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Bansal S, Bae GY, Robinson BM, Dutterer J, Hahn B, Luck SJ, Gold JM. Qualitatively Different Delay-Dependent Working Memory Distortions in People With Schizophrenia and Healthy Control Participants. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1218-1227. [PMID: 37459911 PMCID: PMC10792108 DOI: 10.1016/j.bpsc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Impairments in working memory (WM) have been well documented in people with schizophrenia (PSZ). However, these quantitative WM impairments can often be explained by nonspecific factors, such as impaired goal maintenance. Here, we used a spatial orientation delayed response task to explore a qualitative difference in WM dynamics between PSZ and healthy control participants (HCs). More specifically, we took advantage of the discovery that WM representations may drift either toward or away from previous trial targets (serial dependence). We tested the hypothesis that WM representations would drift toward the previous trial target in HCs but away from the previous trial target in PSZ. METHODS We assessed serial dependence in PSZ (n = 31) and HCs (n = 25) using orientation as the to-be-remembered feature and memory delays lasting from 0 to 8 seconds. Participants were asked to remember the orientation of a teardrop-shaped object and reproduce the orientation after a delay period of varying length. RESULTS Consistent with prior studies, we found that current trial memory representations were less precise in PSZ than in HCs. We also found that WM for the current trial orientation drifted toward the previous trial orientation in HCs (representational attraction) but drifted away from the previous trial orientation in PSZ (representational repulsion). CONCLUSIONS These results demonstrate a qualitative difference in WM dynamics between PSZ and HCs that cannot be easily explained by nuisance factors such as reduced effort. Most computational neuroscience models also fail to explain these results because they maintain information solely by means of sustained neural firing, which does not extend across trials. The results suggest a fundamental difference between PSZ and HCs in longer-term memory mechanisms that persist across trials, such as short-term potentiation and neuronal adaptation.
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Affiliation(s)
- Sonia Bansal
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland.
| | - Gi-Yeul Bae
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Benjamin M Robinson
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Jenna Dutterer
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Britta Hahn
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Steven J Luck
- Center for Mind & Brain and Department of Psychology, University of California, Davis, Davis, California
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
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Cai R, Huang C, Ni L, Liu Z, Zhang S, Qiu Y, Hu J, Gao J, Yu M, Tang X, Zhou C, Zhang X, Zhang X, Fang X. The motivation and pleasure deficits but not expressivity affects social functioning through cognitive function in male patients with schizophrenia: A structural equation model. Asian J Psychiatr 2023; 85:103616. [PMID: 37163944 DOI: 10.1016/j.ajp.2023.103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study aims to compare cognitive function and social functioning in male schizophrenia patients with deficit syndrome (DS) and non-DS, and to explore the associations among two different dimensions of negative symptoms (motivation and pleasure (MAP) and expressivity (EXP) deficits), cognitive function and social functioning base on a Structural Equation Model (SEM). METHODS The current study enrolled 161 male schizophrenia patients and 120 age- and education- matched healthy controls. The DS and non-DS group were categorized by the Chinese version of Schedule for the Deficit Syndrome (SDS). The psychotic and negative symptoms were evaluated by the Brief Psychiatric Rating Scale (BPRS) and the Brief Negative Symptoms Scale (BNSS). The Social functioning was measured by Scale of Social function in Psychosis Inpatients (SSPI). A battery of classical neurocognitive tests was used for assessing cognition including sustained vigilance/attention, cognitive flexibility, ideation fluency and visuospatial memory. RESULTS Our study indicated that DS patients performed worser in cognitive function and social functioning than non-DS patients. The SEM model demonstrated that MAP significantly affected social functioning through direct influence and mediation of cognitive function. However, our results found that EXP had little influence on cognitive function and social function. CONCLUSION Our findings provided evidence supporting that DS may represent as a subtype of schizophrenia, and the MAP factor play a pivotal role to influence the cognitive and social functioning in schizophrenia patients.
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Affiliation(s)
- Renliang Cai
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chengbing Huang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Psychiatry, The Third People's Hospital of Huai'an, Huaian 223001, China
| | - Longyan Ni
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zihan Liu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Sijie Zhang
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Yufeng Qiu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Jianing Hu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Ju Gao
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou, Jiangsu 215008, China
| | - Miao Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaowei Tang
- Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou, Jiangsu 215008, China; Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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3
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Bansal S, Bae GY, Robinson BM, Dutterer J, Hahn B, Luck SJ, Gold JM. Qualitatively different delay-dependent working memory distortions in people with schizophrenia and healthy control subjects. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.04.535597. [PMID: 37066149 PMCID: PMC10104073 DOI: 10.1101/2023.04.04.535597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Impairments in working memory(WM) have been well-documented in people with schizophrenia(PSZ). However, these quantitative WM impairments can often be explained by nonspecific factors, such as impaired goal maintenance. Here, we used a spatial orientation delayed-response task to explore a qualitative difference in WM dynamics between PSZ and healthy control subjects(HCS). Specifically, we took advantage of the discovery that WM representations may drift either toward or away from previous-trial targets(serial dependence). We tested the hypothesis that WM representations drift toward the previous-trial target in HCS but away from the previous-trial target in PSZ. Methods We assessed serial dependence in PSZ(N=31) and HCS(N=25), using orientation as the to-be-remembered feature and memory delays from 0 to 8s. Participants were asked to remember the orientation of a teardrop-shaped object and reproduce the orientation after a varying delay period. Results Consistent with prior studies, we found that current-trial memory representations were less precise in PSZ than in HCS. We also found that WM for the current-trial orientation drifted toward the previous-trial orientation in HCS(representational attraction) but drifted away from the previous-trial orientation in PSZ(representational repulsion). Conclusions These results demonstrate a qualitative difference in WM dynamics between PSZ and HCS that cannot easily be explained by nuisance factors such as reduced effort. Most computational neuroscience models also fail to explain these results, because they maintain information solely by means of sustained neural firing, which does not extend across trials. The results suggest a fundamental difference between PSZ and HCS in longer-term memory mechanisms that persist across trials, such as short-term potentiation and neuronal adaptation.
