism. The validity of FCQ-S and FCQ-A was confirmed: schizophrenics reached high scores in FCQ-S and low scores in FCQ-A; alcoholics scored high in FCQ-A and low in FCQ-S; schizophrenics with an additional alcohol disorder scored high in both of the subscales. It is concluded that direct group comparisons seem to be promising for the identification of non-psychotic subjective phenomena which are characteristic for schizophrenia.

Basic self-disturbance, neurocognition and metacognition: A pilot study among help-seeking adolescents with and without attenuated psychosis syndrome

AIM

The goal of this pilot study was to assess the association between basic self-disturbance (SD) and deficits in neurocognitive and metacognitive functioning among help-seeking adolescents with and without attenuated psychosis syndrome (APS).

METHODS

Sixty-one non-psychotic, help-seeking adolescents (age 13-18) were assessed with the examination of anomalous self-experience, the structured interview for prodromal syndromes and a new metacognitive approach to neurocognitive assessment applied to two non-social (executive functions and verbal memory) and two social (theory of mind and emotion recognition) domains. After each answer, subjects were also requested to indicate their level of confidence in the answer and to decide whether they desired it to be "counted" toward their total score on the task. Each volunteered answer earned a 5-cent gain if correct, but an equal fine if wrong.

RESULTS

As hypothesized, metacognitive monitoring and control had a significant contribution to the prediction of SD over and above neurocognitive functioning and attenuated psychotic symptoms. However, the direction of this association was positive rather than negative. Also, inconsistent with or hypothesis, it was not moderated by the presence of APS.

CONCLUSIONS

These pilot results provide preliminary support a modest association between SD and metacognition, which is not reducible to neurocognition and APS. In addition, they raise an intriguing possibility regarding metacognitive monitoring and control being indicators of hyper-reflectivity that characterizes individuals with SD. However, further research with larger samples and high-stress assessment conditions are needed to assess this possibility.

Insight and major mental illness: an update for clinicians

This article will concentrate on insight into serious mental disorder. Not psychoanalytic insight – nor indeed, the insight all of us have, to a greater or lesser extent, into our own attitudes, motives and behaviour – but the insight which patients with psychosis have into their mental pathology. This is no longer considered an all-or-none phenomenon, but rather a dimensional one, so that subjects can have different levels of awareness into their illness. The suggestion was first mooted by Aubrey Lewis (1934) in his seminal work on insight. Conceptual exploration of insight has been activated in the past decade and is proceeding in parallel with the construction of special scales to measure insight and research into its cognitive, biological, social and cultural basis.

Phenomenology and neurobiology of self disorder in schizophrenia: Primary factors

Schizophrenia is a heterogeneous syndrome, varying between persons and over course of illness. In this and a companion article, we argue that comprehension of this condition or set of conditions may require combining a phenomenological perspective emphasizing disorders of basic-self experience ("ipseity disturbance") with a multidimensional appreciation of possible neurobiological correlates--both primary and secondary. Previous attempts to link phenomenology and neurobiology generally focus on a single neurocognitive factor. We consider diverse aspects of schizophrenia in light of a diverse, albeit interacting, set of neurocognitive abnormalities, examining both synchronic (structural) interdependence and diachronic (temporal) succession. In this article we focus on the primary or foundational role of early perceptual and motoric disturbances that affect perceptual organization and especially intermodal or multisensory perceptual integration (“perceptual dys-integration”). These disturbances are discussed in terms of their implications for three interconnected aspects of selfhood in schizophrenia, primary forms of: disrupted "hold" or "grip" on the world, hyperreflexivity, diminished self-presence (self-affection). Disturbances of organization or integration imply forms of perceptual incoherence or diminished cognitive coordination. The effect is to disrupt one's ability to apprehend the world in holistic, vital, or contextually grounded fashion, or to fully identify with or experience the unity of one's own body or thinking--thereby generating an early and profound (albeit often subtle) disruption or diminishment of basic or core self and of the sense of existing in a coherent world. We discuss interrelationships or possible complementarities between these three aspects, and consider their relevance for a neurodevelopmental account of schizophrenia.

Self-perceived cognitive functioning and its relationship with objective performance in first-episode schizophrenia: the Subjective Cognitive Impairment Scale

BACKGROUND

Self-perceived cognitive dysfunction is under-recognized in clinical practice and under-studied in schizophrenia, particularly in the early illness stage. Findings on the relationship between subjective and objective cognitive measures were inconsistent. This study aimed to examine psychometric properties of a newly developed scale, Subjective Cognitive Impairment Scale (SCIS) and to investigate the relationship of self-reported ratings with objective test performance in first-episode schizophrenia.

