Reduction in dissociation due to aging and cognitive deficit

Cognition in Patients with Schizophrenia: Interplay between Working Memory, Disorganized Symptoms, Dissociation, and the Onset and Duration of Psychosis, as Well as Resistance to Treatment

Schizophrenia is traditionally associated with the presence of psychotic symptoms. In addition to these, cognitive symptoms precede them and are present during the entire course of the schizophrenia process. The present study aims to establish the relationship between working memory (short-term memory and attention), the features of the clinical picture, and the course of the schizophrenic process, gender distribution and resistance to treatment.

METHODS

In total, 105 patients with schizophrenia were observed. Of these, 66 were women and 39 men. Clinical status was assessed using the Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Dimensional Obsessive-Compulsive Symptom Scale (DOCS), scale for dissociative experiences (DES) and Hamilton Depression Rating Scale (HAM-D)-cognitive functions using the Luria 10-word test with fixation assessment, reproduction and attention analysis. The clinical evaluation of resistance to the treatment showed that 45 patients were resistant to the ongoing medical treatment and the remaining 60 had an effect from the therapy.

RESULTS

Our study showed that, in most patients, we found disorders of working memory and attention. In 69.82% of the patients, we found problems with fixation; in 38.1%, problems with reproduction; and in 62.86%, attention disorders. Conducting a regression analysis showed that memory and attention disorders were mainly related to the highly disorganized symptoms scale, the duration of the schizophrenic process and the dissociation scale. It was found that there was a weaker but significant association between the age of onset of schizophrenia and negative symptoms. In the patients with resistant schizophrenia, much greater violations of the studied parameters working memory and attention were found compared to the patients with an effect from the treatment.

CONCLUSION

Impairments in working memory and attention are severely affected in the majority of patients with schizophrenia. Their involvement is most significant in patients with resistance to therapy. Factors associated with the highest degree of memory and attention impairment were disorganized symptoms, duration of schizophrenia, dissociative symptoms and, to a lesser extent, onset of illness. This analysis gives us the right to consider that the early and systematic analysis of cognition is a reliable marker for tracking both clinical dynamics and the effect of treatment.

Amnesia, flashbacks, nightmares, and dissociation in aging concentration camp survivors

The current study examined to what extent war memories of Dutch survivors of Japanese/Indonesian concentration camps display characteristics that are often believed to be typical for traumatic memories. Twenty-nine survivors were interviewed about amnesia, flashbacks, nightmares and the sensory quality of their most upsetting war memories. In addition, they completed self-report scales measuring post-traumatic stress symptoms and dissociation. In contrast to prevailing notions, amnesia, flashbacks and nightmares were not typical for this sample. Neither were traumatic memories characterized by a particularly strong sensory loading. Post-traumatic stress symptoms were not related to dissociative experiences. At least for this group of aging survivors, it appears that the pathogenic potential of traumatic memories has more to do with their extremely aversive content than with a qualitatively different type of organization of these memories.

Pathological and nonpathological dissociation: the relevance of childhood trauma

Although previous research has implicated a history of childhood trauma in the development of dissociative tendencies, insufficient cognizance (in this context) has been taken of the distinction between pathological and nonpathological dissociation. In this study, the relationship between childhood trauma and both pathological and nonpathological dissociation was investigated in a sample of 100 Australian adults. Pathological dissociation was positively predicted by dimensions of childhood trauma, but no such relationship was found for nonpathological dissociation (psychological absorption). The data are consistent with the traumagenic model of the dissociative disorders, but factors other than childhood trauma may also be pertinent.