The difference of social cognitive and neurocognitive performance between patients with schizophrenia at different stages and influencing factors

Neurocognitive Deficits in First-Episode and Chronic Psychotic Disorders: A Systematic Review from 2009 to 2022

Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.

The alternate-form reliability study of six variants of the Brief Visual-Spatial Memory Test-Revised and the Hopkins Verbal Learning Test-Revised

Introduction

The revised Hopkins Verbal Learning Test-Revised (HVLT-R) and the Brief Visual-Spatial Memory Test-Revised (BVMT-R) are two widely used test involving verbal and visual learning and memory. In the two tests, six different versions are assembled, respectively, to prevent learning effects. Currently, no researchers have compared the six versions of the two tests. Thus, their usefulness in clinical studies requiring multiple follow-ups is limited. In this work, we confirm the equivalence of six HVLT-R and BVMT-R versions.

Methods

20 people completed all six HVLT-R and BVMT-R versions, while 120 people were randomly assigned to complete one of the six versions of each test. The Intelligence Quotient (IQ) level is measured using the short version of the Wechsler Adult Intelligence test. R4.2.0 is used for statistical analysis. The K-Related sample test (a non-parametric test) is used to observe the differences in test scores among the 20 subjects. The one-way Analysis of Variance (ANOVA) test is utilized to analyze the differences in test scores among the 120 subjects. The scores on different versions are compared using two similar sample tests. The HVLT-R Total Learning, the HVLT-R Delayed Recall, the BVMT-R Total Learning, and the BVMT-R Delayed Recall are indexes for comparison. Version and test scores are used as research factors, while different versions are used as research levels.

Results

The results suggest that HVLT-R and BVMT-R versions 3, 5 and 6 are equally difficult, and relatively easy compared to versions 1, 2 and 4. HVLT-R versions 3, 5, and 6 show good reliability and can be used interchangeably when testing word learning ability or short-term memory; BVMT-R Versions 3, 5, and 6 show acceptable reliability and can be can be used interchangeably.

Discussion

In the study of multiple follow-ups, it is a must to avoid discrepant versions and choose other equivalent versions. The results from this study could be used as a guide for upcoming studies and clinical applications in China.

A cross-sectional analysis of registry data of severe mental disorders in Fuzhou, China: current status and prospects

OBJECTIVE

To investigate the proportion of registered cases relative to size, distribution characteristics, medication status, and management status of patients diagnosed with severe mental disorders (SMD) in Fuzhou. The medication status and management status were compared between patients in urban and non-urban areas to provide scientific evidence for improving SMD care, control, and treatment in primary health care institutions.

METHODS

Data (case types, demographic data, distribution data, medication status, and management status, etc.) of patients diagnosed with SMD in 12 districts, counties, and prefectures in the urban and non-urban areas of Fuzhou City were collected from October 2017 to September 2018. Three distributions (population, local, and districts/counties) were used to describe the proportion of registered cases relative to size and clinical characteristics of diagnosed SMD. Chi squared (χ2) test was used to compare the severity in urban and non-urban areas.

RESULTS

A total of 30,362 registered SMD patients were identified in Fuzhou City of which schizophrenia accounted for the highest number of cases (26,204, 86.31%), and paranoid psychosis had the least number of cases (47, 0.15%). Moreover, approximately half of SMD patients were 18 to 44 years old (45.38%). Close to one third of patients were farmers (30.23%), had a primary school or lower education level (54.17%), were poor, with most below the poverty line (55.35%). The proportion of diagnosed SMD relative to size was highest in Minqing County (0.53%) and lowest in Mawei District (0.38%). A total of 22,989 (75.72%) of the patients were taking medications, and only 17,509 (57.67%) were taking medications regularly. Moreover, the percentage of cases taking medications and those taking medications regularly were higher in urban areas than in non-urban areas (P<0.05). A total of 3065 patients were registered for management (10.09%). The managed proportion of SMD cases was higher in the urban areas than in the non-urban areas (P < 0.05).

CONCLUSION

Schizophrenia is a key disease for comprehensive care and control of severe mental disorders in Fuzhou. The management of severe mental disorders should focus on poor groups with low educational backgrounds. Drug usage and management are better in urban areas than in non-urban areas, and thus management should be enhanced in non-urban areas. The medication management and case management of patients with severe mental disorders in Fuzhou need further improvements.

A nation-wide twin study of social cognition in schizophrenia spectrum disorders

We examined social cognition in 32 monozygotic (MZ) and 21 dizygotic (DZ) twin pairs concordant or discordant for a schizophrenia spectrum diagnosis and healthy control (HC) twin pairs (29 MZ/20 DZ). All participants were recruited through the Danish registers. Patients showed several deficits in the ability to detect sarcasm. Impairments were also observed in the unaffected MZ co-twins, indicating that social cognitive deficits could be a genetic vulnerability indicator of the disease. Worse social cognition was associated with lower intelligence and higher levels of psychopathology in patients.