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Affiliation(s)
- Sonia Bansal
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gi-Yeul Bae
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Benjamin M Robinson
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jenna Dutterer
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Britta Hahn
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Steven J Luck
- Center for Mind & Brain and Department of Psychology, University of California, Davis, Davis, California
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Berkovitch L, Gaillard R, Abdel-Ahad P, Smadja S, Gauthier C, Attali D, Beaucamps H, Plaze M, Pessiglione M, Vinckier F. Preserved Unconscious Processing in Schizophrenia: The Case of Motivation. Schizophr Bull 2022; 48:1094-1103. [PMID: 35751516 PMCID: PMC9434445 DOI: 10.1093/schbul/sbac076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND HYPOTHESIS Motivation deficit is a hallmark of schizophrenia that has a strong impact on their daily life. An alteration of reward processing has been repeatedly highlighted in schizophrenia, but to what extent it involves a deficient amplification of reward representation through conscious processing remains unclear. Indeed, patients with schizophrenia exhibit a disruption of conscious processing, whereas unconscious processing appears to be largely preserved. STUDY DESIGN To further explore the nature of motivational deficit in schizophrenia and the implication of consciousness disruption in this symptom, we used a masking paradigm testing motivation both under conscious and unconscious conditions in patients with schizophrenia (n = 31) and healthy controls (n = 32). Participants were exposed to conscious or subliminal coin pictures representing money at stake and were subsequently asked to perform an effort-task by squeezing a handgrip as hard as possible to win this reward. STUDY RESULTS We observed a preserved effect of unconscious monetary rewards on force production in both groups, without any significant difference between them. By contrast, in the conscious condition, patients with schizophrenia were less sensitive to rewards than controls. Our results confirm that unconscious incentives have effects on exerted forces in the general population, and demonstrate that patients with schizophrenia exhibit a dissociation between an impaired conscious motivation and a preserved unconscious motivation. CONCLUSIONS These findings suggest the existence of several steps in motivational processes that can be differentially affected and might have implication for patient care.
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Affiliation(s)
- Lucie Berkovitch
- To whom correspondence should be addressed; Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, GHU Paris Psychiatrie et Neurosciences, Centre Hospitalier Sainte Anne, 1 rue Cabanis, 75014 Paris, France; tel: 0033145658867, fax: 0033145657689, e-mail:
| | - Raphaël Gaillard
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France
| | - Pierre Abdel-Ahad
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France
| | - Sarah Smadja
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France
| | - Claire Gauthier
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France
| | - David Attali
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France
| | - Hadrien Beaucamps
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France
| | - Marion Plaze
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France
| | - Mathias Pessiglione
- Motivation, Brain and Behavior (MBB) Lab, Paris Brain Institute (ICM), Hôpital Pitié-Salpêtrière, F-75013 Paris, France,Sorbonne University, Inserm, CNRS, Paris, France
| | - Fabien Vinckier
- Université Paris Cité, F-75006 Paris, France,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, F-75014 Paris, France,Motivation, Brain and Behavior (MBB) Lab, Paris Brain Institute (ICM), Hôpital Pitié-Salpêtrière, F-75013 Paris, France
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5
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Anxiety and executive functions relationships in schizophrenia: A meta-analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
AbstractThe capacity to sustain attention was explored in a sample of anhedonic subjects according to the Chapman physical anhedonia scale. Sustained attention was determined by studying task-induced changes over the duration of the Eriksen response competition task [Percept. Psychophys. 16 (1974) 143]. Anhedonic subjects had longer reaction times (RTs), but missed no more targets than control subjects. Anhedonic subject RTs got longer with time-on-task (TOT) and displayed greater intra-subject variability. These results confirm those of a previous study indicating that anhedonic subjects may have developed a more conservative response strategy [Psychophysiology 37 (2000) 711] and suggest that this strategy may result in a more rapid decrease in energetical resources. Moreover, the greater intra-subject variability demonstrates the importance of assessing performance over time and its relationship to the variability of responses in the cognitive performance of anhedonic subjects.
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Affiliation(s)
- Stéphanie Dubal
- Hôpital de la Salpêtrière, CNRS UMR 7593, 47 Boulevard de l'Hôpital, Pavillon Clérambault, 75013 Paris, France.
