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Li Z, Kang Z, Xia X, Li L, Wu J, Dai J, Liu T, Chen C, Qiu Y, Chen M, Liu Y, Zhang Z, Han Z, Dai Z, Wei Q. Associations of resilience, white matter topological organization, and cognitive functions in first-episode, drug-naïve schizophrenia patients: A moderated mediation analysis. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110867. [PMID: 37783265 DOI: 10.1016/j.pnpbp.2023.110867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Cognitive deficits are core symptoms of schizophrenia (SZ) and are associated with impaired resilience to stress. Different cognitive functions appeared to be interrelated, and the mechanism may involve neural alterations. The disrupted topological organization indicated abnormalities in the segregation and integration of brain networks that support various cognitive processes in SZ patients. Therefore, this study aimed to assess the direct and indirect effects of resilience on cognitive functions. We hypothesized that topological properties would moderate these associations. METHODS Forty-nine SZ patients and fifty-two healthy controls (HCs) were recruited in this study. The Connor-Davidson Resilience Scale and the MATRICS Consensus Cognitive Battery were used to examine resilience and cognitive functions, respectively, and a graph theory approach was used to assess white matter topological organization. RESULTS Compared to HCs, SZ patients showed lower levels of resilience and cognitive functions in multiple domains as well as abnormal global properties and nodal metrics. In addition, shorter characteristic path length was associated with a stronger indirect effect of resilience on working memory through processing speed in SZ patients. CONCLUSION Characteristic path length might moderate the mediating effects of processing speed in the relationship between resilience and working memory in schizophrenia patients.
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Affiliation(s)
- Zhinan Li
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Zhuang Kang
- Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaowei Xia
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Leijun Li
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Junyan Wu
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Jiamin Dai
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Tong Liu
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Department of Psychiatry, the First Affiliated Hospital of Xi 'an Jiaotong University, Shaanxi, China
| | - Cai Chen
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Yong Qiu
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Ming Chen
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Yanxi Liu
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Ziyi Zhang
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Zili Han
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Zhengjia Dai
- Department of Psychology, Sun Yat-sen University, Guangzhou, China.
| | - Qinling Wei
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Department of Psychology, Sun Yat-sen University, Guangzhou, China.
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Huo L, Qu D, Pei C, Wu W, Ning Y, Zhou Y, Zhang XY. Alexithymia in chronic schizophrenia and its mediating effect between cognitive deficits and negative symptoms. Schizophr Res 2023; 261:275-280. [PMID: 37866075 DOI: 10.1016/j.schres.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/01/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Although cognition is known to impact clinical symptoms of schizophrenia, few studies investigate the potential mediators of this relationship. This study aimed to examine the relationship between cognitive deficits and negative symptoms in schizophrenia, considering the mediating role of alexithymia as an important psychological variable. Moreover, the prevalence of alexithymia in patients with schizophrenia was investigated. METHODS A total of 689 patients with schizophrenia were recruited from two psychiatric hospitals. All patients completed the Positive and Negative Syndrome Scale (PANSS), 20-item Toronto Alexithymia Scale (TAS-20), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). We used structural equation modeling to examine the hypothesized mediated model. RESULTS In total, 31.5 % of patients with schizophrenia were classified as alexithymia. The path analyses showed that two factors of alexithymia (i.e., the difficulty in identifying feelings and difficulty in describing feelings), played a mediating role in the pathway from cognitive deficits to negative symptoms (all p < .001). LIMITATIONS Self-reported measurement for alexithymia may not be sufficiently reliable due to response bias. CONCLUSION Our findings demonstrated a high occurrence of alexithymia in patients with schizophrenia. Moreover, the mediating role of alexithymia suggests that targeting emotion processing and cognition may be a feasible way to mitigate negative symptoms.
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Affiliation(s)
- Lijuan Huo
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, Guangzhou, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Chenran Pei
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, Guangzhou, China
| | - Weibin Wu
- Foshan Mental Health Center, The Third People's Hospital of Foshan, Foshan, China
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 5180005, China.
| | - Xiang Yang Zhang
- Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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Sagayadevan V, Satghare P, Jeyagurunathan A, Koh YS, Shafie S, Chang S, Samari E, Subramaniam M. Mediating effect of symptom severity on the relationship between aggression, impulsivity and quality of life outcomes among patients with schizophrenia and related psychoses. Front Psychiatry 2023; 14:1154083. [PMID: 37810606 PMCID: PMC10556254 DOI: 10.3389/fpsyt.2023.1154083] [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: 01/30/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Aims Aggression and impulsivity among individuals with schizophrenia have been associated with poor clinical outcomes including worsening of symptoms and substance abuse which have been linked to a lower quality of life (QoL). The current study aimed to look at the mediating effect of symptom severity on the relationship between aggression, impulsivity and QoL among outpatients with schizophrenia and related psychoses in a multi-ethnic Asian population. Methods Data (n = 397) were collected from outpatients seeking treatment at the Institute of Mental Health. The World Health Organization quality of life-BREF (WHOQOL-BREF) scale, the symptoms checklist-90 revised (SCL-90-R), Buss Perry aggression questionnaire (BPAQ), and the Barratt impulsiveness scales (BIS) were used to assess subjective well-being, symptom severity, aggression, and impulsivity, respectively. Mediation analysis was performed using the PROCESS macro to understand the mediating effect of symptom severity. Results Motor impulsivity (MI) was indirectly associated with both the physical and psychological health domains of QoL while self-control was indirectly associated with the physical, psychological, and environmental health QoL domains through increased symptom severity. Conclusion The significant indirect effect of symptom severity in our study highlights one potential pathway through which impulsivity impacts the QoL of individuals with schizophrenia and related psychoses. Elucidating other factors besides symptom severity that have an indirect effect on the QoL of individuals provides alternative approaches for treatment through which better clinical outcomes can be achieved.
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Thuaire F, Rondepierre F, Vallet GT, Jalenques I, Izaute M. Executive deficits in schizophrenia: mediation by processing speed and its relationships with aging. Psychol Med 2022; 52:1126-1134. [PMID: 32840193 DOI: 10.1017/s0033291720002871] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Executive deficits are a core characteristic of schizophrenia. Yet, the origin of these impairments remains unclear as they may be caused by processing slowing. This issue is of particular interest for aging insofar as cognitive aging is also associated with a decline in executive functioning and a slowing of processing speed. As schizophrenia patients' life expectancy increases, a better understanding of the origin of older patients' cognitive deficits becomes essential so that healthcare can be adapted to suit them. This study aims to determine whether processing speed mediates how schizophrenia affects executive functions and whether these relationships are moderated by age. METHODS Sixty-two schizophrenia patients (27 women) and 62 healthy comparison subjects matched for age (range: 18-76 years), gender and education performed neurocognitive tests to evaluate their executive functions (shifting, updating, inhibition and access) and processing speed. RESULTS Processing speed mediated the effect of schizophrenia on the four specific executive functions, and age moderated this mediation for shifting, updating and access, but in different ways. Age moderated the effect of processing speed on shifting, the direct effect of schizophrenia on access, and both the effect of processing speed and the direct effect of schizophrenia on updating. CONCLUSIONS This research highlights the need to evaluate processing speed routinely during therapeutic follow-up, as it is easy and simple to assess and appears to be at the heart of the cognitive deficits in schizophrenia. Finally, processing speed abilities yield information about the evolution of cognition with aging in schizophrenia.
