Test-retest stability of neuropsychological testing and individual differences in variability in schizophrenia outpatients

The effects of guided discontinuation of antipsychotics on neurocognition in first onset psychosis

Objective

To assess the effects of second generation antipsychotics on neurocognitive function in patients with stable remission of first episode psychosis.

Methods

Fifty-three patients with first onset psychosis in the schizophrenia spectrum entered a randomised controlled trial of guided discontinuation (GD) versus maintenance treatment (MT) with second generation antipsychotics. A comprehensive neurocognitive test battery was administered at the time of remission and shortly after dose reduction or discontinuation (GD-group) or at the same time in the MT-group.

Results

With the exception of negative symptoms, PANSS scores decreased over time and neurocognition improved significantly on most tests in both groups. The GD-group, however, improved significantly more than the MT-group on three neurocognitive measures in the domain of speed of processing.

Conclusion

These data suggest that, in first episode patients, dose reduction or discontinuation of second generation antipsychotics after stable remission is achieved, might improve neurocognitive function more than continuing second generation antipsychotics, suggesting a negative role for second generation antipsychotics, specifically in the domain of speed of processing.

Effectiveness of integrated psychological therapy on cognitive function among Lebanese patients with schizophrenia: a pilot study

Background: The integrated term emphasises the need for cognitive therapy to always be embedded into an extended treatment concept adapted to cognitive resources and deficits and to patient rehabilitation. One of the first approaches is integrated psychological therapy (IPT).Aim: To assess the effect of the IPT Programme compared to the Treatment as Usual (TaU) in terms of cognitive performance and social skills among a group of schizophrenic patients.Methods: This randomised controlled study enrolled 20 patients in each group. Patients attended 60-min sessions, 3 days/week.Results: When considering the TaU group, the bivariate results showed that significantly higher means of attention scores, lower means in social dysfunction and aggression, social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be weak. When considering the IPT group, significantly higher means attention score, lower means cognitive disorders, social dysfunction, aggression and social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be high.Conclusion: The therapeutic combination of the IPT programme with medical treatment has shown additional beneficial effects on the schizophrenic patients' treatment, enabling them, as far as possible, to reintegrate into the community.KEY POINTSIn cases, a significantly higher GZ-F and KL scores and a lower SDAS-9 and SDAS-6 scores were found post-IPT respectively.In controls, a significant increase in the GZ-F and KL subscales and a decrease in all other scales was found post-IPT respectively.This therapeutic combination of the integrative programme with medical treatment has shown additive beneficial effects in patients with schizophreniaThe treatment approach would allow them, as far as possible, to reintegrate within the community.

Exploring the Role of Meditation and Dispositional Mindfulness on Social Cognition Domains: A Controlled Study

Research suggests that mindfulness can induce changes in the social domain, such as enhancing emotional connection to others, prosocial behavior, and empathy. However, despite growing interest in mindfulness in social psychology, very little is known about the effects of mindfulness on social cognition. Consequently, the aim of this study was to explore the relationship between mindfulness and social cognition by comparing meditators with non-meditators on several social cognition measures. A total of 60 participants (meditators, n = 30; non-meditators, n = 30) were matched on sex, age, and ethnic group, and then asked to complete the following assessment measures: Mindful Awareness Attention Scale (MAAS), Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF), Interpersonal Reactivity Index (IRI), Revised Eyes Test, Hinting Task, Ambiguous Intentions and Hostility Questionnaire (AIHQ), Hospital Anxiety and Depression Scale (HADS), and Screening for Cognitive Impairment in Psychiatry (SCIP). The results showed that meditators reported higher empathy (except for the personal distress subscale), higher emotional recognition, higher theory of mind (ToM), and lower hostile attributional style/bias. The findings also demonstrated that dispositional mindfulness (both total score assessed with MAAS and mindfulness facets using the FFMQ) was associated with social cognition, although it was not equally correlated with all social cognition outcomes, and correlation patterns differ when analyses were conducted separately for meditators and non-meditators. In addition, results showed potential predictors for each social cognition variable, highlighting non-reactivity to inner experience as a key component of mindfulness in order to explain social cognition performance. In summary, the findings indicated that the meditator sample performed better on certain qualities (i.e., empathy, emotional recognition, ToM, hostile attributional style/bias) in comparison to non-meditators and, furthermore, support the notion that mindfulness is related to social cognition, which may have implications for the design of mindfulness-based approaches for use in clinical and non-clinical settings.