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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8
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Hoffmann A, Montoro CI, Reyes del Paso GA, Duschek S. Cerebral blood flow modulations during proactive control in major depressive disorder. Int J Psychophysiol 2018; 133:175-181. [DOI: 10.1016/j.ijpsycho.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/13/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
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9
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White DA, McGuire AB, Luther L, Anderson AI, Phalen P, McGrew JH. Consumer factors predicting level of treatment response to illness management and recovery. Psychiatr Rehabil J 2017; 40:344-353. [PMID: 28910123 PMCID: PMC5739957 DOI: 10.1037/prj0000284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aims to identify consumer-level predictors of level of treatment response to illness management and recovery (IMR) to target the appropriate consumers and aid psychiatric rehabilitation settings in developing intervention adaptations. METHOD Secondary analyses from a multisite study of IMR were conducted. Self-report data from consumer participants of the parent study (n = 236) were analyzed for the current study. Consumers completed prepost surveys assessing illness management, coping, goal-related hope, social support, medication adherence, and working alliance. Correlations and multiple regression analyses were run to identify self-report variables that predicted level of treatment response to IMR. RESULTS Analyses revealed that goal-related hope significantly predicted level of improved illness self-management, F(1, 164) = 10.93, p < .001, R2 = .248, R2 change = .05. Additionally, we found that higher levels of maladaptive coping at baseline were predictive of higher levels of adaptive coping at follow-up, F(2, 180) = 5.29, p < .02, R2 = .38, R2 change = .02. Evidence did not support additional predictors. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Previously, consumer-level predictors of level of treatment response have not been explored for IMR. Although 2 significant predictors were identified, study findings suggest more work is needed. Future research is needed to identify additional consumer-level factors predictive of IMR treatment response in order to identify who would benefit most from this treatment program. (PsycINFO Database Record
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Affiliation(s)
- Dominique A White
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Alan B McGuire
- Health Services Research and Development, Richard L. Roudebush, Veterans Affairs Medical Center
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | | | - Peter Phalen
- School of Psychological Sciences, University of Indianapolis
| | - John H McGrew
- Department of Psychology, Indiana University-Purdue University Indianapolis
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10
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Hartmann-Riemer MN, Hager OM, Kirschner M, Bischof M, Kluge A, Seifritz E, Kaiser S. The association of neurocognitive impairment with diminished expression and apathy in schizophrenia. Schizophr Res 2015; 169:427-432. [PMID: 26526750 DOI: 10.1016/j.schres.2015.10.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 11/24/2022]
Abstract
Negative symptoms can be grouped into the two dimensions of diminished expression and apathy, which have been shown to be dissociable regarding external validators, such as functional outcome. Here, we investigated whether these two dimensions differentially relate to neurocognitive impairment in schizophrenia. 47 patients with schizophrenia or schizoaffective disorder and 33 healthy control participants were subjected to a neurocognitive test battery assessing multiple cognitive domains (processing speed, working memory, verbal fluency, verbal learning and memory, mental planning), which are integrated into a composite cognition score. Negative symptoms in patients were assessed using the Brief Negative Symptom Scale. We found that diminished expression significantly related to neurocognitive impairment, while severity of apathy symptoms was not directly associated with neurocognition. Other assessed clinical variables include chlorpromazine equivalents, positive symptoms, and depressive symptoms and did not influence the results. Our results are in line with a cognitive resource limitation model of diminished expression in schizophrenia and indicate that cognitive remediation therapy might be helpful to ameliorate expressive deficits.
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Affiliation(s)
- Matthias N Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.
| | - Oliver M Hager
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Bischof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Agne Kluge
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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11
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Foussias G, Siddiqui I, Fervaha G, Mann S, McDonald K, Agid O, Zakzanis KK, Remington G. Motivated to do well: an examination of the relationships between motivation, effort, and cognitive performance in schizophrenia. Schizophr Res 2015; 166:276-82. [PMID: 26008882 DOI: 10.1016/j.schres.2015.05.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Abstract
The uncertain relationship between negative symptoms, and specifically motivational deficits, with cognitive dysfunction in schizophrenia is in need of further elucidation as it pertains to the interpretation of cognitive test results. Findings to date have suggested a possible mediating role of motivational deficits on cognitive test measures, although findings from formal examinations of effort using performance validity measures have been inconsistent. The aim of this study was to examine the relationships between motivation, effort exerted during cognitive testing, and cognitive performance in schizophrenia. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were evaluated for psychopathology, severity of motivational deficits, effort exerted during cognitive testing, and cognitive performance. Motivation and degree of effort exerted during cognitive testing were significantly related to cognitive performance, specifically verbal fluency, verbal and working memory, attention and processing speed, and reasoning and problem solving. Further, effort accounted for 15% of the variance in cognitive performance, and partially mediated the relationship between motivation and cognitive performance. Examining cognitive performance profiles for individuals exerting normal or reduced effort revealed significant differences in global cognition, as well as attention/processing speed and reasoning and problem solving. These findings suggest that cognitive domains may be differentially affected by impairments in motivation and effort, and highlight the importance of understanding the interplay between motivation and cognitive performance deficits, which may guide the appropriate selection of symptom targets for promoting recovery in patients.
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Affiliation(s)
- G Foussias
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada.
| | - I Siddiqui
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - G Fervaha
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - S Mann
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - K McDonald
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - O Agid
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - K K Zakzanis
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario M1C 1A4, Canada
| | - G Remington
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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12
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Pihet S, Moses Passini C, Holzer L. Treatment motivation in adolescents with psychosis or at high risk: determinants and impact on improvements in symptoms and cognitive functioning, preliminary results. Psychother Res 2013; 23:464-73. [PMID: 23656510 DOI: 10.1080/10503307.2013.794398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Low motivation is frequent in chronic disorders such as psychosis and may limit treatment efficacy. Although some evidence supports this view in adults, few studies so far have focused on adolescents. We assessed the impact of baseline symptoms, cognitive deficits and cognitive treatment characteristics on treatment motivation (TM), and examined whether TM affected treatment outcome. Twenty-eight adolescents with psychotic disorders participated in 16 sessions of computerized cognitive remediation or games. TM was assessed for each session. Lower TM was predicted by more severe symptoms at baseline, and was associated with smaller improvements in symptoms and both cognitive and psychosocial functioning at the end of the intervention. Experiencing success in the treatment exercises enhanced TM in all patients.
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Affiliation(s)
- Sandrine Pihet
- Department of Psychology, University of Fribourg, Fribourg, Switzerland.