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Affiliation(s)
- Flavien Thuaire
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401-63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume T Vallet
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401-63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
| | - Isabelle Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Institut de Psychiatrie-GDR 3557, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marie Izaute
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401-63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
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Gaillard A, Tan EJ, Carruthers SP, Gurvich C, Hughes ME, Neill E, Sumner PJ, Van Rheenen TE, Rossell SL. No influence of sex on the relationship between schizotypy factors and executive control across the schizophrenia spectrum. J Psychiatr Res 2022; 148:325-331. [PMID: 35193036 DOI: 10.1016/j.jpsychires.2022.02.015] [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: 09/03/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
Sex differences in symptoms and executive control across schizophrenia spectrum disorders (SSD) are consistently reported. Similarly, these findings of sex differences are also observed in schizotypy, that is, schizophrenia-like features occurring in healthy individuals in the absence of a clinical diagnosis. This study aimed to examine the relationships between performance on three major domains of executive control: performance monitoring, response inhibition, and cognitive set-shifting, and schizotypy factor scores in both SSD patients and healthy controls (HCs), and whether sex moderated any relationships observed. A total of 111 (67 males and 44 females) patients with SSD and 258 (129 males and 129 females) HCs were included in this study. Schizotypal personality traits (in both SSD and HC) was assessed using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). Executive control performance was assessed using seven tasks. Stepwise linear regressions revealed that performance on cognitive set-shifting tasks was significantly associated with the introvertive anhedonia, cognitive disorganisation, and unusual experiences subscales of the O-LIFE. When sex was examined as a moderator, it was not a significant moderator of any of the relationships between cognitive set-shifting tasks and schizotypy factors. The results suggest that independent of sex, cognitive set-shifting ability is associated to an increased vulnerability to schizotypal personality traits, although performance monitoring and response inhibition did not.
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Affiliation(s)
- Alexandra Gaillard
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
| | - Eric J Tan
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sean P Carruthers
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
| | - Matthew E Hughes
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Erica Neill
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Philip J Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Tamsyn E Van Rheenen
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Victory, 3053, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
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Thuaire F, Rondepierre F, Bacon E, Vallet GT, Jalenques I, Izaute M. Executive functions in schizophrenia aging: Differential effects of age within specific executive functions. Cortex 2019; 125:109-121. [PMID: 31981891 DOI: 10.1016/j.cortex.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/19/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Abstract
There are common cognitive and brain abnormalities in schizophrenia and healthy aging which may cumulate in schizophrenia aging. However, the course of executive deficits in late-life schizophrenia is still controversial as it remains unclear whether schizophrenia patients show accelerated aging. The use of specific models of executive functions might help to shed new lights on this issue. The aim of this study was then to determine how each of the four specific executive functions (shifting, updating, inhibition and access to long-term memory) is affected by aging in schizophrenia compared to healthy aging. 20 younger (age 18-34), 17 middle-aged (age 35-49) and 25 older (age 59-76) schizophrenia patients and 62 healthy comparison participants matched for gender, age and education performed a neurocognitive battery evaluating the four specific executive functions. Schizophrenia patients performed worse than comparison participants on shifting, updating and access, whereas inhibition appeared preserved. Age affected the four functions with increased degradation of shifting and access in schizophrenia patients, whereas updating and inhibition showed a normal decline with age. These results suggest a vulnerability of prefrontal and cingulate cortexes in schizophrenia aging. Moreover, as age affected the specific executive functions differently, remediation programs should be adapted to older patients. Models of specific executive functions are useful for understanding the complexity of cognition in schizophrenia and its course during later life so that healthcare can be adapted accordingly.
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Affiliation(s)
- Flavien Thuaire
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
| | - Fabien Rondepierre
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - Elisabeth Bacon
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), CHU de Strasbourg, Université de Strasbourg, France.
| | - Guillaume T Vallet
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
| | - Isabelle Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Institut de Psychiatrie-GDR 3557, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Marie Izaute
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
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Hoonakker M, Doignon-Camus N, Bonnefond A. Sustaining attention to simple visual tasks: a central deficit in schizophrenia? A systematic review. Ann N Y Acad Sci 2017; 1408:32-45. [PMID: 29090832 DOI: 10.1111/nyas.13514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/20/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
Abstract
Impairments in sustained attention, that is, the ability to achieve and maintain the focus of cognitive activity on a given stimulation source or task, have been described as central to schizophrenia. Today, sustained attention deficit is still considered as a hallmark of schizophrenia. Nevertheless, current findings on this topic are not consistent. To clarify these findings, we attempt to put these results into perspective according to the type of assessment (i.e., overall and over time assessment), the participants' characteristics (i.e., clinical and demographic characteristics), and the paradigms (i.e., traditionally formatted tasks, go/no-go tasks, and the sustained attention task) and measures used. Two types of assessment lead to opposite findings; they do not evaluate sustained attention the same way. Studies using overall assessments of sustained attention ability tend to reveal a deficit, whereas studies using over time assessments do not. Therefore, further research is needed to investigate the underlying cognitive control mechanisms of changes in sustained attention in schizophrenia.
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Affiliation(s)
- Marc Hoonakker
- INSERM U1114, Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France
| | - Nadège Doignon-Camus
- University of Strasbourg, University of Haute-Alsace, University of Lorraine, LISEC EA 2310, Strasbourg, France
| | - Anne Bonnefond
- INSERM U1114, Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France
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Hoonakker M, Doignon-Camus N, Marques-Carneiro JE, Bonnefond A. Sustained attention ability in schizophrenia: Investigation of conflict monitoring mechanisms. Clin Neurophysiol 2017; 128:1599-1607. [DOI: 10.1016/j.clinph.2017.06.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/06/2017] [Accepted: 06/10/2017] [Indexed: 12/17/2022]
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Amr M, Elsayed H, Ibrahim IMA. Impulsive behavior and its correlates among patients with schizophrenia in a tertiary care psychiatry setting in Mansoura. Asian J Psychiatr 2016; 22:111-5. [PMID: 27520910 DOI: 10.1016/j.ajp.2016.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/07/2016] [Accepted: 06/19/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Impulsive behavior has been repeatedly identified as a major problem in schizophrenia. Our objective was to examine the possible demographical and clinical correlates for impulsive behavior in patients with schizophrenia. METHODS Fifty-eight patients with schizophrenia and Seventy-seven healthy controls were recruited. Sociodemographic data were collected and they were subjected to the Barratt Impulsiveness Scale (BIS), Positive and Negative Syndrome scale (PANSS), and Trauma Assessment for Adults-Brief Revised Version (TAA). RESULTS Correlations between impulsive behavior and psychosocial variables were examined. A significant association between level of impulsive behavior and severity of psychopathological symptoms was observed (P=0.0001). Young age (P=0.001), male patients (P=0.0001) and those with history of childhood sexual or physical abuse (P=0.0001), were more impulsive. Linear regression (step wise) analysis model showed that male sex (P=0.001), positive symptoms (P=0.006), and childhood physical abuse (P=0.001) were significant associations. CONCLUSION Male gender, positive symptoms as well as history of physical and sexual abuse before 18 years of age are important predictors for high levels of impulsive behavior in schizophrenia patients.
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Affiliation(s)
- Mostafa Amr
- Psychiatry Department, MansouraFaculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Hanan Elsayed
- Psychiatry Department, MansouraFaculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ibtihal M A Ibrahim
- Psychiatry Department, MansouraFaculty of Medicine, Mansoura University, Mansoura, Egypt
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Leung MMW, Lui SSY, Wang Y, Tsui CF, Au ACW, Yeung HKH, Yang TX, Li Z, Cheng CW, Cheung EFC, Chan RCK. Patients with bipolar disorder show differential executive dysfunctions: A case-control study. Psychiatry Res 2016; 238:129-136. [PMID: 27086222 DOI: 10.1016/j.psychres.2016.01.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/13/2015] [Accepted: 01/25/2016] [Indexed: 11/30/2022]
Abstract
Executive deficits in euthymic bipolar I disorder were examined in a fractionated manner based on the "Supervisory Attentional System" (SAS) model, and the relationship between the degree of executive impairment and the demographic and clinical characteristics of bipolar I participants was explored. A battery of neurocognitive tests capturing specific components of executive function was administered on 30 patients with bipolar I disorder in euthymic state, and compared with 30 healthy controls who were matched by age, gender and IQ. A differential impairment in executive function was demonstrated in euthymic bipolar I participants by using a fractionated approach of the SAS. Euthymic bipolar I patients were found to have significantly poorer performance in immediate and delayed visual memory; and in the executive domains of "initiation", "sustained attention", and "attention allocation and planning". Those with a greater number of executive impairments had lower IQ and higher negative sub-scores on PANSS. These findings might provide a the basis for further studies on identifying the executive components that are associated with particular disease characteristics of bipolar disorder, and those with poorer functional outcome, so that rehabilitation can be focused on the selective domains concerned.