METHODS

One hundred one Chinese patients aged 18 to 64years presenting with first episode schizophrenia-spectrum disorder were studied. A comprehensive set of assessments examining objective cognitive functioning, clinical and treatment characteristic were administered. Internal consistency, factor structure and construct validity of SCIS were evaluated. Correlations of scale score with objective cognitive measures, clinical and treatment variables were examined.

RESULTS

A single-factor underlying the structure of SCIS items was demonstrated by principal components analysis. Cronbach's alpha coefficient for the scale was 0.92. SCIS score was positively correlated with depression and anxiety symptom severity, and duration of untreated psychosis. SCIS score was not associated with other symptom dimensions, insight and chlorpromazine equivalents. No significant correlations were observed between SCIS score and objective cognitive measures with the exception of letter-number span test.

CONCLUSION

Our results provided preliminary evidence in support of reliability and validity of SCIS in evaluating patient's cognitive complaints. A lack of correspondence between subjective and objective cognitive functioning suggested that they may represent two distinct constructs with potentially differential therapeutic implications. Further research is warranted to examine ecological validity and clinical utility of the scale.

Self-Disorders, Neurocognition and Rationality in Schizophrenia: A Preliminary Study

BACKGROUND/AIMS

Although the very idea that the generative disorder in schizophrenia is a disturbance of the self is as old as the schizophrenia concept itself, empirical studies have only recently emerged, documenting that anomalous self-experiences (i.e. self-disorders, SDs) aggregate in schizophrenia spectrum disorders but not in other mental disorders. The aim of this study is to explore potential associations between SDs, neurocognitive performance, rationality and IQ in patients with schizophrenia.

METHODS

The sample comprises 31 patients diagnosed with schizophrenia (DSM-IV). All patients underwent comprehensive evaluation. SDs were assessed with the Examination of Anomalous Self-Experience scale. Neurocognitive performance was measured with 4 PC-implemented subtests from the Cambridge Neuropsychological Test Automated Battery. Rationality was measured using syllogism tests. The IQ was indexed by a summary score of 4 IST-2000-R computerized subtests.

RESULTS

No correlation was found between SDs and neurocognitive performance or between SDs and IQ. SDs were found to correlate with rationality. Neurocognitive performance correlated with rationality, and both correlated with IQ, respectively.

CONCLUSIONS

The lack of correlation between SDs and neurocognitive performance is consistent with the results from the only previous study exploring this issue, suggesting that SDs depict something essential to schizophrenia, whereas neurocognitive impairment does not. The correlation between SDs and rationality indicates that the syllogism tests reflect something central for schizophrenia, but the result needs further corroboration from larger, empirical studies.

Anomalous subjective experiences in schizophrenia, bipolar disorder, and unipolar depression

BACKGROUND

The purpose of the present study was to compare anomalous subjective experiences in patients with schizophrenia, bipolar disorder, and unipolar depression, in order to elucidate differences in subjective experiences and examine their potential clinical correlates in schizophrenia and mood disorders.

METHODS

The subjective experiences of 78 outpatients with schizophrenia (n=32), bipolar disorder (n=24) and unipolar depression (n=22), and 32 healthy controls were comprehensively assessed using the Frankfurt Complaint Questionnaire (FCQ).

RESULTS

The FCQ total score was significantly higher in the schizophrenia and depression groups than in the healthy control group. There were no significant differences in the FCQ total or subscale scores among the schizophrenia, unipolar depression, and bipolar disorder groups. In the schizophrenia group, the Positive and Negative Syndrome Scale negative factor score was a significant negative predictor of the severity of subjective experiences assessed by the FCQ total score. Disruption of subjective experiences in patients with unipolar depression was associated with greater severity of depressive symptoms and younger age. In the bipolar disorder group, women reported more disruptions in subjective experience.

CONCLUSIONS

Anomalous subjective experiences measured by the FCQ are not specific to schizophrenia, and the severity of these experiences in unipolar depression is substantially high. The finding of a dissimilar pattern of predictors of subjective experiences across different diagnostic groups suggests the complexity and variety of factors contributing to anomalous subjective experiences in schizophrenia and mood disorders.