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13
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Abstract
Actions are goal-directed behaviours that usually involve movem ent. There is evidence that intentional self-generated actions (willed actions) are controlled differently from routine, stereotyped actions that are externally triggered by environmental stimuli. We review evidence from investigations using positron emission tomography (PET), recordings of movement-related cortical potentials (MRCPs) or transcranial magnetic stimulation (TMS), and conclude that willed actions are controlled by a network of frontal cortical (dorsolateral prefrontal cortex, supplementary motor area, anterior cingulate) and subcortical (thalamus and basal ganglia) areas. We also consider evidence suggesting that some of the cognitive and motor deficits of patients with frontal lesions, Parkinson's disease, or schizophrenia as well as apathy and abulia and rarer phenomena such as primary obsessional slowness can be considered as reflecting im pairment of willed actions. We propose that the concept of a willed action system based on the frontostriatal circuits provides a useful framework for integrating the cognitive, motor, and motivational deficits found in these disorders. Problems remaining to be resolved include: identification of the component processes of willed actions; the specific and differential role played by each of the frontal cortical and subcortical areas in the control of willed actions; the specific mechanisms of impairm ent of willed actions in Parkinson's disease, schizophrenia, and frontal damage; and the precise role of the neurotransmitter dopamine in the willed action system.
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Nakasujja N, Allebeck P, Agren H, Musisi S, Katabira E. Cognitive dysfunction among HIV positive and HIV negative patients with psychosis in Uganda. PLoS One 2012; 7:e44415. [PMID: 22970214 PMCID: PMC3435287 DOI: 10.1371/journal.pone.0044415] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 08/07/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cognitive impairment is an established phenomenon in HIV infected individuals and patients that have psychosis. However there is need to establish the severity of the impairment if patients are co morbid with both conditions. AIM To compare cognitive function among HIV positive individuals and HIV negative individuals with psychosis. METHODS We recruited patients with psychosis at two national referral hospitals. A standardized demographics questionnaire and psychiatric, physical, and laboratory assessments were conducted. Types of psychosis were diagnosed using the Mini International Neuropsychiatric Inventory-PLUS while cognitive functioning was determined using the Mini mental state examination (MMSE) and a neuropsychological test battery. Follow-up assessments on cognitive function and severity of psychiatric illness were performed at 3 and 6 months. Pairwise comparison and multivariable logistic regression analysis were used to determine the differences between the HIV positive and HIV negative individuals. RESULTS There were 156 HIV positive and 322 HIV negative participants. The mean age was 33 years for the HIV positive group and 29 years for the HIV negative group (p<0.001). The HIV positive individuals were almost three times (OR = 2.62 CI 95% 1.69-4.06) more likely to be cognitively impaired on the MMSE as well as the following cognitive tests:- WHO-UCLA Auditory Verbal Learning Test (OR 1.79, 95% CI 1.09-2.92), Verbal Fluency (OR 3.42, 95% CI 2.24-5.24), Color Trails 1 (OR 2.03, 95% CI 1.29-3.02) and Color Trails 2 (OR 3.50 95% 2.00-6.10) all p = 0.01. There was improvement in cognitive function at follow up; however the impairment remained higher for the HIV positive group (p<0.001). CONCLUSION Cognitive impairment in psychosis was worsened by HIV infection. Care plans to minimize the effect of this impairment should be structured for the management of individuals with HIV and psychosis.
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Affiliation(s)
- Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
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15
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16
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Yamada AM, Lee KK, Dinh TQ, Barrio C, Brekke JS. Intrinsic motivation as a mediator of relationships between symptoms and functioning among individuals with schizophrenia spectrum disorders in a diverse urban community. J Nerv Ment Dis 2010; 198:28-34. [PMID: 20061866 PMCID: PMC2946838 DOI: 10.1097/nmd.0b013e3181c8aa71] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study investigated intrinsic motivation as a mediator of the relationship between clinical symptoms and functioning. The mediation model was tested with a sample of 166 adults with schizophrenia spectrum disorders attending psychosocial rehabilitation programs in a diverse urban community. Ethnic minority status was examined as a moderator of the mediation model. Motivation was measured using items reflecting intrapsychic drive. Symptoms were assessed with the expanded Brief Psychiatric Rating Scale and functioning with the Role Functioning Scale. Motivation was a significant mediator of the relationship between functioning and all symptom scores; fully mediating the relationship between functioning and negative, disorganized, and global symptoms, and partially mediating the relationship between positive symptoms and functioning. Motivation scores between ethnic minority and nonminority individuals differed significantly (p < 0.05), but no moderation effect was indicated. The strong mediation effect schizophrenia of motivation on the symptoms-functioning relationship supports future work to translate findings into effective recovery-oriented services.
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Affiliation(s)
- Ann-Marie Yamada
- School of Social Work, University of Southern California, Los Angeles, CA 90089, USA.
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17
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Halberstadt AL, Geyer MA. Habituation and sensitization of acoustic startle: opposite influences of dopamine D1 and D2-family receptors. Neurobiol Learn Mem 2009; 92:243-8. [PMID: 18644244 PMCID: PMC2745310 DOI: 10.1016/j.nlm.2008.05.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 05/27/2008] [Indexed: 12/01/2022]
Abstract
The startle response evoked by repeated presentation of a loud acoustic stimulus is regulated by the independent processes of sensitization and habituation. While schizophrenia is associated with information processing impairments, there is conflicting evidence regarding the existence of habituation deficits in schizophrenic patients. Recent clinical evidence, however, indicates that patients with schizophrenia display exaggerated startle sensitization and diminished habituation. Given the linkage between dopaminergic abnormalities and schizophrenia, the goal of the present investigation was to examine the effect of deleting D1 and D2-like dopamine receptors on sensitization and habituation of the acoustic startle reflex in mice. For these experiments, the acoustic startle reflex was assessed in dopamine D1, D2, and D3 receptor wild-type (WT) and knockout (KO) mice on a C57BL/6J background, using a methodology that can measure both sensitization and habituation. Mice lacking the D1 receptor gene displayed enhanced sensitization, along with a decrease in the amount of habituation that occurs in response to repetitive presentations of a startling stimulus. Conversely, the loss of the dopamine D2 or D3 receptor gene produced a sensitization deficit and a significant increase in habituation. The behavioral phenotype exhibited by D1 receptor KO mice is clearly distinct from that of the D2 and D3 receptor KO mice. The findings in D1 receptor KO mice are reminiscent of the abnormalities observed in schizophrenic patients tested in comparable startle paradigms, and indicate that D1 agonists may possess therapeutic efficacy against the information processing deficits associated with schizophrenia.