Rethinking Body Ownership in Schizophrenia: Experimental and Meta-analytical Approaches Show no Evidence for Deficits

Schizophrenia is a severe psychiatric disorder, in which patients experience an abnormal sense of self. While deficits in sensorimotor self-representation (agency) are well documented in schizophrenia, less is known about other aspects of bodily self-representation (body ownership). Here, we tested a large cohort (N = 59) of chronic schizophrenia patients and matched controls (N = 30) on a well-established body illusion paradigm, the Full Body Illusion (FBI). In this paradigm, changes in body ownership are induced through prolonged multisensory stimulation, in which participants are stroked on their back while seeing the stroking on the back of a virtual body. When the felt and seen stroking are synchronous, participants typically feel higher identification with the seen body as well as a drift in self-location towards it. However, when the stroking is asynchronous, no such changes occur. Our results show no evidence for abnormal body ownership in schizophrenia patients. A meta-analysis of previous work corroborates this result. Thus, while schizophrenia patients may be impaired in the sense of agency, their multisensory bodily self-representation, as tested here, seems to be unaffected by the illness.

Social cognition psychometric evaluation (SCOPE) in people with early psychosis: A preliminary study

Social cognition is an important outcome in schizophrenia research. Unfortunately, there has been a lack of consensus regarding which measures of social cognition best capture this domain of functioning. The Social Cognition Psychometric Evaluation (SCOPE) study was developed to address the need for a battery of measures that have sound psychometric properties and can be implemented in clinical trials for individuals with chronic schizophrenia. The current study expands upon the SCOPE study by examining the psychometric properties of the eight candidate measures administered to individuals early in the course of psychosis. Thirty-eight stable outpatients with first episode psychosis and thirty-nine healthy controls completed the battery at baseline and one-month follow-up assessments. The SCOPE battery was evaluated on a collection of psychometric properties, including: (1) Reliability - including test-retest and internal consistency, (2) Between group differences, (3) Utility as a repeated measure, (4) Relationship to social and occupational functioning, (5) Incremental validity - variance in functioning beyond neurocognition, and (6) Feasibility - including practicality of administration and tolerability. Social cognition accounted for substantially more variance in functional outcome than neurocognition. Only one measure, the Hinting task, displayed adequate psychometric properties to be recommended for use in clinical research with first episode psychosis. The remaining candidate measures would require modifications before implementation or cannot be recommended for use in clinical research with first episode psychosis.

Cognitive Performance in Patients with Chronic Schizophrenia Across the Lifespan

Abstract. Chronic schizophrenia involves neuropsychological deficits that primarily strike executive functions and episodic memory. Our study investigated these deficits throughout the lifespan in patients with chronic schizophrenia and in healthy controls. Important neuropsychological functions were tested in 94 patients and 66 healthy controls, who were assigned to three age groups. Compared with the healthy controls, patients performed significantly poorer on all tests applied. Significant age effects occurred on all tests except the digit span forward, with older subjects scoring well below the younger ones. With respect to cognitive flexibility, age effects were more pronounced in the patients. These findings underline the importance of cognitive deficits in chronic schizophrenia and indicate that diminished cognitive flexibility shows age-associated differences.