Dynamics of neurological soft signs and its relationship to clinical course in patients with first-episode schizophrenia

The aim of the study was to assess the dynamics of neurological soft signs (NSS) over four years from the clinical onset of schizophrenia, depending on the clinical course of the disease, and to evaluate the relationship of NSS to symptomatic dimensions in patients with first-episode schizophrenia. Sixty-eight patients with first-episode schizophrenia were included in the trial. The clinical status was assessed using Positive and Negative Syndrome Scale (PANSS) at the same time as the neurological examination, at admission to the hospital for first-episode schizophrenia and at a check-up examination four years later. The assessment of NSS using the Neurological Evaluation Scale (NES) coincided with the assessment of the clinical condition of the patients. According to the Andreasen remission criterion of schizophrenia, after four years we found that 57% of patients' were remitters and 43% were non-remitters. During the monitoring period, in remitters total NES score and sensory integration/sequencing of motor acts items of the NES decreased. In non-remitters, increase in the total NES score and the 'others' item of the NES was observed. A connection between the dynamics of NSS and the clinical course of schizophrenia, over the period of four years, and a relationship between NSS and negative schizophrenia symptoms was found.

Neurocognition, psychopathology, and subjective disturbances in schizophrenia: a comparison between short-term and remitted patients

Patients with schizophrenia present deficits in multiple domains of cognition. The study of the relationship between cognitive performance and symptoms of schizophrenia has yielded heterogeneous results. The purposes of this study were to examine the extent of the relationship between psychopathologic symptoms, cognitive function, and subjective disturbances in a group of patients affected by schizophrenia spectrum disorders and to compare short-term with remitted patients. Seventy-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for schizophrenia, schizophreniform disorder, and schizoaffective disorder were assessed through the Positive and Negative Syndrome Scale, the Frankfurt Complaint Questionnaire, and a neuropsychologic battery exploring the 7 Measurement and Treatment Research to improve Cognition in Schizophrenia cognitive domains (speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition) plus executive control. Neuropsychologic and psychopathologic variables were compared and correlated. Treatment groups did not differ in neuropsychologic and psychopathologic measures. The cognitive factor of the Positive and Negative Syndrome Scale correlated with worse performance on cognitive tasks and with higher scores on the Frankfurt Complaint Questionnaire 24 in the short-term, remitted, and combined groups. Subjective disturbances correlated with impaired executive control, reasoning and problem solving, and social cognition but not during the short-term phase. Both "objective" and subjective psychopathology are intertwined with cognitive function, suggesting some common underlying neural bases. The condition of being in a short-term or a remitted phase of the illness influences this interrelationship, regardless of the type of antipsychotic medication taken.

The association between self-disorders and neurocognitive dysfunction in schizophrenia

BACKGROUND

Neurocognitive deficits and self-disorders (i.e. altered basic self-awareness or - sense of self) have both been suggested as fundamental trait features of schizophrenia. However, no study until now has investigated the relationship between these two core features.

AIM

To investigate the relationship between self-disorders and neurocognitive performance in patients with schizophrenia.

METHOD

Self-disorders were assessed in 57 patients in the early phase of schizophrenia by means of the Examination of Anomalous Self-Experience (EASE) instrument. The neurocognitive assessments included measures of psychomotor speed, working memory, executive- and memory functions.

RESULTS

There were few associations between self-disorders and neurocognitive impairments. However, high levels of SDs were significantly associated with impaired verbal memory.

CONCLUSION

The reason for the general lack of associations between self-disorders and neurocognition could be that they represent different basic features of the illness. Verbal memory may however be linked to deficits in the patients' ability to comprehend, direct, remember and reason about their thoughts, functions that are intimately related to the basic sense of self.

Psychometrically matched tasks evaluating differential fMRI activation during form and motion processing

OBJECTIVE

Deficits in visual perception and working memory are commonly observed in neuropsychiatric disorders and have been investigated using functional MRI (fMRI). However, interpretation of differences in brain activation may be confounded with differences in task performance between groups. Differences in task difficulty across conditions may also pose interpretative issues in studies of visual processing in healthy subjects.

METHOD

To address these concerns, the present study characterized brain activation in tasks that were psychometrically matched for difficulty; fMRI was used to assess brain activation in 10 healthy subjects during discrimination and working memory judgments for static and moving stimuli. For all task conditions, performance accuracy was matched at 70.7%.

RESULTS

Areas associated with V2 and V5 in the dorsal stream were activated during motion processing tasks and V4 in the ventral stream were activated during form processing tasks. Frontoparietal areas associated with working memory were also statistically significant during the working memory tasks.