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MESH Headings
- Acoustic Stimulation
- Animals
- Disease Models, Animal
- Habituation, Psychophysiologic/physiology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Receptors, Dopamine D1/genetics
- Receptors, Dopamine D1/metabolism
- Receptors, Dopamine D2/genetics
- Receptors, Dopamine D2/metabolism
- Receptors, Dopamine D3/genetics
- Receptors, Dopamine D3/metabolism
- Reflex, Startle/physiology
- Schizophrenia/physiopathology
- Schizophrenic Psychology
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Affiliation(s)
- Adam L Halberstadt
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0804, USA
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18
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La mémoire de travail dans la schizophrénie : revue de la littérature. Encephale 2008; 34:289-98. [DOI: 10.1016/j.encep.2006.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Accepted: 12/28/2006] [Indexed: 11/30/2022]
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Porter RJ, Bourke C, Gallagher P. Neuropsychological impairment in major depression: its nature, origin and clinical significance. Aust N Z J Psychiatry 2007; 41:115-28. [PMID: 17464689 DOI: 10.1080/00048670601109881] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Neuropsychological impairment is well established as a feature of major depressive disorder (MDD) but studies have shown a variable pattern of impairment. This paper seeks first to clarify this by examining methodological and clinical factors that give rise to variability in study findings. Second, it examines theories of the origin of these neuropsychological abnormalities. Third, it reviews evidence regarding the clinical significance of different patterns of deficit. A selective review was undertaken of the literature with a particular emphasis on methodological factors, the influence of clinical subtypes and prevalent theories of neuropsychological abnormality. Methodological issues and the heterogeneity of MDD account for considerable variability in results. Specific investigation of the subtypes of psychotic MDD, melancholic MDD and bipolar depression reduces this heterogeneity and results are more consistent in the elderly. Hypothalamic-pituitary-adrenal axis dysfunction is associated with neuropsychological dysfunction in MDD although evidence of direct causation is not definitive at present. Impairment of executive and psychomotor function is a consistent finding, particularly in the elderly, and may reflect frontostriatal-limbic dysfunction. There is growing evidence that this may have clinical significance. It is suggested that future research take very careful account of the exact phenotype of MDD. Classification based on neuropsychological profile may, in fact, be useful. Further research should examine further the clinical importance of patterns of neuropsychological impairment.
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Affiliation(s)
- Richard J Porter
- Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand.
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van Beilen M, Withaar FK, van Zomeren EH, van den Bosch RJ, Bouma A. Deviant Strategy on the Modified Six Elements Test in Patients with Schizophrenia. Clin Neuropsychol 2006; 20:469-79. [PMID: 16895859 DOI: 10.1080/13854040590967126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Impaired executive functioning is found in a considerable proportion of schizophrenia patients. Neuropsychological tests are originally designed to measure the behavior of neurological patients and may therefore miss psychiatry-related cognitive deficits. Qualitative information on tests for executive functioning is important in psychiatric populations. The Modified Six Elements Test (MSET) is a planning test that consists of 6 tasks, for which subjects have limited time and have to obey to switching rules. This study concerns a qualitatively different approach schizophrenia patients use on the MSET, and its relationship with cognitive measures. MSET scores and strategies of schizophrenia patients were compared to those of healthy controls, closed-head-injury patients, and peripheral injury patients. Also, schizophrenia patients and healthy controls were compared on verbal memory and vigilance. Schizophrenia patients finish fewer assignments on the MSET, receive a lower profile score compared to healthy controls, and use a different strategy on the test compared to the other groups. They also perform below healthy controls on the tests for verbal memory and vigilance. Use of the different strategy in schizophrenia patients was related to impaired cognitive functioning. An interesting strategy used by schizophrenia patients on the MSET appears to be indicative of impaired cognitive functioning. This strategy may be a compensatory strategy to spare cognitive resources. It could also be the result of a concrete interpretation of the test instructions.
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Affiliation(s)
- Marije van Beilen
- Department of Psychotic Disorders, GGZ-Drenthe, Assen, The Netherlands.
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21
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Cairo TA, Woodward TS, Ngan ETC. Decreased encoding efficiency in schizophrenia. Biol Psychiatry 2006; 59:740-6. [PMID: 16229823 DOI: 10.1016/j.biopsych.2005.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 07/25/2005] [Accepted: 08/04/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Working memory deficits are a cardinal feature of schizophrenia that contribute to social and occupational dysfunction. METHODS We used functional magnetic resonance imaging to compare the response to varying task demands during the performance of an item recognition task. Study design and analysis procedures were optimized for the detection of load dependent activity during the encoding phase of working memory. RESULTS At the lowest load conditions the schizophrenia group performed as well as controls, however to achieve this equivalent performance the schizophrenia group had a significantly higher magnitude of activation compared to the controls. At the higher load conditions, the magnitude of activation between groups became more similar and we began to see performance deficits in the schizophrenic group. CONCLUSIONS These results suggest that patients with schizophrenia have decreased efficiency in the cognitive processes that underlie the early encoding phase of this task. For lower demand tasks, patients with schizophrenia can compensate for decreased efficiency by working harder to achieve equivalent performance. Encoding utilizes attentional and perceptual cognitive operations that are likely common to many other cognitive tasks; therefore, inefficiency may underlie the deficits observed in a wide range of cognitive tasks in schizophrenia compared to healthy controls.