Temporal stability and moderating effects of age and sex on CNTRaCS task performance

Research in schizophrenia has increasingly focused on incorporating measures from cognitive neuroscience, but little is known about their psychometric characteristics. Here, we extend prior research by reporting on temporal stability, as well as age and sex effects, for cognitive neuroscience paradigms optimized as part of the Cognitive Neuroscience Test Reliability and Clinical applications for Schizophrenia consortium. Ninety-nine outpatients with schizophrenia and 131 healthy controls performed 5 tasks assessing 4 constructs at 3 sessions. The constructs were (1) Goal maintenance (Dot Probe Expectancy [DPX] and AX continuous performance tasks [AX-CPT]); (2) Episodic memory (Relational and Item-Specific Encoding and Retrieval task [RiSE]); (3) Visual integration (Jittered Orientation Visual Integration task [JOVI]); and (4) Perceptual gain control (Contrast-Contrast Effect Task [CCE]). Patients performed worse than controls on all but the CCE, and the magnitude of these group differences was stable across sessions, with no sex differences observed. Improvements over sessions were seen for the AX-CPT, the DPX, and the JOVI though practice effects for the AX-CPT and the DPX were primarily present in older participants. For the AX-CPT and the JOVI, practice effects were larger for T1 to T2 than for T2 to T3. Age was associated with poor associative recognition on the RiSE and accuracy on the JOVI. Test-rest reliability ranged from poor for the JOVI threshold score to adequate to good for the DPX, AX-CPT, and JOVI accuracy measures, with RiSE and CCE measures in the moderate range. These results suggest that group differences in DPX, AX-CPT, RiSE, and JOVI are robust and consistent across repeated testing.

The robust reliability of neuropsychological measures: meta-analyses of test-retest correlations

Test-retest reliability is an important psychometric property relevant to assessment instruments typically used in neuropsychological assessment. This review presents a quantitative summary of test-retest reliability coefficients for a variety of widely used neuropsychological measures. In general, the meta-analytic test-retest reliabilities of the test scores ranged from adequate to high (i.e., r=.7 and higher). Furthermore, the reliability values were largely robust across factors such as age, clinical diagnosis, and the use of alternate forms. The values for some of the memory and executive functioning scores were lower (i.e., less than r=.7). Some of the possible reasons for these lower values include ceiling effects, practice effects, and across time variability in cognitive abilities measured by those tests. In general, neuropsychologists who use these measures in their assessments can be encouraged by the magnitude of the majority of the meta-analytic test-retest correlations obtained.

Combining computerized social cognitive training with neuroplasticity-based auditory training in schizophrenia

OBJECTIVE

Social cognitive deficits are an important treatment target in schizophrenia, but it is unclear to what degree they require specialized interventions and which specific components of behavioral interventions are effective. In this pilot study, we explored the effects of a novel computerized neuroplasticity-based auditory training delivered in conjunction with computerized social cognition training (SCT) in patients with schizophrenia.

METHODS

Nineteen clinically stable schizophrenia subjects performed 50 hours of computerized exercises that place implicit, increasing demands on auditory perception, plus 12 hours of computerized training in emotion identification, social perception, and theory of mind tasks. All subjects were assessed with MATRICS-recommended measures of neurocognition and social cognition, plus a measure of self-referential source memory before and after the computerized training.

RESULTS

Subjects showed significant improvements on multiple measures of neurocognition. Additionally, subjects showed significant gains on measures of social cognition, including the MSCEIT Perceiving Emotions, MSCEIT Managing Emotions, and self-referential source memory, plus a significant decrease in positive symptoms.

CONCLUSIONS

Computerized training of auditory processing/verbal learning in schizophrenia results in significant basic neurocognitive gains. Further, addition of computerized social cognition training results in significant gains in several social cognitive outcome measures. Computerized cognitive training that directly targets social cognitive processes can drive improvements in these crucial functions.

Cognitive efficacy of quetiapine in early-onset first-episode psychosis: a 12-week open label trial

Twenty-three adolescents with psychotic disorders, aged from 13 to 18 years, participated in a 12-week open label trial (17 adolescents completed the study) in order to examine the impact of quetiapine on clinical status and cognitive functions (encompassing processing speed, attention, short-term memory, long-term memory and executive function). An improvement in Clinical Global Impression and Positive and Negative Symptom Scale (P's ≤ 0.001) was observed. In addition, after controlling for amelioration of symptoms, a significant improvement was observed on one executive function (P = 0.044; Trail Making Part B). The remaining cognitive abilities showed stability. In addition, we observed an interaction between quetiapine doses (>300 mg/day or <300 mg/day) and time, where lower doses showed more improvement in verbal short-term memory (P = 0.048), inhibition abilities (P = 0.038) and positive symptoms (P = 0.020). The neuropsychological functioning of adolescents with psychotic disorders remained mainly stable after 12 weeks of treatment with quetiapine. However, lower doses seemed to have a better impact on two components of cognition (inhibition abilities and verbal short-term memory) and on positive symptoms.