CONCLUSIONS

Application of psychophysical methods to equate task demands provides a practical method to equate performance levels across conditions in fMRI studies and to compare healthy and cognitively impaired groups at comparable levels of effort. These psychometrically matched tasks can be applied to patients with a variety of cognitive disorders to investigate dysfunction of multiple a priori defined brain regions. Measuring the changes in typical activation patterns in patients with these diseases can be useful for monitoring disease progression, evaluating new drug treatments, and possibly for developing methods for early diagnosis.

Subjective and Objective Cognitive Dysfunction in Schizophrenia - is there a Link?

Cognitive dysfunction is a well recognized symptom of schizophrenia, as well as patients having poor insight into their illness. The subjective scale to investigate cognition in schizophrenia (SSTICS) is one of several scales that have been developed to study subjective cognitive dysfunction and has been compared to patients’ objective cognitive level. A literature search was performed using PubMed, psychINFO, Web of Science, and cross-referencing to find 26 articles which used 14 different subjective cognitive dysfunction scales to investigate the relationship between subjective and objective measures of cognition in schizophrenia. Although the majority of studies using the SSTICS found significant correlations between subjective and objective measures of cognition, the findings from the other scales were less clear. From this review, the issue of whether or not schizophrenic patients have good cognitive insight remains unsure. However, due to the heterogeneous nature of the study designs and their outcome measures, continued work in this area with consistency on these points is necessary; on the path to better provide management options for a very debilitating component of this illness.

Is the lack of association between cognitive complaints and objective cognitive functioning in patients with bipolar disorder moderated by depressive symptoms?

OBJECTIVES

To investigate the association between cognitive complaints and objective cognitive functioning in bipolar patients, with a focus on the moderating role of depressive symptoms.

METHODS

The association between cognitive complaints (measured by the total score and four subscales of the Cognitive Failure Questionnaire; CFQ) and objective cognitive functioning (domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory and executive functioning/working memory, and the total score) was assessed in 108 euthymic (n=45) or mildly to moderately depressed bipolar patients (n=63). We studied potential moderation of this association by depressive symptoms (total score of the Inventory of Depressive Symptomatology-self rating). Analyses were performed using Pearson correlations and multiple linear regression.

RESULTS

Cognitive complaints were not associated with objective cognitive functioning, except for CFQ 'memory for names' which was positively correlated with speed of information processing (r=0.257, p=0.007). Although depressive symptoms were positively associated with cognitive complaints (total score and three subscales; p<0.01), the association between cognitive complaints and objective cognitive functioning was not moderated by depressive symptoms (p for interaction 0.054 to 0.988).

LIMITATIONS

It can be argued whether the retrospective questionnaire (CFQ) is sufficiently accurate to measure the type of cognitive dysfunctions seen in bipolar patients.

CONCLUSIONS

Cognitive complaints are not associated with objective cognitive functioning, irrespective of depressive symptoms. However, cognitive complaints are indicative for depressive symptoms. Clinicians should be to be alert to depressive symptoms rather than objective cognitive problems in patients expressing cognitive complaints.

Relationship between subjective experiences and psychopathological dimensions in schizophrenia

OBJECTIVE

Subjective experiences are subtle, self-experienced disturbances, a thorough description of which is provided within the framework of the concept of basic symptoms. Recent studies have shown that subjective experiences have important diagnostic implications for schizophrenia and related disorders. The purpose of the present study was to examine the relationship between subjective experiences and psychopathological dimensions in schizophrenia.

METHOD

Sixty-seven outpatients with schizophrenia were evaluated. Subjective experiences were comprehensively assessed using the Frankfurt Complaint Questionnaire (FCQ). Symptoms of schizophrenia were evaluated using the Manchester Scale (MS). Pearson's partial correlation analysis was performed between the FCQ and the MS scores, controlling for the influence of extrapyramidal adverse effects.

RESULTS

The analysis revealed that the MS positive symptom score had significant positive correlations with the FCQ total score and subscales scores. The MS negative symptom score did not have significant correlations with the FCQ scores.

CONCLUSIONS

The results of our study suggest that subjective experiences are significantly associated with positive symptomatology in schizophrenia, suggesting that they may share a common underlying neural basis. Future prospective studies are necessary to confirm the stability of these relationships and to explore the diagnostic and therapeutic implications of subjective experiences in a diverse group of patients at different stages of illness.

