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Guan X, Leng W, Hu Q, Xiu M, Zhang X. Association between cognitive function and IL-18 levels in schizophrenia: Dependent on IL18 - 607 A/C polymorphism. Psychoneuroendocrinology 2023; 158:106386. [PMID: 37741261 DOI: 10.1016/j.psyneuen.2023.106386] [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: 06/23/2023] [Revised: 08/26/2023] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
Accumulating evidence suggests that immune system dysregulation is associated with debilitating neurodevelopment in schizophrenia (SZ). Cognitive impairment is a persistent feature that occurs during the onset of SZ and persists throughout the course of the disease. Early studies have found that elevated interleukin (IL)- 18 interacts with IL18 polymorphism and is correlated with psychotic symptoms in SZ. This study aimed to investigate whether elevated IL-18 levels interacted with the -607 A/C polymorphism to determine cognitive decline in patients with chronic SZ. We recruited 693 inpatients and 422 healthy controls to measure IL-18 levels and genotype the - 607 A/C polymorphism. Further, cognitive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). We found that IL-18 serum levels were higher in patients than those in healthy controls, and were not associated with IL18 - 607 A/C in combined subjects or either patients or healthy controls, respectively. Moreover, - 607 A/C was correlated with the visuospatial/constructional index only in the patients. In addition, our research found that IL-18 levels were positively correlated to immediate memory only in patients with the C/C genotype, but not in patients with C/A or A/A genotype. This study suggests that the relationship of IL-18 with cognitive function depends on the IL18 - 607 A/C polymorphism of SZ patients.
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Affiliation(s)
- Xiaoni Guan
- Peking University, Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | | | - Qiongyue Hu
- Qingdao Mental Health Center, Qingdao, China
| | - Meihong Xiu
- Peking University, Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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2
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Gebreegziabhere Y, Habatmu K, Cella M, Alem A. Introducing an interview-based cognitive assessment tool for people with Schizophrenia in Ethiopia. Psychiatry Res 2023; 328:115474. [PMID: 37738683 DOI: 10.1016/j.psychres.2023.115474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
Assessment of cognitive impairment in people with schizophrenia (PWS) is limited in low and middle-income countries due to lack of context-appropriate measures. This study aimed to select, adapt, and evaluate an interview-based cognitive tool for PWS in Ethiopia. The study was carried out in three phases. In the first phase, we followed a rigorous instrument selection procedure to select a tool for adaptation. We then applied a rigorous instrument adaption procedure, including interviews with 24 participants. Finally, we evaluated the psychometric properties of the adapted tool with 208 PWS and 208 matched controls. The Cognitive Assessment Interview was selected as the appropriate tool for adaptation. This tool is practical and tolerable, with short time of administration. We reported high inter-rater reliability and test-retest reliability for the adapted scale. One-factor structure better represented the data with excellent internal consistency. Weak but significant correlation with a performance-based battery was reported. At a cut-off value of > 13, the tool significantly differentiated PWS from controls (62 % sensitivity and 82 % specificity). Item Response Theory-based analysis showed that the tool gives much information among severely impaired participants. The findings show that the tool is reliable, valid, and practical in resource-scarce settings.
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Affiliation(s)
- Yohannes Gebreegziabhere
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia; Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kassahun Habatmu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, United Kingdom
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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3
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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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4
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Rajji TK, Mamo DC, Holden J, Granholm E, Mulsant BH. Cognitive-Behavioral Social Skills Training for patients with late-life schizophrenia and the moderating effect of executive dysfunction. Schizophr Res 2022; 239:160-167. [PMID: 34896870 DOI: 10.1016/j.schres.2021.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
The objectives of this study are to test the efficacy of Cognitive-Behavioral Social Skills Training (CBSST) in enhancing social function in a sample of older patients with schizophrenia, and to assess whether baseline cognition moderates response to CBSST. To address these objectives, we conducted a randomized controlled trial of 63 participants, randomized 1:1 into CBSST or Treatment-As-Usual (TAU). The setting was a community-based geriatric mental health outpatient clinic in Toronto, Ontario, Canada. Data were collected at baseline, and week 18, 36 and 52, between June 2008 and May 2014. Participants were outpatients, aged 60 or older, with a diagnosis of schizophrenia or schizoaffective disorder and no evidence of dementia or other conditions associated with cognitive or functional impairment. The intervention was a weekly group CBSST for 36 weeks. Cognition, including executive function, was assessed at baseline. Modified total score on the Independent Living Skills Survey (ILSS) at 18, 36, and 52 weeks was the primary outcome measure. In a linear mixed model analysis, the ILSS trajectory was better in the CBSST group than the TAU group, with significantly better function at 36 (Cohen's d = 0.75) and 52 weeks (Cohen's d = 0.92). Baseline executive dysfunction moderated CBSST response, whereby participants with more severe executive dysfunction experienced the most improvement in ILSS. CBSST was efficacious in patients with late-life schizophrenia and prevented decline in social function over a one-year period. CBSST was most beneficial for patients with more severe executive dysfunction, i.e., those who needed skills training the most.