Memory profiles in schizophrenia: categorization validity and stability

BACKGROUND

Memory profiles corresponding to nearly normal (NN), Subcortical impairment (Sub) and Cortical impairment (Cort) have been identified in schizophrenia by several investigators using cluster analytic techniques. Specific aims of the current study were to (1) perform a K means cluster analysis using Hopkins Verbal Learning Test-R scores (2) create classification rules based upon cluster distributions and expected memory profiles and to determine their concordance with cluster analysis; (3) explore differences among classified groups on demographic, neurocognitive and social cognitive domains; and (4) determine the stability of the classifications 12 months later.

METHODS

Clinical and neuropsychological assessments were obtained at intake and 12 months from 151 outpatients with schizophrenia or schizoaffective disorder from an urban community mental health center.

RESULTS

Clusters corresponded to those of the three expected subgroups. Using simple decision rules, rationally-derived groups were created and had 90% classification agreement with cluster groups. Groups did not differ on illness characteristics. Groups differed significantly in neurocognitive and social cognitive domains with NN>Cort and NN>Sub in all domains except visual/motor speed. Sub>Cort in verbal working memory. NN>Cort in social cognition. Rationally derived groupings showed fair stability at 12 month follow-up with 65% classification agreement. Specificity was good for NN (82.4%).

DISCUSSION

Results support validity of memory profiles and offer some support for their stability at 12 months. The simple rules for classification can be used by other investigators for neuroimaging and other studies. Findings support the hypothesis that verbal memory may be an important source of heterogeneity in schizophrenia.

Effects of presentation modality and valence on affect recognition performance in schizophrenia and healthy controls

The majority of affect recognition research has used visual stimuli, with only a minority of studies examining auditory affect recognition, and fewer still comparing affect recognition across presentation modalities. In the current study, we evaluated affect recognition between 45 outpatients with schizophrenia or schizoaffective disorder and 56 healthy community controls on an auditory-only affect recognition task, as compared to a multichannel (videotape) version of the same task. We further examined between-group performance differences on auditory versus multichannel presentation modalities for a subset of positive and negative valence items. Results indicated that: 1) in general, healthy controls performed better than schizophrenia patients on affect recognition; 2) schizophrenia patients benefited less from a multichannel task presentation than did healthy controls, and 3) schizophrenia patients did not significantly differ from healthy controls on positive-valenced items presented in the auditory modality. These findings suggest the importance of carefully considering presentation modality and affective valence when assessing affect recognition in schizophrenia.

Stability of cognitive impairment in chronic schizophrenia over brief and intermediate re-test intervals

OBJECTIVE

This study examined between- and within-subject stability of cognitive performance in individuals with chronic schizophrenia.

METHODS

Thirty individuals with schizophrenia and 20 healthy controls matched by age, sex, education, and estimated IQ underwent repeated cognitive assessments at baseline and 30 days using computerized tests of psychomotor function, visual attention/information processing, non-verbal learning, and executive function.

RESULTS

Compared to healthy controls, individuals with schizophrenia scored lower on all cognitive measures and demonstrated greater variability in cognitive performance. Within-subject variability in cognitive performance in both the schizophrenia and healthy control groups remained stable at brief (i.e., hours) and intermediate (i.e., one month) assessments.

CONCLUSIONS

These results demonstrate the stability of between- and within-subject variability in cognitive performance in schizophrenia, and suggest that variability in cognitive performance may reflect an inherent characteristic of the disorder, rather than differences in test-retest reliability/error of cognitive measures.