Psychopathological assessment of schizophrenia: relevance for classification

Considerable effort has been focused on updating the clinical aspects of psychiatric classifications based on recent progress in the field of neurobiology. In this article, recent developments in the primary assessment methods within clinical psychiatry, which are based in phenomenological psychopathology, are reviewed as nosotaxies that are still embedded in clinical description. New directions for research on psychopathology are outlined to elicit better descriptions of subjective experience from patients. Finally, the known limitations of the Kraepelinian dichotomy are summarized, and future problems related to the inclusion of the new dimensional assessment methods in the next psychiatric classifications are described.

Potential Endophenotype for Schizophrenia: Neurological Soft Signs

Introduction: Neurological soft signs (NSS) are suggested as a candidate endophenotype for schizophrenia. This article aims to review relevant literature and discuss the role of NSS in understanding schizophrenia. Methods: This is an update on a review article published in 2003. Articles from 2003 onwards were specifically reviewed and discussed with relevance to the role of NSS as endophenotype for schizophrenia. Results: Consistent data suggest an excess of NSS in schizophrenic patients. NSS appear to be related to schizophrenic symptoms, in particular negative symptoms and disorganisation. Information on NSS and demographic correlates is scarce, and the confounding effects between age, education and intelligence on NSS constitute an important gap in current knowledge. Longitudinal data suggest NSS as both a trait and state variable in the course of disease. NSS are not specific with regard to diagnosis, although there are claims that individual sub-components may be more specific. The weight of evidence raises question on the specificity of NSS for schizophrenia. Conclusions: The usefulness and feasibility of NSS as a specific endophenotype target for schizophrenia is unclear. However, NSS remain an important feature and symptom correlate of schizophrenia. Future research should focus on delineating the effects of NSS from those of confounding demographic variables, and the stability of NSS over the course of illness to elucidate its role in schizophrenia. Key words: Diagnostic specificity, Neurological examination abnormalities, Psychotic symptoms, Review, Trait

Non-motor cognitive-perceptual dysfunction associated with drug-induced parkinsonism

OBJECTIVE

The purpose of the present study was to examine the relationship between drug-induced parkinsonism (DIP) and subjective non-motor cognitive impairments in schizophrenia by performing comprehensive assessments of extrapyramidal side effects (EPS) and the subjective cognitive-perceptual functioning.

METHODS

Ninety-one outpatients with schizophrenia were evaluated for DIP and other EPS. Subjective cognitive-perceptual dysfunction was comprehensively assessed using the Frankfurt Complaint Questionnaire (FCQ). To examine the association between DIP and non-motor cognitive-perceptual dysfunction, Pearson's partial correlation analysis was performed between the FCQ scores and the severity of DIP, controlling for relevant variables.

RESULTS

The analysis revealed that the severity of DIP had a significant correlation with the total FCQ score (p < 0.05). In phenomenological subscales, the severity of DIP showed significant correlations with "deterioration of discrimination," "psychomotor disorder," "perceptual disorder," "cognitive floating," and "automatic behavior disorder" (p < 0.05).

CONCLUSIONS

The results of our study suggest that DIP is significantly associated with a wide range of subjective non-motor cognitive impairments. Clinicians should be careful of the appearance of DIP and the associated non-motor cognitive-perceptual symptoms, which may cause considerable distress and reduce the quality of life in an already vulnerable group of patients.

Cognitive performance and basic symptoms in first-degree relatives of schizophrenic patients

The aim of the present study was to examine cognitive performance and basic symptoms (BS) in the relatives of schizophrenic patients. The experimental sample comprised 24 first-degree relatives of patients. Each relative was matched to one control. Cognitive tests were: Continuous Performance Test (CPT), N-Back Working Memory Test (N-BACK), Negative Priming Test (NPT), and Span of Apprehension Test (SPAN). The Basic Symptoms Questionnaire (FBF) was used to measure subjective disturbances. The relatives showed only slightly worse cognitive performance than the controls, especially in the tasks with greater cognitive processing load. The relatives also revealed more BS than the controls in the domain of thought, attention, memory, language, and visual representation. Only CPT performance was hardly associated with BS. The negative correlation between FBF and CPT was strongly evident in the relatives with poorer processing capacity. This finding suggests that the BS are associated with sustained attention performance. Future research is needed to clarify whether BS are related to other cognitive domains.

Association of subjective cognitive dysfunction with akathisia in patients receiving stable doses of risperidone or haloperidol

BACKGROUND AND OBJECTIVE

Antipsychotic-induced akathisia leads to poor compliance with medication and is still a source of concern in the treatment with antipsychotic drugs. Regarding clinical characteristics, the distinguishing features of akathisia in comparison with other extrapyramidal syndromes are prominent subjective symptoms. The purpose of the present study was to examine the subjective cognitive dysfunction associated with antipsychotic-induced akathisia.