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Affiliation(s)
- Tara A Cairo
- Department of Research, Riverview Hospital, Coquitlam, Canada
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22
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Rose EJ, Ebmeier KP. Pattern of impaired working memory during major depression. J Affect Disord 2006; 90:149-61. [PMID: 16364451 DOI: 10.1016/j.jad.2005.11.003] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 11/02/2005] [Accepted: 11/03/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to assess working memory (WM) in patients with major depressive disorder (MDD), using a robust parametric WM task (the n-back task). METHODS Twenty patients with MDD and twenty healthy controls completed a visual version of the paradigm, comprising four levels of task difficulty (i.e. 0-, 1-, 2-, and 3-back). Performance accuracy and reaction time (RT) were measured at each difficulty level. RESULTS In comparison with controls, patients with MDD exhibited slower RTs (F((1,38)) = 25.16, p < 0.001), and reduced accuracy (F((1,38)) = 5.93, p < 0.001). There was no diagnosis-specific effect of task difficulty on performance accuracy. However, the faster response to memory (1-3-back) than to shadowing (0-back) tasks observed in controls was not as pronounced in patients. CONCLUSIONS These observations support a relatively specific impairment of WM/central executive function in MDD, which may potentially mediate the diverse pattern of cognitive dysfunction noted in MDD. The parametric n-back task is applicable to subjects with MDD and yields results interpretable across the dimensions of task difficulty and performance in controls and patients.
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Affiliation(s)
- E J Rose
- National Institute on Drug Abuse, Intramural Research Programme, Baltimore, MD, USA
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Gorissen M, Sanz JC, Schmand B. Effort and cognition in schizophrenia patients. Schizophr Res 2005; 78:199-208. [PMID: 16154055 DOI: 10.1016/j.schres.2005.02.016] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 02/21/2005] [Accepted: 02/23/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether low cognitive test scores in schizophrenia patients are due to insufficient effort and, if so, to what extent. METHOD Mental effort was measured with the Word Memory Test (WMT), an effort test that has been extensively validated. Schizophrenic patients (n=64), non-psychotic psychiatric patients (n=63), neurological controls (n=20), and normal controls (n=44) were tested with a neuropsychological test battery measuring memory, attention and executive functioning. RESULTS The majority of the schizophrenia patients and a quarter of the psychiatric patients scored below the cut-offs for normal effort on the WMT. Scores on the effort test explained a significant amount of variance in the neuropsychological test performance of schizophrenic patients. This lends support to the notion that cognitive functioning in schizophrenia is compromised by insufficient effort. Furthermore, poor mental effort was related to negative symptoms. CONCLUSIONS Poor mental effort might be considered a core symptom of schizophrenia, representing an executive, monitoring or motivational problem. Mental effort should be taken into consideration in the neuropsychological assessment of schizophrenic patients and of psychiatric patients in general. Controlling for this variable may have a considerable impact on research, assessment and treatment of cognitive disorders in schizophrenic patients.
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Affiliation(s)
- Marielle Gorissen
- Psychiatric hospital Meerkanten, Veldwijk Research Institute, PO box 1000, 3850 BA Ermelo, The Netherlands.
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Krabbendam L, Aleman A. Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology (Berl) 2003; 169:376-82. [PMID: 12545330 DOI: 10.1007/s00213-002-1326-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2002] [Accepted: 10/17/2002] [Indexed: 10/26/2022]
Abstract
RATIONALE Cognitive rehabilitation is now recognized as an important tool in the treatment of schizophrenia, and findings in this area are emerging rapidly. There is a need for a systematic review of the effects of the different training programs. OBJECTIVES To review quantitatively the controlled studies on cognitive rehabilitation in schizophrenia for the effect of training on performance on tasks other than those practiced in the training procedure. METHODS A meta-analysis was conducted on 12 controlled studies of cognitive rehabilitation in schizophrenia taking into account the effects of type of rehabilitation approach (rehearsal or strategy learning) and duration of training. RESULTS The mean weighted effect size was 0.45, with a 95% confidence interval from 0.26 to 0.64. Effect sizes differed slightly, depending on rehabilitation approach, in favor of strategy learning, but this difference did not reach statistical significance. Duration of training did not influence effect size. CONCLUSIONS Cognitive rehabilitation can improve task performance in patients with schizophrenia and this effect is apparent on tasks outside those practiced during the training procedure. Future studies should include more real-world outcomes and perform longitudinal evaluations.
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Affiliation(s)
- Lydia Krabbendam
- Department of Psychiatry and Neuropsychology (PAR45), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Davalos DB, Kisley MA, Polk SD, Ross RG. Mismatch negativity in detection of interval duration deviation in schizophrenia. Neuroreport 2003; 14:1283-6. [PMID: 12824776 DOI: 10.1097/00001756-200307010-00019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Temporal processing deficits have been noted in behavioral studies assessing patients with schizophrenia. The current study sought to explore the physiology of temporal perception while controlling the effects of motivation, attention and other cognitive processes that may contribute to behavioral measures of temporal processing. Mismatch negativity (MMN) waveforms were measured in response to variations in the temporal parameters of an ongoing train of pure tones. A standard inter-stimulus interval of 400 ms was interrupted, on average, every 20th tone by an inter-stimulus interval of 340 ms. Amplitude of MMN waveform elicited by the temporal deviance was significantly reduced in the schizophrenia group compared with controls (p = 0.016). Results suggest that behavioral difficulties on time processing tasks in schizophrenia may reflect a physiological deficit in temporal perception in this population rather than simply more general difficulties in attention or motivation.