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Affiliation(s)
- Meranda M W Leung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Chi F Tsui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Angie C W Au
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Hera K H Yeung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Tian-Xiao Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zhi Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Chi-Wai Cheng
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Maeder J, Schneider M, Bostelmann M, Debbané M, Glaser B, Menghetti S, Schaer M, Eliez S. Developmental trajectories of executive functions in 22q11.2 deletion syndrome. J Neurodev Disord 2016; 8:10. [PMID: 27018204 PMCID: PMC4807556 DOI: 10.1186/s11689-016-9141-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/08/2016] [Indexed: 12/13/2022] Open
Abstract
Background 22q11.2 deletion syndrome (22q11.2DS) is a genetic disorder associated with a specific cognitive profile. Higher-order cognitive skills like executive functions (EF) are reported as a relative weakness in this population. The present study aimed to delineate the developmental trajectories of multiple EF domains in a longitudinal sample using a broader age range than previous studies. Given the high incidence of psychotic symptoms in 22q11.2DS, we also compared the development of EF in participants with/without comorbid psychotic symptoms. Given the importance of EF in daily life, the third aim of the study was to characterize the link between EF and adaptive functioning. Methods The sample consisted of 95 individuals with 22q11.2DS and 100 typically developing controls aged 6–26 years. A large proportion of the sample (55.38 %) had multiple time points available. Between-group differences in the developmental trajectories of three subdomains of EF (verbal fluency, working memory, and inhibition) were examined using mixed models regression analyses. Analyses were repeated comparing only the 22q11.2DS group based on the presence/absence of psychotic symptoms to investigate the influence of executive dysfunction on the emergence of psychotic symptoms. Hierarchical stepwise regression analyses were also conducted to investigate the predictive value of EF on adaptive functioning. Results We observed lower performance on EF domains, as well as atypical development of working memory and verbal fluency. Participants who presented with negative symptoms exhibited different developmental trajectories of inhibition and working memory. Adaptive functioning level was not significantly predicted by EF scores. Conclusions The present study highlighted domain-specific atypical trajectories of EF in individuals with 22q11.DS and explored the link with psychotic symptoms. However, no relation between EF and adaptive functioning was observed.
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Affiliation(s)
- Johanna Maeder
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Maude Schneider
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Mathilde Bostelmann
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Martin Debbané
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland ; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Bronwyn Glaser
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Sarah Menghetti
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Marie Schaer
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Stanford Cognitive and Systems Neuroscience Laboratory, Stanford University School of Medicine, California, USA
| | - Stephan Eliez
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland ; Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
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Spagna A, Dong Y, Mackie MA, Li M, Harvey PD, Tian Y, Wang K, Fan J. Clozapine improves the orienting of attention in schizophrenia. Schizophr Res 2015; 168:285-91. [PMID: 26298539 DOI: 10.1016/j.schres.2015.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
Attentional deficits are prominent in the cognitive profile of patients with schizophrenia. However, it remains unclear whether treatment with clozapine, an atypical antipsychotic and first-line intervention used to reduce positive and negative symptoms of psychosis, improves the attentional functions. We used the revised attention network test to measure alerting, orienting, and executive control of attention both pre- and post-treatment with clozapine in patients with schizophrenia (n=32) and compared performance to healthy controls (n=32). Results revealed that there were deficits in all three attentional functions pre-treatment, and while clozapine improved the orienting function in patients with schizophrenia, there was no evidence for improvement in the alerting and executive control of attention. The enhancement of the orienting function by clozapine may increase the ability of patients with schizophrenia to orient towards objects and thoughts of interest.
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Affiliation(s)
- Alfredo Spagna
- Department of Psychology, Queens College, The City University of New York, Queens, NY, USA
| | - Yi Dong
- Hefei Psychiatry Hospital, Hefei, Anhui Province, China
| | - Melissa-Ann Mackie
- Department of Psychology, Queens College, The City University of New York, Queens, NY, USA
| | - Ming Li
- Department of Psychology, University of Nebraska-Lincoln, NE, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
| | - Jin Fan
- Department of Psychology, Queens College, The City University of New York, Queens, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Mitchell RLC, Rossell SL. Perception of emotion-related conflict in human communications: what are the effects of schizophrenia? Psychiatry Res 2014; 220:135-44. [PMID: 25149130 DOI: 10.1016/j.psychres.2014.07.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 07/29/2014] [Accepted: 07/31/2014] [Indexed: 11/18/2022]
Abstract
Our ability to make sense of emotional cues is of paramount importance for understanding state of mind and communicative intent. However, emotional cues often conflict with each other; this presents a significant challenge for people with schizophrenia. We conducted a theoretical review to determine the extent and types of impaired processing of emotion-related conflict in schizophrenia; we evaluated the relationship with medication and symptoms, and considered possible mediatory mechanisms. The literature established that people with schizophrenia demonstrated impaired function: (i) when passively exposed to emotion cues whilst performing an unrelated task, (ii) when selectively attending to one source of emotion cues whilst trying to ignore interference from another source, and (iii) when trying to resolve conflicting emotion cues and judge meta-communicative intent. These deficits showed associations with both negative and positive symptoms. There was limited evidence for antipsychotic medications attenuating impaired emotion perception when there are conflicting cues, with further direct research needed. Impaired attentional control and context processing may underlie some of the observed impairments. Neuroanatomical correlates are likely to involve interhemispheric transfer via the corpus callosum, limbic regions such as the amygdala, and possibly dorsolateral prefrontal and anterior cingulate cortex through their role in conflict processing.
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Affiliation(s)
- Rachel L C Mitchell
- Centre for Affective (PO Box 72), Department of Psychological Medicine, Institute of Psychiatry, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Susan L Rossell
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia
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Deficient grip force control in schizophrenia: behavioral and modeling evidence for altered motor inhibition and motor noise. PLoS One 2014; 9:e111853. [PMID: 25369465 PMCID: PMC4219790 DOI: 10.1371/journal.pone.0111853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022] Open
Abstract
Whether upper limb sensorimotor control is affected in schizophrenia and how underlying pathological mechanisms may potentially intervene in these deficits is still being debated. We tested voluntary force control in schizophrenia patients and used a computational model in order to elucidate potential cerebral mechanisms underlying sensorimotor deficits in schizophrenia. A visuomotor grip force-tracking task was performed by 17 medicated and 6 non-medicated patients with schizophrenia (DSM-IV) and by 15 healthy controls. Target forces in the ramp-hold-and-release paradigm were set to 5N and to 10% maximal voluntary grip force. Force trajectory was analyzed by performance measures and Principal Component Analysis (PCA). A computational model incorporating neural control signals was used to replicate the empirically observed motor behavior and to explore underlying neural mechanisms. Grip task performance was significantly lower in medicated and non-medicated schizophrenia patients compared to controls. Three behavioral variables were significantly higher in both patient groups: tracking error (by 50%), coefficient of variation of force (by 57%) and duration of force release (up by 37%). Behavioral performance did not differ between patient groups. Computational simulation successfully replicated these findings and predicted that decreased motor inhibition, together with an increased signal-dependent motor noise, are sufficient to explain the observed motor deficits in patients. PCA also suggested altered motor inhibition as a key factor differentiating patients from control subjects: the principal component representing inhibition correlated with clinical severity. These findings show that schizophrenia affects voluntary sensorimotor control of the hand independent of medication, and suggest that reduced motor inhibition and increased signal-dependent motor noise likely reflect key pathological mechanisms of the sensorimotor deficit.