METHODS

Sixty-seven outpatients with schizophrenia receiving stable doses of risperidone or haloperidol were evaluated for akathisia and other extrapyramidal side effects. Subjective cognitive dysfunction was comprehensively assessed using the Frankfurt Complaint Questionnaire (FCQ). The severity of subjective cognitive deficits was compared between the groups with and without akathisia using analysis of covariance with relevant variables as covariates.

RESULTS

The akathisia group (n = 25) scored significantly higher on the total FCQ score than the non-akathisia group (n = 42) (P < 0.05). In phenomenological subscale scores, the akathisia group had significantly higher scores on various subscales, i.e. 'anxiety', 'disorder of selective attention', 'deterioration of discrimination', 'perceptual disorder' and 'disorder of coping responses' than the non-akathisia group (P < 0.05).

CONCLUSIONS

These results suggest that akathisia is significantly associated with a variety of subjective cognitive-perceptual deficits. Early therapeutic interventions for akathisia should be performed considering its significant association with the subjective cognitive dysfunction and the impairment of coping responses.

Subjective cognitive dysfunction associated with drug-induced parkinsonism in schizophrenia

The authors investigated the subjective cognitive dysfunction associated with drug-induced parkinsonism (DIP) among 58 stabilized schizophrenic outpatients. Subjective cognitive dysfunction was comprehensively assessed using the Frankfurt Complaint Questionnaire (FCQ). Multivariate analysis revealed that the DIP group scored significantly higher on the total FCQ score than the non-DIP group. In phenomenological subscale scores, the DIP group had significantly higher scores on "deterioration of discrimination", "psychomotor disorder", and "perceptual disorder" than the non-DIP group. These results suggest that DIP is significantly associated with subjective cognitive-perceptual dysfunction, reflecting the complex nature of DIP that includes motor and cognitive aspects.

Eppendorfer Schizophrenie-Inventar (ESI) vs. Frankfurter Beschwerde-Fragebogen (FBF)

This study is the first to directly compare two clinical questionnaires which are both aimed at self-experienced cognitive dysfunctions of schizophrenia: Eppendorf Schizophrenia Inventory (ESI) and Frankfurt Complaint Questionnaire (FCQ). Evaluated were (a) diagnostic validity, (b) psychometric properties, (c) scale intercorrelations, and (d) factor analytic stability. Ad (a): schizophrenic subjects (n=36) show highly significant increases in the ESI scales and sum score when compared to other clinical groups (patients with depression, alcohol dependence, or obsessive-compulsive disorder, n>30, respectively); on the other hand, the FCQ yields no systematic group differences. Ad (b): mean of reliability coefficients (Cronbach alpha) of the ESI scales is r(tt)=0.86, mean of reliability coefficients of the FCQ scales is significantly lower. Ad (c): the mean intercorrelation between ESI and FCQ scales amounts to r(xy)=0.56 (minimum 0.29, maximum 0.73), corresponding to an average shared variance of about 31%. Ad (d): factor analysis yielded an ESI factor and a FBF factor; one-way ANOVA with the factor scores confirms the diagnostic validity of the ESI.

CONCLUSIONS

ESI and FCQ measure essentially different aspects of schizophrenic psychopathology. Regarding reliability and diagnostic validity, the ESI is superior to the FCQ.

Abnormal subjective experiences of schizophrenia: evaluation of the Eppendorf Schizophrenia Inventory

The Eppendorf Schizophrenia Inventory (ESI) is a new clinical questionnaire aimed at self-experienced cognitive disturbances that are considered to be diagnostically specific for schizophrenia. Two ESI validation studies are presented in this report. The aim of study I was to search for objective correlates of the ESI in 100 schizophrenic inpatients. In study II, the diagnostic validity of the ESI was examined by group comparisons (inpatients with first episode or chronic schizophrenia, alcoholism, depression, or obsessive-compulsive disorder, and healthy adults). Study I yielded numerous plausible correlations between ESI subscales and other clinical scales, neuropsychological tests, psychopathological interview data, and neurological symptoms. Study II supported the diagnostic validity of the ESI. A confirmatory factor analysis conducted with the combined schizophrenic sample from both studies corroborated the assumed factor structure. These results confirm the reliability and validity of the ESI.