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Affiliation(s)
- Deana B Davalos
- Denver VA Medical Center, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Campus Box C268-71, Denver, CO 80262, USA.
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Cirillo MA, Seidman LJ. Verbal declarative memory dysfunction in schizophrenia: from clinical assessment to genetics and brain mechanisms. Neuropsychol Rev 2003; 13:43-77. [PMID: 12887039 DOI: 10.1023/a:1023870821631] [Citation(s) in RCA: 254] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The recent literature on the neuropsychology of schizophrenia has emphasized memory deficits as a key area of impairment. Abnormalities in the medial temporal lobe, a brain region crucial for long-term memory formation, have also consistently been reported. We conducted a comprehensive review of verbal declarative memory (VDM) in schizophrenia with the aim of systematically addressing the nature of this impairment. We conclude that verbal declarative memory is significantly impaired in schizophrenia and is largely accounted for by deficits in the encoding stage. Subtle impairments in increased rates of forgetting are present, but are mild compared with those in amnestic disorders. Impairment in other cognitive domains studied thus far (e.g., attention), medication effects, or fluctuations in symptoms do not completely account for the deficit. VDM is among the most impaired neurocognitive domains in schizophrenia (along with attention and executive functions). Milder encoding deficits are present in high-risk subjects and non-psychotic relatives of individuals with schizophrenia suggesting that components of the deficit are associated with a genetic vulnerability to the illness, and are independent of the frank psychotic illness. Furthermore, VDM is observed in individuals experiencing their first-psychotic episode and it remains fairly consistent over time. Preliminary imaging studies and other work suggest abnormalities in prefrontal-hippocampal processing networks. Future work should emphasize delineating specific information processing components contributing to the deficit. This would allow imaging studies to determine which brain regions contribute to specific information processing deficits in schizophrenia.
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Affiliation(s)
- Michael A Cirillo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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Manoach DS. Prefrontal cortex dysfunction during working memory performance in schizophrenia: reconciling discrepant findings. Schizophr Res 2003; 60:285-98. [PMID: 12591590 DOI: 10.1016/s0920-9964(02)00294-3] [Citation(s) in RCA: 508] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Working memory (WM) deficits are a persistent, disabling and relatively treatment-resistant feature of schizophrenia that may underlie many cognitive deficits and symptoms. They are associated with prefrontal cortex dysfunction. While most neuroimaging studies of WM demonstrate "task-related hypofrontality" in schizophrenic relative to healthy subjects, several recent studies have reported equal or increased prefrontal activity. These findings challenge central assumptions regarding cognitive deficits and prefrontal cortex dysfunction in schizophrenia. The goal of this review is to reconcile these seemingly discrepant findings. Methodological factors addressed include the use of intersubject averaging, WM task parameters and the reliability of the measures. Factors intrinsic to schizophrenia and their relevance to the selection of experimental methods and the interpretation of group data are also discussed. Both hypo- and hyperfrontality are hypothesized to be valid and informative reflections of prefrontal cortex dysfunction in schizophrenia. Due to the heterogeneity and variability of both performance and regional recruitment in schizophrenia, whether individual data is considered, the level and type of WM demands and the composition of the sample with regard to performance deficits all influence study outcome and contribute to discrepancies. Although the prefrontal cortex is consistently implicated in WM deficits, the basis of its dysfunction and its exact contribution remain unclear. Future work might focus on delineating the exact WM processes, domains and components that are deficient. In addition, variability in behavior and activation might best be regarded as intrinsic to schizophrenia and having a neural basis that requires explanation. In combination with other techniques, neuroimaging can identify the neural circuitry responsible for WM deficits and elucidate the contribution of each anatomical component.
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Affiliation(s)
- Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital-East and Harvard Medical School, 36 First Avenue, Room 420, 02129, Charlestown, MA, USA
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Rüsch N, Corrigan PW. Motivational interviewing to improve insight and treatment adherence in schizophrenia. Psychiatr Rehabil J 2002; 26:23-32. [PMID: 12171279 DOI: 10.2975/26.2002.23.32] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Poor insight and low treatment adherence are common features among persons with schizophrenia that are often related to poor outcome. While insight is a multidimensional phenomenon, common measures of insight have shortcomings and do not include all items relevant for insight and compliance. Different causes of poor insight and compliance such as neurocognitive deficits and psychological coping mechanisms are considered and also the role of awareness in the context of health behavior theory and the stages of change-model. Motivational Interviewing can, with specific modifications for persons with schizophrenia, successfully increase their insight and compliance, because it allows them to explore their own goals and to take a more active role in treatment.
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Affiliation(s)
- Nicolas Rüsch
- Department of Psychiatry, University of Freiburg, Germany.