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Neill E, Gurvich C, Rossell SL. Category fluency in schizophrenia research: is it an executive or semantic measure? Cogn Neuropsychiatry 2014; 19:81-95. [PMID: 23822137 DOI: 10.1080/13546805.2013.807233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The semantic fluency task is described as a measure of semantic function and utilised in schizophrenia (SZ) research to demonstrate semantic deficits. Two meta-analyses support the efficacy of this task in measuring semantic function in SZ; however, a more recent meta-analysis suggests that executive dysfunction is the predominant determinant of semantic fluency performance in this group. By (1) matching the semantic and executive fluency tasks on discriminant validity, and (2) including an additional fluency task containing both semantic and executive elements (animals by size), this study aimed to determine whether semantic fluency is in fact an appropriate measure of semantic function in SZ. METHODS Forty-two SZ participants and 40 healthy controls performed 3 fluency tasks: executive (F, A, S), semantic (body parts), and semantic/executive (animals by size). Performance on these tasks was analysed in two ways, (1) based on discriminant validity and (2) by matching output between the semantic and semantic/executive fluency tasks. RESULTS When the semantic and executive fluency tasks were matched, executive fluency performance was either (1) mildly impaired or (2) not impaired in SZ. Both semantic and semantic/executive performance was impaired in SZ regardless of calculation. Group differences on the semantic/executive task remained when executive function was controlled for, but disappeared when semantic fluency effects were controlled for. CONCLUSIONS The findings support earlier meta-analyses in finding that the semantic fluency task is a robust measure of semantic memory function in SZ.
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Affiliation(s)
- Erica Neill
- a Monash Alfred Psychiatry research centre (MAPrc), Central Clinical School, Faculty of Medicine, Nursing and Health Sciences , Monash University and The Alfred Hospital , Melbourne , Australia
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16
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Chang WC, Hui CLM, Chan SKW, Lee EHM, Wong GHY, Chen EYH. Relationship between diminished expression and cognitive impairment in first-episode schizophrenia: a prospective three-year follow-up study. Schizophr Res 2014; 152:146-51. [PMID: 24333004 DOI: 10.1016/j.schres.2013.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 11/08/2013] [Accepted: 11/18/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Diminished expression (DE) is a core sub-domain of negative symptoms construct in schizophrenia. There is limited, yet inconsistent data regarding DE and its associations with cognition, particularly in the early illness course. This study aimed to examine cross-sectional and longitudinal relationships of DE with cognitive functions in first-episode schizophrenia utilizing a prospective design. METHOD Ninety-three Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. Severity of DE was measured as sum of individual item scores indicative of affect flattening and alogia. Symptom evaluation was conducted at intake, after clinical stabilization of first psychotic episode, at 12, 24 and 36 months. Cognitive functions were evaluated at clinical stabilization, 12, 24 and 36 months. RESULTS DE was significantly correlated with various cognitive functions in successive follow-up assessments. Regression analyses adjusting confounding effects of sex, pre-morbid adjustment, duration of untreated psychosis and chlorpromazine equivalents showed that DE was associated with performance on verbal fluency at 12 (p<0.01) and 24 months (p<0.05), visual reproduction at 24 (p<0.05) and 36 months (p<0.01), logical memory at 36 months (p<0.05) and Modified Wisconsin Card Sorting test at 24 (p<0.05) and 36 months (p<0.05). Neither cross-lagged associations between DE and cognition nor significant correlations between changes in these two domains over three years were observed. CONCLUSIONS DE and cognitive functions were correlated concurrently but no longitudinal associations between these two domains could be demonstrated. Our findings indicated that DE and cognitive impairment represented relatively independent domains of the illness with potentially distinctive therapeutic implications.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong.
| | | | | | | | | | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Poor savouring and low self-efficacy are predictors of anhedonia in patients with schizophrenia spectrum disorders. Psychiatry Res 2013; 210:830-4. [PMID: 24135552 DOI: 10.1016/j.psychres.2013.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 09/15/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022]
Abstract
Previous research suggests that negative schizotypes may be impaired in their ability to savour pleasant events (Applegate et al., 2009) and that schizophrenia patients believe that everyday tasks are excessively difficult to complete so that they attempt these tasks less frequently (MacCarthy et al., 1986; Bentall et al., 2010). It is possible that these beliefs and behaviours underpin negative symptoms such as anhedonia, avolition, apathy and associality. In the present study, 50 schizophrenia patients and 100 matched controls (half employed and half unemployed) completed self-report measures of self-efficacy and savouring. Patients reported savouring past, present and future events less than employed and unemployed groups, irrespective of mood state and I.Q. Patients also rated everyday tasks as more difficult to master. Inpatients compared to outpatients rated tasks more difficult but less important although they did not differ on the savouring measure. Abnormal judgements of difficulty and the reduced propensity to mentally rehearse past or future positive experiences to up-regulate mood could explain negative symptom patients' lack of engagement in everyday activities and eventual social withdrawal. These findings suggest the need to develop cognitive-behavioural savouring and self-efficacy interventions for patients experiencing the negative symptoms of schizophrenia.
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18
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Donohoe G, Deary IJ, Glahn DC, Malhotra AK, Burdick KE. Neurocognitive phenomics: examining the genetic basis of cognitive abilities. Psychol Med 2013; 43:2027-2036. [PMID: 23194477 DOI: 10.1017/s0033291712002656] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cognitive deficits are core to the disability associated with many psychiatric disorders. Both variation in cognition and psychiatric risk show substantial heritability, with overlapping genetic variants contributing to both. Unsurprisingly, therefore, these fields have been mutually beneficial : just as cognitive studies of psychiatric risk variants may identify genes involved in cognition, so too can genome-wide studies based on cognitive phenotypes lead to genes relevant to psychiatric aetiology. The purpose of this review is to consider the main issues involved in the phenotypic characterization of cognition, and to describe the challenges associated with the transition to genomewide approaches. We conclude by describing the approaches currently being taken by the international consortia involving many investigators in the field internationally (e.g. Cognitive Genomics Consortium; COGENT) to overcome these challenges.
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Affiliation(s)
- G Donohoe
- Department of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Republic of Ireland.
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Neill E, Rossell SL. Executive functioning in schizophrenia: the result of impairments in lower order cognitive skills? Schizophr Res 2013; 150:76-80. [PMID: 23973320 DOI: 10.1016/j.schres.2013.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 06/28/2013] [Accepted: 07/14/2013] [Indexed: 10/26/2022]
Abstract
Executive functioning (EF) impairments are common in schizophrenia. There are two propositions regarding the causes of these impairments: (1) executive impairments are the result of the compounding effects of deficits in lower order cognitive skills (e.g. processing speed, attention) or (2) EF impairments exist in their own right regardless of lower order skills. It is difficult to examine the separable effects of lower order cognitive skills on EF given the overlap required to complete most neuropsychological measures. One battery designed to parcel out the contributions of lower order skills from EF is the Delis-Kaplan Executive Function System (D-KEFS). Inhibition and switching specifically were examined using the D-KEFS versions of the Stroop and Trails task. No group differences in task performance after controlling for lower level skills would provide evidence for a generalised cognitive deficit. Group differences remaining after controlling for these influences would suggest a disproportionate deficit. Results supported both propositions. On both tasks, group differences reflecting slowed reaction time in the schizophrenia group disappeared when lower order skills were controlled for. Differences between groups performance in errors were only evident on the most complex versions of each task with more errors made by the schizophrenia group. These results suggest that (1) both RT and error data are needed to provide a full picture of performance and (2) the relationship between lower order and EF is too complex to provide support for one or the other proposal.
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Affiliation(s)
- Erica Neill
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Level 4, 607 St Kilda Rd, Melbourne, VIC 3004 Australia.