Memory and attention performance in psychiatric patients: lack of correspondence between clinician-rated and patient-rated functioning with neuropsychological test results

In the present study, the correspondence between clinician-assessed and self-reported neurocognitive performance was contrasted with scores obtained from psychometric neuropsychological tests in 148 psychiatric in-patients. Results revealed that self-reported cognitive functioning was strongly associated with depressive symptomatology but was only poorly related to psychometric neurocognitive performance, particularly in schizophrenia. After illness denial was controlled for, the overall association between subjective and objective test performance was slightly increased but still failed to reach significance in six out of eight analyses. In approximately 20% to 40% of all cases, clinicians judged memory performance to be normal despite substantial impairment revealed by neuropsychological test results (attention parameters: 7-51%). Since (ecological) validity and reliability have been demonstrated for many neurocognitive paradigms, the present results question the validity of non-psychometric neurocognitive assessment and call for a complementation of clinical judgment with neurocognitive assessment. Reasons for decreased sensitivity of self-reported and clinician-assessed neurocognitive functioning are discussed.

Psychometrische Erfassung charakteristischer subjektiver Zeichen und Symptome der Schizophrenie mit dem Eppendorfer Schizophrenie-Inventar (ESI)

Zusammenfassung. Theoretischer Hintergrund: Das Eppendorfer Schizophrenie-Inventar (ESI) erfasst charakteristische subjektive Zeichen und Symptome der Schizophrenie und kann so zur Verbesserung der Diagnostik beitragen, z.B. bei der Früherkennung und -behandlung psychotischer Störungen. In der vorliegenden Arbeit werden zwei Validierungsstudien zum ESI präsentiert. Fragestellung und Methode: Studie I hatte das Ziel, nach objektivierbaren Korrelaten der mit dem ESI erfassten subjektiven Phänomene zu suchen; N = 100 akut erkrankte Schizophrene wurden eingeschlossen. In Studie II wurde die diagnostische Spezifizität des ESI durch Gruppenvergleiche geprüft (37 ersterkrankte und 30 chronifizierte Schizophrene, 31 Alkoholkranke, 37 Depressive, 34 Zwangskranke, 30 Gesunde). Ergebnisse und Schlussfolgerungen: Studie I erbrachte zahlreiche plausible Korrelationen zwischen ESI-Skalen und anderen klinischen Fragebögen, neuropsychologischen Tests, fremdbeurteilten psychopathologischen und neurologischen Symptomen. Studie II bestätigte die differentialdiagnostische Validität des ESI.

Exploring cognitive complaints in schizophrenia: the subjective scale to investigate cognition in schizophrenia

While it has become commonplace to test the various components of memory in schizophrenia with paper-and-pencil or in-lab tasks, very little data exist on the subjective complaints of patients regarding their memory. Few instruments have been designed to collect systematically the complaints of patients with schizophrenia. We present a work in progress on the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a 21-item, Likert-type scale that is simple and easy to use. It allows a quantitative approach to the subjective and cognitive dimensions of schizophrenia. Stip constructed the scale based on a questionnaire covering several cognitive domains: memory (working memory, explicit long-term memory), attention (divided, distractibility, alertness, sustained), language, and praxia. We evaluated the psychometric properties of the SSTICS in a population of 114 French-speaking patients in Montreal. Patients were recruited in the community and assessed with the Structured Clinical Interview for DSM-III-R (SCID), the Positive and Negative Syndrome Scale (PANSS), and the Extrapyramidal Symptoms Rating Scale (ESRS). Cognition was measured using the Rey Auditory Verbal Learning Test (RAVLT) (long-term memory), Controlled Oral Word Association Test (verbal fluency), and Trails A and B. Preliminary analyses showed very good internal consistency for the global score (alpha=0.88), and alphas varying from 0.57 to 0.72 for the subscales. Stability over time was very good. The principal components analysis accounted for a multiple structure. Correlations between subjective scores and objective cognitive assessment were significant for several domains. Validation of the SSTICS needs to be completed through further exploration of the factorial structure and testing of the English version.

Relationship between neuroleptic dosage and subjective cognitive dysfunction in schizophrenic patients treated with either conventional or atypical neuroleptic medication

Previous research has suggested that high doses of conventional neuroleptics may induce neurocognitive deficits when assessed with standard tasks. However, little is known about the effects of high doses of neuroleptics (conventional or atypical) on subjective cognitive dysfunction. Recent research stresses the putative importance of self-reported cognitive deficits for both symptomatic outcome and medication compliance. The aim of the present study was to investigate the impact of neuroleptic medication on subjective cognition in patients treated with either conventional or atypical agents (clozapine, risperidone, olanzapine). Patients were asked to endorse the items of a questionnaire entitled 'Subjective Well-Being under Neuroleptic Treatment' prior to discharge. Subjective impairment, as assessed with the subscale 'mental functioning', was significantly correlated with greater conventional neuroleptic dosage after controlling for psychopathology (P<0.05). The difference between patients medicated with higher doses of conventional neuroleptics and those with lower doses was highly significant (P<0.001). In contrast, higher atypical neuroleptic doses were not associated with impairment.