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Affiliation(s)
- Tarek K Rajji
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
| | - David C Mamo
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason Holden
- University of California, San Diego, San Diego, CA, USA
| | - Eric Granholm
- University of California, San Diego, San Diego, CA, USA
| | - Benoit H Mulsant
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
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5
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No Effect of Coenzyme Q10 on Cognitive Function, Psychological Symptoms, and Health-related Outcomes in Schizophrenia and Schizoaffective Disorder: Results of a Randomized, Placebo-Controlled Trial. J Clin Psychopharmacol 2021; 41:53-57. [PMID: 33347024 DOI: 10.1097/jcp.0000000000001330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cognitive impairments, negative symptoms, affective symptoms, and low energy are highly prevalent features of schizophrenia. Mitochondrial dysfunction has been hypothesized as one of the numerous factors to underlie the manifestation of these symptoms. The objective of this study was to evaluate whether Coenzyme Q10 (CoQ10) has a role in the treatment of schizophrenia and schizoaffective disorder. METHODS A double-blind, randomized, placebo-controlled trial was conducted to assess the effects of CoQ10 supplementation (300 mg/day) on the co-primary outcomes of attention and working memory performance after 3 and 6 months. Secondary outcomes included plasma CoQ10 levels, mitochondrial function, energy, depression, anxiety, negative symptoms, and quality oflife. FINDINGS In total, 72 patients were randomized to intervention groups. Overall, there was no effect of CoQ10 supplementation on the primary outcome measures at 3 or 6 months. Further, with the exception of plasma CoQ10 levels, CoQ10 supplementation also had no effect on the secondary outcomes. At 3 months, CoQ10 concentration was significantly higher in the CoQ10 group (3.85 μg/mL) compared with placebo (1.13 μg/mL); this difference was not present at 6 months. CONCLUSIONS The results of the study suggest that CoQ10 supplementation at 300 mg/day for 6 months is unlikely to be beneficial for cognitive, psychological and health-related outcomes in schizophrenia and schizoaffective disorder. However, a number of limitations including low adherence, modest sample size, and attrition, likely reduce estimates of effects. As such, results should be considered preliminary.
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Abstract
PURPOSE OF REVIEW The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia. RECENT FINDINGS The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia. SUMMARY Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.
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Becker ML, Ahmed AO, Benning SD, Barchard KA, John SE, Allen DN. Bifactor model of cognition in schizophrenia: Evidence for general and specific abilities. J Psychiatr Res 2021; 136:132-139. [PMID: 33588227 DOI: 10.1016/j.jpsychires.2021.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite extensive study of cognition in schizophrenia, it remains unclear as to whether cognitive deficits and their latent structure are best characterized as reflecting a generalized deficit, specific deficits, or some combination of general and specific constructs. METHOD To clarify latent structure of cognitive abilities, confirmatory factor analysis was used to examine the latent structure of cognitive data collected for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) for Schizophrenia study. Baseline assessment data (n = 813) were randomly divided into calibration (n = 413) and cross-validation samples (n = 400). To examine whether generalized or specific deficit models provided better explanation of the data, we estimated first-order, hierarchical, and bifactor models. RESULTS A bifactor model with seven specific factors and one general factor provided the best fit to the data for both the calibration and cross-validation samples. CONCLUSIONS These findings lend support for a replicable bifactor model of cognition in schizophrenia, characterized by both a general cognitive factor and specific domains. This suggests that cognitive deficits in schizophrenia might be best understood by separate general and specific contributions.
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Affiliation(s)
- Megan L Becker
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Anthony O Ahmed
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Stephen D Benning
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Kimberly A Barchard
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Samantha E John
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA; Department of Brain Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA.
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Khan WU, Ghazala Z, Brooks HJ, Subramaniam P, Mulsant BH, Kumar S, Voineskos AN, Blumberger DM, Kern RS, Rajji TK. The Impact of Anticholinergic Burden on Functional Capacity in Persons With Schizophrenia Across the Adult Life Span. Schizophr Bull 2021; 47:249-257. [PMID: 32619225 PMCID: PMC7825090 DOI: 10.1093/schbul/sbaa093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19-79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.