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20
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Harciarek M, Malaspina D, Sun T, Goldberg E. Schizophrenia and frontotemporal dementia: shared causation? Int Rev Psychiatry 2013; 25:168-77. [PMID: 23611347 DOI: 10.3109/09540261.2013.765389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The relationship between specific genes and particular diseases in neuropsychiatry is unclear, and newer studies focus on shared domains of neurobiological and cognitive pathology across different disorders. This paper reviews the evidence for an association between schizophrenia and frontotemporal dementia, including symptom similarity, familial co-morbidity, and neuroanatomical changes. Genetic as well as epigenetic findings from both schizophrenia and frontotemporal dementia are also discussed. As a result, we introduce the hypothesis of a shared susceptibility for certain subgroups of schizophrenia and frontotemporal dementia. This common causation may involve the same gene(s) at different stages of life: early in schizophrenia and late in frontotemporal dementia. Additionally, we provide a rationale for future research that should emphasize both genetic and cognitive parallels between certain forms of schizophrenia and frontotemporal dementia in a synergistic, coordinated way, placing both in the context of aberrant lateralization patterns.
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Affiliation(s)
- Michał Harciarek
- Division of Clinical Psychology and Neuropsychology, Institute of Psychology, University of Gdansk, Poland
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21
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Bagney A, Rodriguez-Jimenez R, Martinez-Gras I, Sanchez-Morla EM, Santos JL, Jimenez-Arriero MA, Lobo A, McGorry PD, Palomo T. Negative symptoms and executive function in schizophrenia: does their relationship change with illness duration? Psychopathology 2013; 46:241-8. [PMID: 23147471 DOI: 10.1159/000342345] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 07/26/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Negative symptoms and cognitive dysfunction are of crucial functional and prognostic importance in schizophrenia. However, the nature of the relationship between them and the factors that may influence it have not been well established. AIMS To investigate whether the relationship between negative symptoms and executive function changes according to the duration of illness in schizophrenia. METHODS The Positive and Negative Syndrome Scale was used to assess psychopathology and the Wisconsin Card Sorting Test (WCST) to evaluate executive function in a sample of 200 schizophrenic patients who were classified in 3 groups according to their duration of illness: up to 5 years (short duration group), 6-20 years (intermediate duration group) and over 20 years of illness (long duration group). RESULTS Medium-sized correlations were found between negative symptoms and WCST performance as assessed by the number of completed categories in all 3 groups. However, differences were found according to the duration of schizophrenia. For patients in the short duration group, negative symptoms correlated with WCST nonperseverative errors, but for those in the long duration group the correlation was with perseverative errors. CONCLUSION We found a differential relationship between negative and cognitive symptoms in different stages of schizophrenia. Illness duration should be considered when studying the relationship between negative symptoms and cognition.
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Affiliation(s)
- Alexandra Bagney
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.
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Understanding the executive functioning heterogeneity in schizophrenia. Brain Cogn 2012; 79:60-9. [DOI: 10.1016/j.bandc.2012.01.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/09/2012] [Indexed: 11/21/2022]
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Poldrack RA, Kittur A, Kalar D, Miller E, Seppa C, Gil Y, Parker DS, Sabb FW, Bilder RM. The cognitive atlas: toward a knowledge foundation for cognitive neuroscience. Front Neuroinform 2011; 5:17. [PMID: 21922006 PMCID: PMC3167196 DOI: 10.3389/fninf.2011.00017] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 08/17/2011] [Indexed: 11/13/2022] Open
Abstract
Cognitive neuroscience aims to map mental processes onto brain function, which begs the question of what “mental processes” exist and how they relate to the tasks that are used to manipulate and measure them. This topic has been addressed informally in prior work, but we propose that cumulative progress in cognitive neuroscience requires a more systematic approach to representing the mental entities that are being mapped to brain function and the tasks used to manipulate and measure mental processes. We describe a new open collaborative project that aims to provide a knowledge base for cognitive neuroscience, called the Cognitive Atlas (accessible online at http://www.cognitiveatlas.org), and outline how this project has the potential to drive novel discoveries about both mind and brain.
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Affiliation(s)
- Russell A Poldrack
- Imaging Research Center and Departments of Psychology and Neurobiology, University of Texas Austin, TX, USA
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24
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Bruder GE, Alschuler DM, Kroppmann CJ, Fekri S, Gil RB, Jarskog LF, Harkavy-Friedman JM, Goetz R, Kayser J, Wexler BE. Heterogeneity of auditory verbal working memory in schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 120:88-97. [PMID: 21319926 DOI: 10.1037/a0021661] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The heterogeneity of schizophrenia remains an obstacle for understanding its pathophysiology. Studies using a tone discrimination screening test to classify patients have found evidence for 2 subgroups having either a specific deficit in verbal working memory (WM) or deficits in both verbal and nonverbal memory. This study aimed to (a) replicate in larger samples differences between these subgroups in auditory verbal WM; (b) evaluate their performance on tests of explicit memory and sustained attention; (c) determine the relation of verbal WM deficits to auditory hallucinations and other symptoms; and (d) examine medication effects. The verbal WM and tone discrimination performance did not differ between medicated (n = 45) and unmedicated (n = 38) patients. Patients with schizophrenia who passed the tone screening test (discriminators; n = 60) were compared with those who did not (nondiscriminators; n = 23) and healthy controls (n = 47). The discriminator subgroup showed poorer verbal WM than did controls and a deficit in verbal but not visual memory on the Wechsler Memory Scale-Revised (Wechsler, 1987), whereas the nondiscriminator subgroup showed overall poorer performance on both verbal and nonverbal tests and a marked deficit in sustained attention. Verbal WM deficits in discriminators were correlated with auditory hallucinations but not with negative symptoms. The results are consistent with a verbal memory deficit in a subgroup of schizophrenia having intact auditory perception, which may stem from dysfunction of language-related cortical regions, and a more generalized cognitive deficit in a subgroup having auditory perceptual and attentional dysfunction.
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25
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Bowins B. A cognitive regulatory control model of schizophrenia. Brain Res Bull 2011; 85:36-41. [PMID: 21329746 DOI: 10.1016/j.brainresbull.2011.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/28/2010] [Accepted: 02/07/2011] [Indexed: 01/15/2023]
Abstract
A puzzling aspect of schizophrenia concerns the relationship between negative and positive symptoms. Perspectives suggesting that they arise from the same pathophysiological process are not consistent with the numerous differences such as treatment response, and the underlying neurochemistry relevant to treatment. Explanations viewing negative and positive symptoms as independent processes or diseases cannot readily account for the typical developmental course of schizophrenia, consisting of a lengthy prodromal phase of negative followed by positive symptoms. A model of schizophrenia is presented positing that negative and positive symptoms are distinct but interrelated processes, with the former bringing forth the latter due to damaged or impaired cognitive regulatory control processes. The extensive cognitive distortions, thought form variants, and sensory perceptual experiences comprising psychosis represent a natural propensity derived from the evolution of human intelligence. To facilitate reality congruency typically necessary for adaptive functioning, cognitive regulatory control processes normally prevent these extreme variants from entering the conscious and awake state. During sleep when there is no need for reality congruency the cognitive regulatory control processes are deactivated and psychotic equivalents are expressed. Psychological defensive functioning can also deactivate these processes and allow psychosis to manifest. The negative symptoms of schizophrenia are seen as arising from diverse neural deficits that impair to varying degrees the cognitive regulatory control processes, thus producing psychosis. The pattern of neural damage determines the negative symptom profile, and the impact on cognitive regulatory control processes influences whether negative or positive symptoms dominate or exist in relatively equal proportions.