Basic symptoms and P300 abnormalities in young schizophrenic patients

Among the reasons for the relatively limited number of investigations of self-knowledge phenomena should be included, in addition to theoretical motives, the difficulties regarding the use of instruments available for this kind of approach and their content validity. This study investigates the relationship between subjective and objective deficits in schizophrenia, taking into account subjective experiences of cognitive impairment, clinical symptoms, and cognitive evoked potentials (P300 component). A group of 36 young schizophrenic patients (29 on neuroleptic treatment and seven drug-naive) were considered, together with a comparison group of 36 healthy subjects. Auditory event-correlated potentials (ERPs) were obtained using a simple "oddball" paradigm. Clinical symptoms were rated with the Brief Psychiatric Rating Scale (BPRS) and Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS), and while subjective disturbances were assessed by the Frankfurter Beschwerde Fragebogen (FBF, also called the Complaint Questionnaire). Correlation analysis showed that P300 amplitude was inversely correlated with subjective experiences of cognitive deficit, especially in the area of automatic skills and overstimulation. No relationship emerged between BPRS, SANS, and SAPS scores and P300 alterations. The results suggest that subjective cognitive disturbances, more than objective symptoms, are related to P300 alterations in schizophrenia, and that the FBF questionnaire appropriately covers the domain of schizophrenic cognitive disorders.

Neuroleptic-induced extrapyramidal symptoms are accompanied by cognitive dysfunction in schizophrenia

Cognitive impairments in schizophrenics have been found to precede tardive dyskinesia and to co-exist with other motor deficits. However, little is yet known about the prevalence of cognitive disturbances in patients with neuroleptic-induced parkinsonism. From the literature on idiopathic parkinson, it was inferred that extrapyramidal symptoms (EPS) are accompanied by cognitive dysfunction. 85 schizophrenic in-patients were divided into EPS high and low scorers according to an established criterion (Simpson Angus Scale, cut-off score: 0.4). Cognitive impairments were assessed using a self-rating instrument measuring disturbances of information processing. Patients with high EPS exhibited significantly elevated scores in six of ten cognitive and perceptual subscales (t = 2.1-3.1) as compared to low EPS patients. It is concluded that high EPS patients suffer from cognitive disturbances which are assumed to possess high relevance for both psycho-social and medical treatment. Cognitive problems may, when not considered, disturb compliance, insight of illness and transfer of learnt skills into everyday life.

Causal mechanisms of subjective cognitive dysfunction in schizophrenic and depressed patients

We examined causal mechanisms of subjective cognitive (dis)abilities in schizophrenic and depressed patients, and in patient and normal control groups. This exploratory study included objective cognitive performance (Continuous Performance Task) as well as mood and mental effort ratings. Self-report of cognitive dysfunction in patients was not correlated with objective cognitive deficits. Correlational patterns differed between groups. Our findings in schizophrenic and depressed patients point to different causal mechanisms of their subjective cognitive malaise, despite similar subjective ratings. Depressed patients associate high mental effort during task performance with a reduced cognitive efficacy, whereas schizophrenic patients associate high effort with cognitive symptoms like distractibility and overload.

Early self-experienced neuropsychological deficits and subsequent schizophrenic diseases: an 8-year average follow-up prospective study

The aim of the present study was to investigate the potential predictive value of early self-experienced neuropsychological deficits for the subsequent development of schizophrenia. A total of 96 patients with DSM-III-R diagnoses of personality disorders (formerly called 'neurotic disorders') who had been examined for the presence of such subjective experiences of deficits with standardized instruments were re-examined for the possible development of schizophrenic symptoms. After an average follow-up period of about 8 years, more than 50% of the patients had developed schizophrenia according to DSM-III-R criteria. In 77% of cases the outcome 'schizophrenia vs. no schizophrenia' was correctly predicted by the earlier presence or absence of self-experienced disturbances of thought, speech, memory, perception and action. These findings suggest that certain self-experienced neuropsychological deficits are able to indicate susceptibility to psychosis.