Sex Differences in Social Cognition and Association of Social Cognition and Neurocognition in Early Course Schizophrenia

Background

Both impairment and sex differences in social cognition and neurocognition have been documented in schizophrenia. However, whether sex differences exist in the association between social cognition and neurocognition are not known. We aimed to investigate the contribution of areas of neurocognition to theory of mind (ToM) and hostility bias, representing social cognition, according to sex in early course schizophrenia.

Methods

In this cross-sectional study, we assessed neurocognition using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS) and assessed the ToM and hostility bias subdomains of social cognition using the Social Cognition Screening Questionnaire (SCSQ) in 131 participants (65 female, 66 male) diagnosed with schizophrenia within 5 years of onset. Sex differences were analyzed using t-tests. The associations of neurocognitive subdomains with ToM and hostility bias according to sex were analyzed using multiple regression analysis. Results were adjusted by age, estimated premorbid intelligence quotient, and symptomatology.

Results

No sex differences were found in ToM (p = 0.071) or hostility bias (p = 0.057). Higher verbal fluency was significantly associated with higher ToM in females (p < 0.01), whereas higher executive function was significantly associated with higher ToM in males (p < 0.05). Higher verbal fluency was significantly associated with lower hostility bias in females (p < 0.05), whereas neurocognition and hostility bias were not significantly associated in males.

Conclusion

The results suggest that neurocognition associated with social cognition differ according to sex. These differences should be considered for more effective treatment of social cognition.

Emotional Processing Profile in Patients with First Episode Schizophrenia: The Influence of Neurocognition

This study sought to investigate the influence of neurocognition on the emotional processing profiles of patients with first-episode schizophrenia, using the 4-branch Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Perceiving Emotions; Facilitating Emotions; Understanding Emotions and Managing Emotions). A sample of 78 patients with first-episode schizophrenia and a group of 90 non-psychiatric control subjects were included in this work. The initial results showed that patients had lower scores than controls for the “Understanding Emotions” and “Managing Emotions” MSCEIT branches. However, after controlling for neurocognition, the only deficits were found on the “Managing Emotions” branch of the MSCEIT. This branch can be considered as measuring a more sophisticated level of emotional processing, which may constitute a deficit in itself. In conclusion, patients with first-episode schizophrenia present deficits in social cognition at the highest level that seem to be independent from neurocognition. These findings support the inclusion of the “Managing Emotions” branch of the MSCEIT as part of the MCCB.

rTMS Induces Brain Functional and Structural Alternations in Schizophrenia Patient With Auditory Verbal Hallucination

BACKGROUND

Low-frequency transcranial magnetic stimulation (rTMS) over the left temporoparietal cortex reduces the auditory verbal hallucination (AVH) in schizophrenia. However, the underlying neural basis of the rTMS treatment effect for schizophrenia remains not well understood. This study investigates the rTMS induced brain functional and structural alternations and their associations with clinical as well as neurocognitive profiles in schizophrenia patients with AVH.

METHODS

Thirty schizophrenia patients with AVH and thirty-three matched healthy controls were enrolled. The patients were administered by 15 days of 1 Hz rTMS delivering to the left temporoparietal junction (TPJ) area. Clinical symptoms and neurocognitive measurements were assessed at pre- and post-rTMS treatment. The functional (amplitude of low-frequency fluctuation, ALFF) and structural (gray matter volume, GMV) alternations were compared, and they were then used to related to the clinical and neurocognitive measurements after rTMS treatment.

RESULTS

The results showed that the positive symptoms, including AVH, were relieved, and certain neurocognitive measurements, including visual learning (VisLearn) and verbal learning (VerbLearn), were improved after the rTMS treatment in the patient group. Furthermore, the rTMS treatment induced brain functional and structural alternations in patients, such as enhanced ALFF in the left superior frontal gyrus and larger GMV in the right inferior temporal cortex. The baseline ALFF and GMV values in certain brain areas (e.g., the inferior parietal lobule and superior temporal gyrus) could be associated with the clinical symptoms (e.g., positive symptoms) and neurocognitive performances (e.g., VerbLearn and VisLearn) after rTMS treatment in patients.

CONCLUSION

The low-frequency rTMS over the left TPJ area is an efficacious treatment for schizophrenia patients with AVH and could selectively modulate the neural basis underlying psychiatric symptoms and neurocognitive domains in schizophrenia.