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Clark LK, Warman D, Lysaker PH. The relationships between schizophrenia symptom dimensions and executive functioning components. Schizophr Res 2010; 124:169-75. [PMID: 20800998 DOI: 10.1016/j.schres.2010.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 07/27/2010] [Accepted: 08/03/2010] [Indexed: 11/29/2022]
Abstract
Research investigating the relationships between executive functioning impairments and the positive, negative, and cognitive schizophrenia symptoms has produced inconsistent results. This inconsistency may be due to the tendency to view executive functioning as a unified process as opposed to multiple fractionated processes. A fractionated model of executive functioning has been supported in several studies of various populations, but few schizophrenia studies have used the factor analytic methods of these studies to empirically determine separate executive functioning components, causing conclusions regarding the relationships between these components and schizophrenia symptoms to be unreliable. The purposes of the present study were to (1) identify separate components of executive functioning by conducting a factor analysis of the performance of individuals with schizophrenia on the Delis Kaplan Executive Function System (D-KEFS) and (2) investigate the relationships between executive functioning components and the three schizophrenia symptom dimensions by correlating the derived factor scores with the scale scores of the Positive and Negative Symptom Scale (PANSS). An exploratory factor analysis revealed two separate components: inhibition/set shifting and mental flexibility. The results showed that the symptom dimensions were differentially related to impairments in executive functioning, with both negative and cognitive symptoms associated with the inhibition/set shifting component, cognitive symptoms alone associated with the mental flexibility component, and positive symptoms unrelated to either component.
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Affiliation(s)
- Laura K Clark
- University of Indianapolis, School of Psychological Sciences, 1400 East Hanna Avenue, Indianapolis, IN 46227, USA.
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27
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Ventura J, Thames AD, Wood RC, Guzik LH, Hellemann GS. Disorganization and reality distortion in schizophrenia: a meta-analysis of the relationship between positive symptoms and neurocognitive deficits. Schizophr Res 2010; 121:1-14. [PMID: 20579855 PMCID: PMC3160271 DOI: 10.1016/j.schres.2010.05.033] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 05/23/2010] [Accepted: 05/26/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Factor analytic studies have shown that in schizophrenia patients, disorganization (e.g., conceptual disorganization and bizarre behavior) is a separate dimension from other types of positive symptoms such as reality distortion (delusions and hallucinations). Although some studies have found that disorganization is more strongly linked to neurocognitive deficits and poor functional outcomes than reality distortion, the findings are not always consistent. METHODS A meta-analysis of 104 studies (combined n=8015) was conducted to determine the magnitude of the relationship between neurocognition and disorganization as compared to reality distortion. Additional analyses were conducted to determine whether the strength of these relationships differed depending on the neurocognitive domain under investigation. RESULTS The relationship between reality distortion and neurocognition was weak (r=-.04; p=.03) as compared to the moderate association between disorganization and neurocognition (r=-.23; p<.01). In each of the six neurocognitive domains that were examined, disorganization was more strongly related to neurocognition (r's range from -.20 to -.26) than to reality distortion (r's range from .01 to -.12). CONCLUSIONS The effect size of the relationship between neurocognition and disorganization was significantly larger than the effect size of the relationship between neurocognition and reality distortion. These results hold across several neurocognitive domains. These findings support a dimensional view of positive symptoms distinguishing disorganization from reality distortion.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry, 300 Medical Plaza, Room 2243, Los Angeles CA 90095-6968, United States.
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28
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Abstract
OBJECTIVE Fronto-limbic interactions facilitate the generation of task-relevant responses while inhibiting interference from emotionally distracting information. Schizophrenia is associated with deficits in both executive attention and affective regulation. This study aims to elucidate the neural correlates of emotion-attention regulation and shifting in schizophrenia. METHOD We employed functional magnetic resonance imaging to probe the fronto-limbic regions in 16 adults with schizophrenia and 13 matched adults with no history of psychiatric illness. Subjects performed a forced-choice visual oddball task where they detected infrequent target circles embedded in a series of infrequent nontarget aversive and neutral pictures and frequent squares. RESULTS In control participants, target events activated a dorsal frontoparietal network, whereas these regions were deactivated by aversive stimuli. Conversely, ventral frontolimbic brain regions were activated by aversive stimuli and deactivated by target events. In the patient group, regional hemodynamic timecourses revealed not only reduced activation to target and aversive events in dorsal executive and ventral limbic regions, respectively, but also reduced deactivation to target and aversive stimuli in ventral and dorsal regions, respectively, relative to the control group. Patients further showed reduced spatial extent of activation in the right inferior frontal gyrus during the target and aversive conditions. Activation of the anterior cingulate to aversive images was inversely related to severity of avolition and anhedonia symptoms in the schizophrenia group. CONCLUSIONS These results suggest both frontal and limbic dysfunction in schizophrenia as well as aberrant reciprocal inhibitions between these regions during attention-emotion modulation in this disorder.
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Affiliation(s)
- Gabriel S. Dichter
- Neurodevelopmental Disorders Research Center,Duke-UNC Brain Imaging and Analysis Center
| | - Carolyn Bellion
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, CB 7160, 101 Manning Drive, Chapel Hill, NC 27599-7160
| | - Michael Casp
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, CB 7160, 101 Manning Drive, Chapel Hill, NC 27599-7160
| | - Aysenil Belger
- Neurodevelopmental Disorders Research Center,Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, CB 7160, 101 Manning Drive, Chapel Hill, NC 27599-7160,Duke-UNC Brain Imaging and Analysis Center,To whom correspondence should be addressed; tel: 919-843-7368, fax: 919-966-9172, e-mail:
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29
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Wobrock T, Ecker UKH, Scherk H, Schneider-Axmann T, Falkai P, Gruber O. Cognitive impairment of executive function as a core symptom of schizophrenia. World J Biol Psychiatry 2010; 10:442-51. [PMID: 18609418 DOI: 10.1080/15622970701849986] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cognitive dysfunction is a common finding in schizophrenia. Nevertheless the specific pattern of neuropsychological impairment in schizophrenia compared to other severe mental illnesses has not been intensively studied. Twenty-four patients with schizophrenia belonging to different stages of the disease (11 first-episode patients, 13 patients with multiple episodes), 18 patients with bipolar disorder and 23 healthy control subjects underwent standardized neuropsychological assessment. Statistical analysis of covariance (ANCOVA) demonstrated that, compared to control subjects, patients with schizophrenia performed significantly worse in the trail-making test (P = 0.012), verbal fluency (category letter, P = 0.004), verbal learning/memory (P = 0.005), and the Wisconsin Card Sorting Test (WCST) (P = 0.004 for administered trials; P = 0.025 for perseverative responses, T value) indicating significant deficits in attention and psychomotor performance, and in particular in verbal working memory and cognitive flexibility for schizophrenic patients. A significant difference between schizophrenic and bipolar patients was found only in the WCST. Schizophrenic patients made significantly more perseverative responses (P = 0.002, ANCOVA), indicating a more pronounced and specific deficit in cognitive flexibility and frontally based executive function. In conclusion, these results may suggest a cognitive endophenotype in schizophrenia and underline the role of the prefrontal cortex in schizophrenic pathophysiology.
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Affiliation(s)
- Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University, Göttingen, Germany.
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30
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Schettino A, Lauro LR, Crippa F, Anselmetti S, Cavallaro R, Papagno C. The comprehension of idiomatic expressions in schizophrenic patients. Neuropsychologia 2009; 48:1032-40. [PMID: 19963000 DOI: 10.1016/j.neuropsychologia.2009.11.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 11/03/2009] [Accepted: 11/30/2009] [Indexed: 11/30/2022]
Abstract
Recent fMRI and TMS studies on idiom comprehension have shown that the prefrontal cortex is involved in idiom processing. Since schizophrenic patients exhibit prefrontal structural changes and dysexecutive behavioural deficits, we hypothesised an impairment in idiom comprehension, correlating with performance on executive tasks. In this study, idiom comprehension was evaluated by means of a sentence-to-picture-matching task in 45 schizophrenic patients and 45 control subjects, matched for age and educational level. The task included 62 idiomatic and 62 literal sentences. Participants were presented with a written sentence, either literal or idiomatic, followed by a picture, which appeared below the sentence. They were instructed to judge whether the picture represented the meaning of the sentence or not, and responded by pressing one of two response keys. Half of the items correctly represented the meaning, half did not. Reaction times and accuracy were measured. Schizophrenics were impaired in both types of idiomatic sentence. However, their performance was particularly poor in the case of ambiguous idioms. Wisconsin Card Sorting Test and Digit Sequencing were the unique predictors of performance for idiom comprehension in general, while thought disorganization was not. Cognitive decline either did not appear to predict performance.