Brief report: feasibility of social cognition and interaction training for adults with high functioning autism

The goal of this study was to evaluate the feasibility and utility of a group-based cognitive behavioral intervention to improve social-cognitive functioning in adults with high-functioning autism (HFA). We modified the treatment manual of a previously validated intervention, Social Cognition and Interaction Training (SCIT), for optimal use with HFA adults (SCIT-A). We then conducted a pilot study to compare SCIT-A (n = 6) to treatment as usual (TAU) (n = 5) for adults with HFA. Feasibility was supported; attendance was high (92%) and satisfaction reports were primarily positive. Participants in SCIT-A showed significant improvement in theory-of-mind skills and trend level improvements in social communication skills; TAU participants did not show these improvements. Findings indicate SCIT-A shows promise as an intervention for adults with HFA.

Improved cognitive function in schizophrenia after one year of cognitive training and vocational services

A year-long program of Neurocognitive Enhancement Therapy (NET) was used to remediate cognitive deficits in people with schizophrenia who were participating in a vocational program. Seventy-two stable outpatients with schizophrenia or schizoaffective disorder, recruited from an urban community mental health center were randomly assigned to a twelve-month vocational program (VOC) or NET+VOC. The vocational program had characteristics of individual placement and support (IPS) programs but also included transitional funding. NET included computer-based cognitive training exercises, a social information processing group and a work feedback group. Sixty-two participants completed a neuropsychological test battery before and after treatment. After one year of treatment, participants receiving NET+VOC had significantly greater improvements on measures of executive function and working memory than did participants in the VOC only condition. Augmenting vocational services with a multifaceted cognitive remediation program may improve cognition in participants with schizophrenia or schizoaffective disorder.

Cognitive remediation therapy in schizophrenia: randomised controlled trial

BACKGROUND

Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long-term functioning.

AIMS

To evaluate the effectiveness of cognitive remediation therapy on cognitive difficulties experienced by people with schizophrenia.

METHOD

Participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty (n=85) were randomised to 40 sessions of cognitive remediation or treatment as usual in a single-blind randomised controlled trial. Working memory, cognitive flexibility and planning, were measured at weeks 0,14 and 40.

RESULTS

There were durable improvements in working memory (advantage 1.33 points, 95% CI 0.43-2.16, standardised effect size 0.34) as well as an indication of improvement in cognitive flexibility. Memory improvement predicted improvement in social functioning. Costs were lower in the cognitive remediation group following therapy but rose at follow-up. However, cost-effectiveness analyses showed that improvements in memory were achieved at little additional cost.

CONCLUSIONS

Cognitive remediation therapy is associated with durable improvements in memory, which in turn are associated with social functioning improvements in people with severe mental illness.

Therapieverfahren zu sozialen Fertigkeiten bei schizophren Erkrankten in der Arbeitsrehabilitation

Zusammenfassung. Theoretischer Hintergrund: Die Arbeitsrehabilitation zählt heute zu den zentralen Ansätzen in der Behandlung und Rehabilitation schizophren Erkrankter. Fragestellung: Evaluation eines neu entwickelten manualisierten kognitiven Therapieverfahrens zu sozialen Fertigkeiten für den Arbeitsbereich (Experimentalgruppe, EG). Methode: Ziel der Studie war die EG mit einem herkömmlichen, unspezifischen Sozialen Fertigkeitstraining (Kontrollgruppe, KG) in einem bedingt randomisierten Studiendesign zu vergleichen. Insgesamt nahmen 41 ambulante oder teilstationäre schizophren Erkrankte an der Studie teil. Ergebnisse: Die EG-Patienten erzielten signifikant größere Effekte in Variablen zu Psychopathologie und Therapiemotivation verglichen mit den KG-Patienten. EG und KG unterschieden sich in der kognitiven und sozialen Funktionsfähigkeit nicht signifikant. Eine höhere Therapiemotivation erwies sich als Prädiktor für eine Reduktion negativer Symptome und ein verbessertes soziales Funktionsniveau in der Katamneseerhebung. Zusätzlich nahmen EG-Patienten vermehrt eine kompetitive Arbeit auf als KG-Patienten. Schlussfolgerungen: Der neu entwickelte Therapieansatz (EG) könnte eine effektive zusätzliche Behandlungsmöglichkeit innerhalb einer multimodalen Arbeitsrehabilitation darstellen.