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Abstract
The present study was designed to evaluate the integrity of cognitive fronto-temporal processes in drug naive patients with schizophrenia. The evaluation of drug naive patients discards the potential influence of medication, and may allow the specification of cognitive impairments that are truly illness-related. Subcomponents of long-term memory as well as several measures of attention were examined. A group of 16 patients who had never taken antipsychotics and a group of 20 normal controls underwent tests of alertness, information maintaining, and sustained and selective attention, as well as tests of explicit and implicit recall. The psychopathological manifestations of patients were also assessed with the BPRS, PANSS, ESRS clinical scales. Attention test performances revealed that drug naive patients presented a decrease in their ability to respond promptly to a stimulus, sustain their attention on a task, display normal selective attention strategies, and maintain information for on-line processing. The results also suggest that the drug naive patients are impaired when both strategic and associative processes must be triggered to explicitly recover information in long-term memory. In contrast, the results revealed that implicit access to perceptual mental representations is spared in schizophrenic patients. Finally, features of the patients' clinical symptomatology and some cognitive deficits were also shown to be correlated. Overall, results showed that, in relation to normals, drug naive patients were mildly impaired, with little intersubject variability, and that not all cognitive processes were equally disturbed in relation to the normal subjects' performances. Results support the idea that an important part of the impairments seen in schizophrenia is present before the introduction of neuroleptic medication and chronic illness.
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Affiliation(s)
- I Lussier
- Centre de Recherche Fernand-Seguin, Département de Psychiatrie, Université de Montréal, 7331 rue Hochelaga, Que. H1N 3V2, Montreal, Canada
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Abstract
OBJECTIVE To review the literature on compliance in psychoses and to evaluate the significance of the different compliance components presented. METHOD Different definitions of the term compliance were first gathered. A search covering the years 1974-1997 was conducted in Medline and PsycLit databases using the keywords 'schizophrenia' or 'psychosis' and 'compliance'. The studies that took compliance into account as a separate variable were collected for further analysis. RESULTS Unpleasant side-effects of medication, attitudes towards medication, delusional symptoms, substance abuse, insight, and supportive family environment were found to have the strongest correlation with compliance. The influence of cognitive impairment is not clearly proven. Integrated, cognitive-behavioural and psychoeducational treatment models include several methods to improve therapeutic alliance and compliance. CONCLUSION As the majority of the studies have concentrated on neuroleptic treatment, the medication-related factors are best documented. In clinical practice, treatment compliance is based on patient-related, medication-related and interactional factors, such as treatment model and therapeutic alliance. Difficulties with insight and cognitive functioning are specific patient-related factors in the treatment of psychoses.
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Affiliation(s)
- O Kampman
- Tampere University, Medical School, and Tampere University Hospital Department of Psychiatry, Finland
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Oades RD. Frontal, temporal and lateralized brain function in children with attention-deficit hyperactivity disorder: a psychophysiological and neuropsychological viewpoint on development. Behav Brain Res 1998; 94:83-95. [PMID: 9708842 DOI: 10.1016/s0166-4328(97)00172-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article considers deficits in the selective aspects of perception underlying symptoms of impaired attention and impulsivity in children with attention-deficit hyperactivity syndrome (ADHD) in terms of frontal and temporal lobe function and cerebral asymmetry. Tomographic studies suggest a disturbed fronto-striatal function, but have neglected limbic contributions under activating conditions and are equivocal on the nature of apparent lateralized differences. Neuropsychological and psychophysiological studies suggest that early and late stages of information processing are affected in both the frontal and temporal lobes and imply impaired intercortical dialog. Given the evidence for a normal specialization in global processing in the right and the processing of details in the left hemisphere, the lateralized impairment may progress from situational ADHD (impaired selective aspects of perception on the right) to pervasive ADHD (additional impairment in decision-making on the left). Accordingly some ADHD children may experience an early negative neurodevelopmental influence that only appears as the brain region matures while others show a delayed development of CNS function.
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Affiliation(s)
- R D Oades
- University Clinic for Child and Adolescent Psychiatry (RLHK), Essen, Germany.
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Elliott R, Sahakian BJ, Herrod JJ, Robbins TW, Paykel ES. Abnormal response to negative feedback in unipolar depression: evidence for a diagnosis specific impairment. J Neurol Neurosurg Psychiatry 1997; 63:74-82. [PMID: 9221971 PMCID: PMC2169625 DOI: 10.1136/jnnp.63.1.74] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess in further detail the specific form of motivational impairment influencing neuropsychological performance in depression-oversensitivity to perceived failure. The present study considers two questions: firstly whether this is specific to depression and secondly how the effect relates to clinical features. METHODS Unipolar depressed patients and matched controls were assessed on two neuropsychological tests giving explicit performance feedback. The data were analysed in two separate studies to consider the questions above. The first study considered the specificity of the effect to depressed patients, using data on the same tests collected from other patient groups. The second study was a longitudinal assessment of the depressed patients on clinical recovery to determine whether the effect is specific to the depressed state. RESULTS The effect was not seen in non-depressed patient groups, either neurological or psychiatric groups. The longitudinal study showed a residual abnormal response to negative feedback on clinical recovery. CONCLUSIONS Abnormal response to negative feedback is specific to a primary diagnosis of depression and may be a trait rather than a state factor of the disorder. These results are discussed in relation to the putative neuropathology of depression and also to cognitive and behavioural accounts of the disorder. The findings presented here have important implications for establishing a link between mood and cognition in unipolar depression.
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Affiliation(s)
- R Elliott
- Department of Experimental Psychology, University of Cambridge, UK
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Abstract
Verbal memory function was assessed in 27 schizophrenic patients and 19 healthy control subjects matched for premorbid IQ and age using a test battery comprising measures of short-term, long-term and source memory. Patients were also rated for positive and negative symptoms. Results indicated that the patient group evinced poorer performance on all tests of short-term memory, and most tests of long-term memory, and that these differences remained when current IQ was introduced as a covariate. Within the patient group, overall verbal memory performance was associated only with a negative symptoms. Results are discussed in the context of a generalised neuropsychological deficit in schizophrenia.
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Affiliation(s)
- J D Stirling
- Department of Psychology and Speech Pathology, Manchester Metropolitan University, UK
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