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Affiliation(s)
- Antonio Schettino
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milano, Italy
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31
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Josman N, Schenirderman AE, Klinger E, Shevil E. Using virtual reality to evaluate executive functioning among persons with schizophrenia: a validity study. Schizophr Res 2009; 115:270-7. [PMID: 19850451 DOI: 10.1016/j.schres.2009.09.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/08/2009] [Accepted: 09/13/2009] [Indexed: 10/20/2022]
Abstract
Persons with Schizophrenia experience difficulties with Executive Functioning (EF) that affect independence and participation in activities. Specifically, EF impacts performance in Instrumental Activities of Daily Living (IADL) that require flexible thinking and accommodation to complex environments. However, less is known how schizophrenia affects EF and individuals' performance in activities. IADL performance can be tested using a virtual reality (VR) environment that simulates real life activities. The purpose of this study was: 1) to examine the feasibility and validity of the Virtual Action Planning-Supermarket (VAP-S) to assess EF in persons with schizophrenia as compared to a standardized EF measure (the Behavioral Assessment of Dysexecutive Syndrome, BADS); 2) to compare performance of persons with schizophrenia and healthy controls in the VAP-S; 3) to assess the ability of the VAP-S to differentiate between different levels of EF within schizophrenia; 4) to explore the relationships between negative and positive symptoms and performance on the tests. Thirty persons with schizophrenia were matched with 30 healthy controls. Significant differences in performance between research and control groups were detected on the VAP-S and BADS, with the research group performing worse. Large variations in number of purchases within the VAP-S by the research group point to level of task completion thus secondary analysis was conducted. There was a significant negative correlation between level of the negative signs and overall performance on the BADS and on most measures of the VAP-S. Results of this study support the use the VAP-S to assess EF among persons with Schizophrenia.
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Affiliation(s)
- Naomi Josman
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, 31905, Israel.
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32
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Potentiel d’apprentissage et revalidation cognitive dans la schizophrénie. Encephale 2009; 35:353-60. [DOI: 10.1016/j.encep.2008.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 06/06/2008] [Indexed: 11/19/2022]
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Young SE, Friedman NP, Miyake A, Willcutt EG, Corley RP, Haberstick BC, Hewitt JK. Behavioral disinhibition: liability for externalizing spectrum disorders and its genetic and environmental relation to response inhibition across adolescence. JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:117-30. [PMID: 19222319 DOI: 10.1037/a0014657] [Citation(s) in RCA: 286] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral disinhibition has been characterized as a generalized vulnerability to externalizing disorders. Despite increasing evidence for its validity and heritability, the structural stability of behavioral disinhibition across adolescence and the strength and etiology of its relation to executive functions have not been studied. In this multivariate twin study, the authors assessed behavioral disinhibition using measures tapping substance use, conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and novelty seeking at ages 12 and 17. Executive functions were assessed with laboratory-based cognitive tasks at age 17. Results indicated that, at age 12, behavioral disinhibition was dominated by ADHD and conduct problems and was highly heritable. At age 17, the contributions of the 4 components were more balanced, and the proportion of variance attributable to genetic factors was somewhat smaller, with additional variance due to shared environmental influences. At both ages, behavioral disinhibition was more closely related to response inhibition than other executive functions (working memory updating and task-set shifting), and this relationship was primarily genetic in origin. These results highlight the dynamic nature of behavioral disinhibition across adolescence and suggest that response inhibition may be an important mechanism underlying vulnerability to disinhibitory psychopathology.
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Affiliation(s)
- Susan E Young
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO 80309, USA.
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Olgiati P, Mandelli L, Lorenzi C, Marino E, Adele P, Ferrari B, De Ronchi D, Serretti A. Schizophrenia: genetics, prevention and rehabilitation. Acta Neuropsychiatr 2009; 21:109-20. [PMID: 26953749 DOI: 10.1111/j.1601-5215.2009.00360.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Genetic factors are largely implicated in predisposing to schizophrenia. Environmental factors contribute to the onset of the disorder in individuals at increased genetic risk. Cognitive deficits have emerged as endophenotypes and potential therapeutic targets for schizophrenia because of their association with functional outcome. The aims of this review were to analyse the joint effect of genetic and environmental (G×E) factors on liability to schizophrenia and to investigate relationships between genes and cognitive endophenotypes focusing on practical applications for prevention and rehabilitation. METHODS Medline search of relevant studies published between 1990 and 2008. RESULTS In schizophrenia, examples of G×E interaction include the catechol-O-methyl transferase (COMT) (Val158Met) polymorphism, which was found to moderate the onset of psychotic manifestations in response to stress and to increase the risk for psychosis related to cannabis use, and neurodevelopmental genes such as AKT1 (serine-threonine kinase), brain-derived neurotrophic factor (BDNF), DTNBP1 (dysbindin) and GRM3 (metabotropic glutamate receptor 3), which were associated with development of schizophrenia in adulthood after exposure to perinatal obstetric complications. Neurocognitive deficits are recognised as core features of schizophrenia that facilitate the onset of the disorder and have a great impact on functional outcome. Neurocognitive deficits are also endophenotypes that have been linked to a variety of genes [COMT, neuregulin (NRG1), BDNF, Disrupted-In-Schizophrenia 1 (DISC1) and dysbindin] conferring susceptibility to schizophrenia. Recently, it has emerged that cognitive improvement during rehabilitation therapy was under control of COMT (Val158Met) polymorphism. CONCLUSION This review could indicate a pivotal role of psychiatric genetics in prevention and rehabilitation of schizophrenic psychoses.
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Affiliation(s)
- Paolo Olgiati
- 1Department of Psychiatry, Institute of Psychiatry, Bologna University, Italy
| | - Laura Mandelli
- 1Department of Psychiatry, Institute of Psychiatry, Bologna University, Italy
| | - Cristina Lorenzi
- 2Department of Psychiatry, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
| | - Elena Marino
- 2Department of Psychiatry, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
| | - Pirovano Adele
- 2Department of Psychiatry, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
| | - Barbara Ferrari
- 1Department of Psychiatry, Institute of Psychiatry, Bologna University, Italy
| | - Diana De Ronchi
- 1Department of Psychiatry, Institute of Psychiatry, Bologna University, Italy
| | - Alessandro Serretti
- 1Department of Psychiatry, Institute of Psychiatry, Bologna University, Italy
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35
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Behavioral Assessment of the Dysexecutive Syndrome Battery (BADS) in Schizophrenia. Cogn Behav Neurol 2009; 22:95-100. [DOI: 10.1097/wnn.0b013e318192cd08] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raffard S, Bayard S, Gely-Nargeot MC, Capdevielle D, Maggi M, Barbotte E, Morris D, Boulenger JP. Insight and executive functioning in schizophrenia: a multidimensional approach. Psychiatry Res 2009; 167:239-50. [PMID: 19395049 DOI: 10.1016/j.psychres.2008.04.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 04/05/2008] [Accepted: 04/19/2008] [Indexed: 11/17/2022]
Abstract
Past research suggests that unawareness of illness in schizophrenia is associated with deficits in executive functions; however, the relationships between executive processes and the various dimensions of insight are still unclear. Recent models of executive functioning have proposed that four executive processes - inhibition, updating, shifting and dual task coordination - are moderately related yet separable. In this study, we proposed to investigate and clarify the relationships between insight dimensions and the aforementioned four executive components. A total of 60 patients were administered the Test for Attentional Performance and the Scale to Assess Unawareness of Mental Disorder. The effect of potential confounding variables such as medication, symptomatology, demography, psycho-affective state, and general processing speed were also examined in a preliminary statistical analysis. We found that both awareness of disorder and awareness of response to medication were significantly related to Updating. Awareness of the social consequences of the disease was significantly related to Updating, Divided Attention and Inhibition Processes. The analysis indicates that poor insight in schizophrenia may be partially related to executive dysfunction. Finally, our study emphasizes the possible role of neuropsychological intervention in improving patients' insight into illness.
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Affiliation(s)
- Stéphane Raffard
- University Department of Adult Psychiatry, CHU, Université Montpellier 1, France.
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37
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Guillem F, Rinaldi M, Pampoulova T, Stip E. The complex relationships between executive functions and positive symptoms in schizophrenia. Psychol Med 2008; 38:853-860. [PMID: 18261245 DOI: 10.1017/s0033291707002577] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Relationships between performance on various tests of executive functions and positive symptoms, especially delusions and hallucinations, have not been found consistently. This may be related to method of rating symptoms, to possible interactions between them, as well as to the low specificity of the cognitive test measures used. In this study, we have investigated the relationships between different aspects of positive symptomatology and several executive subprocesses. METHOD Stable schizophrenia patients (n=96) were assessed for disorganization, delusion and hallucination symptoms rated from the Scale for Assessment of Positive Symptoms and the Scale for Assessment of Negative Symptoms. Interference sensitivity, inhibition and flexibility were assessed using the Wickens paradigm. The relationships between symptom dimensions as well as with cognitive and other potentially confounding variables were assessed using Pearson correlations and (simple and partial) stepwise regressions. RESULTS Generally consistent with the cognitive constructs used to account for positive symptoms, the results indicated relationships between delusions, disorganization and inhibition, and between hallucinations and interference sensitivity. However, these relationships appeared more complex than expected, with some being dependent on interactions between symptoms. CONCLUSIONS These results suggest: (i) that the global measures usually employed may not be appropriate for demonstrating specific relationships between symptoms and executive functions and (ii) that it is necessary to take into account the interactions between positive symptoms as well as with other factors to reveal these relationships.
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Affiliation(s)
- F Guillem
- Fernand-Seguin Research Centre, L-H Lafontaine Hospital and Department of Psychiatry, University of Montreal, Montreal, Canada.
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Serper M, Beech DR, Harvey PD, Dill C. Neuropsychological and symptom predictors of aggression on the psychiatric inpatient service. J Clin Exp Neuropsychol 2008; 30:700-9. [PMID: 18608673 DOI: 10.1080/13803390701684554] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neuropsychological assessment of executive dysfunction may identify psychiatric patients who may be at high risk for aggressive behavior because impairment of the prefrontal cortex has been indicated as a possible anatomical correlate of aggression. No consensus, however, has been reached on the extent that executive dysfunction contributes to the formation of psychopathology and to aggressive behavior in psychiatric inpatients. We hypothesized a mediating model wherein patients' executive-functioning deficits contribute to the formation of psychopathological symptoms, which then underlies aggressive behavior. To test this model, we examined the relationship between executive functioning, psychiatric symptomatology, and aggressive behavior in 85 psychiatric inpatients presenting over an acute hospital admission using structure equation modeling techniques. The results revealed that psychiatric inpatients' executive function impairment significantly predicted the formation of psychiatric symptomatology, which in turn significantly contributed to the manifestation of aggressive behavior. Executive dysfunction also directly predicted inpatient aggressive behavior. Combining the indirect and direct effects, 59% of our inpatient aggression measure factor variance was accounted for by our measures of executive dysfunction and clinical symptom severity. These findings suggest that neurocognitive deficits underlie both psychiatric symptom formation and aggression. Patients with executive dysfunction may not possess the behavioral inhibition skills needed to cope with the presence of symptoms and other stressful events that accompany acute psychosis and hospitalization that may result, consequently, in increased manifestations of aggressive behavior.
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Affiliation(s)
- Mark Serper
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
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Abstract
Cognitive dysfunction is a major component of schizophrenia, with deficits in executive function particularly pertinent to successful daily living and outcome. Executive deficits and negative/disorganised symptoms remain relatively resistant to amelioration by antipsychotic medication in comparison to positive symptoms. While there is a relative paucity of data on the effects of antipsychotics on specific executive deficits, atypical antipsychotics would appear to be more beneficial than typical antipsychotics at improving these functions, with muscarinic, glutamatergic and cholinergic systems variously implicated. Recent research focusing on the relationships between specific symptoms and specific executive deficits holds important implications for future psychopharmacological interventions in the area by elucidating the neural substrates and pathways which underpin schizophrenic symptomatology. This review attempts to evaluate the research thus far for the specific executive components of spatial working memory (SWM), inhibition, sustained attention and set shifting. Issues significant to future psychopharmacology in the area are discussed, with particular emphasis on the need for a greater consensus in methodology and definition executive function research in schizophrenia.
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Affiliation(s)
- Cara O'Grada
- Department of Psychiatry and Alimentary Pharmabiotic Centre, University College Cork, Ireland.
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Donohoe G, Morris DW, Clarke S, McGhee KA, Schwaiger S, Nangle JM, Garavan H, Robertson IH, Gill M, Corvin A. Variance in neurocognitive performance is associated with dysbindin-1 in schizophrenia: A preliminary study. Neuropsychologia 2007; 45:454-8. [PMID: 16930638 DOI: 10.1016/j.neuropsychologia.2006.06.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 04/02/2006] [Accepted: 06/01/2006] [Indexed: 11/22/2022]
Abstract
Susceptibility genes for schizophrenia have been hypothesised to mediate liability for the disorder at least partly by influencing cognitive performance. We investigated the association between genotype and cognitive performance for a Dysbindin risk haplotype which is associated with schizophrenia in our sample. Fifty-two patients with schizophrenia or schizoaffective disorder (24 risk haplotypes carriers versus 28 non-risk haplotype carriers) were assessed in areas of cognition showing evidence of familial deficits in schizophrenia. Verbal and spatial memory, working memory, and attentional control was assessed using selected measures from the Weschler memory scale (WMS), Cambridge automated test battery (CANTAB), continuous performance test (CPT), and a simple go/no-go task. Pre-morbid IQ was also assessed using the Weschler Test of Adult Reading (WTAR). Patients carrying the Dysbindin risk haplotype showed significantly lower spatial working memory performance than patients who were non-risk carriers, with genotype explaining 12% of variance in performance. Our study suggests that the increased risk for schizophrenia associated with dysbindin may be partly mediated by its influence on pre-frontal function.
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Affiliation(s)
- Gary Donohoe
- Department of Psychology & Trinity Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
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Donohoe G, Reilly R, Clarke S, Meredith S, Green B, Morris D, Gill M, Corvin A, Garavan H, Robertson IH. Do antisaccade deficits in schizophrenia provide evidence of a specific inhibitory function? J Int Neuropsychol Soc 2006; 12:901-6. [PMID: 17064452 DOI: 10.1017/s135561770606108x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 06/26/2006] [Accepted: 06/26/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite its inhibitory control requirements, antisaccade deficits have been consistently associated with working memory impairments in schizophrenia. We investigated whether variance in antisaccade performance could be better accounted for in terms of a specific inhibitory function. METHOD We assessed 48 clinically stable out-patients with schizophrenia on an antisaccade task, as well as on measures of spatial and verbal working memory, sustained selective attention, and a simple motoric go/no-go measure of response inhibition. RESULTS In a stepwise multiple regression analysis, go/no-go task performance accounted for a considerably greater percentage of variance in antisaccade performance (25.3%) than either working memory (8.4%) or sustained selective attention task (9.1%). DISCUSSION We conclude that antisaccade deficits in schizophrenia appear to be better understood in terms of a specific deficit of inhibitory control than in terms of more general difficulties with context maintenance or goal neglect.
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Affiliation(s)
- Gary Donohoe
- Neuropsychiatric Genetics Research Group, Department of Psychiatry, & Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland.
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