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Affiliation(s)
- Waqas Ullah Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zaid Ghazala
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Ponnusamy Subramaniam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert S Kern
- Department of Psychiatry, University of California–Los Angeles, Los Angeles, CA
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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9
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Huo L, Zheng Z, Lu X, Wu F, Ning Y, Zhang XY. Decreased Peripheral BDNF Levels and Cognitive Impairment in Late-Life Schizophrenia. Front Psychiatry 2021; 12:641278. [PMID: 34239458 PMCID: PMC8257950 DOI: 10.3389/fpsyt.2021.641278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/14/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives: There are relatively few studies on mechanisms of cognitive deficits in late-life schizophrenia (LLS). Brain-derived neurotrophic factor (BDNF), as an important neuroplastic molecule, has been reported to be involved in neurocognitive impairment in schizophrenia. This study aimed to examine whether peripheral BDNF levels were associated with cognitive deficits in LLS, which has not been explored yet. Methods: Forty-eight LLS patients and 45 age-matched elderly controls were recruited. We measured all participants on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for cognition and serum BDNF levels. Psychopathological symptoms in patients were assessed by the Positive and Negative Syndrome Scale (PANSS). Results: The levels of BDNF in LLS patients were significantly lower than those in healthy controls (8.80 ± 2.30 vs. 12.63 ± 5.08 ng/ml, p < 0.001). The cognitive performance of LLS patients was worse than that of the controls on RBANS total score and scores of immediate memory, attention, language, and delayed memory (all p ≤ 0.005). BDNF was positively associated with attention in LLS patients (r = 0.338, p = 0.019). Conclusion: Our findings suggest that older patients with schizophrenia exhibit lower BDNF levels and more cognitive deficits than older controls, supporting the accelerated aging hypothesis of schizophrenia. Moreover, decreased BDNF is related to attention deficits, indicating that BDNF might be a candidate biomarker of cognitive impairments in LLS patients.
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Affiliation(s)
- Lijuan Huo
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhiwei Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xiaobing Lu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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10
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Quek YF, Yang Z, Dauwels J, Lee J. The Impact of Negative Symptoms and Neurocognition on Functioning in MDD and Schizophrenia. Front Psychiatry 2021; 12:648108. [PMID: 34381384 PMCID: PMC8350050 DOI: 10.3389/fpsyt.2021.648108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/25/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction: Negative symptoms, neurocognitive deficits and functional impairment are prevalent in individuals with major depressive disorder (MDD) and schizophrenia (SCZ). However, unlike neurocognitive deficits, little is known about the role of negative symptoms toward functioning in individuals with MDD. On the other hand, both factors are well-studied in individuals with SCZ. Thus, this study aimed to examine the contributions of negative symptoms and neurocognitive impairments in functioning in individuals with MDD, compared to individuals with SCZ. Methods: Participants included 50 individuals with MDD, 49 individuals with SCZ and 49 healthy controls. The following measures were administered-Negative Symptom Assessment (NSA-16), Brief Assessment of Cognition in Schizophrenia (BACS), Patient Health Questionnaire (PHQ-9), and MIRECC-Global Assessment of Functioning (MIRECC-GAF) to evaluate negative symptoms, neurocognition, depressive symptoms, and functioning respectively. Results: Both MDD and SCZ groups had significantly more severe negative symptoms, depressive symptoms, and poorer functioning than healthy controls. Individuals with SCZ performed significantly poorer on the BACS than the other two groups. Both negative symptoms and neurocognition were significantly correlated with social and occupational functioning in SCZ. Motivation subdomain of the negative symptoms was significantly correlated with occupational functioning, while depressive symptoms correlated with functioning in MDD. Conclusion: Both negative symptoms and neurocognitive deficits appear to play differential roles on individual domains of functioning between MDD and SCZ. Future longitudinal studies with larger sample sizes should be done for a better understanding about the associations between the factors and functioning.
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Affiliation(s)
- Yue Feng Quek
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Zixu Yang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Justin Dauwels
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore.,North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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11
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Izaute M, Thuaire F, Méot A, Rondepierre F, Jalenques I. Metacognitive preserved generation strategy benefits for both younger and elderly participants with schizophrenia. PLoS One 2020; 15:e0241356. [PMID: 33216755 PMCID: PMC7679005 DOI: 10.1371/journal.pone.0241356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 10/13/2020] [Indexed: 11/19/2022] Open
Abstract
Cognitive memory and introspection disturbances are considered core features of schizophrenia. Moreover, it remains unclear whether or not participants with schizophrenia are more cognitively impaired with ageing than healthy participants. The aims of this study were to use a metacognitive approach to determine whether elderly participants with schizophrenia are able to improve their memory performance using a specific generation strategy and to evaluate the memory benefits for them using this strategy. 20 younger and 20 older participants with schizophrenia and their comparison participants matched for age, gender and education learned paired associates words with either reading or generation, rated judgment of learning (JOL) and performed cued recall. Participants with schizophrenia recalled fewer words than healthy comparison participants, but they benefited more from generation, and this difference was stable with ageing. Their JOL magnitude was lower than that of healthy comparison participants, but JOL accuracy was not affected by either age or the pathology. In spite of their memory deficit, elderly and younger participants with schizophrenia benefited remarkably from the memory generation strategy. This result gives some cause for optimism as to the possibility for participants with schizophrenia to reduce memory impairment if learning conditions lead them to encode deeply.
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Affiliation(s)
- Marie Izaute
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
- * E-mail:
| | - Flavien Thuaire
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
| | - Alain Méot
- Université Clermont Auvergne, CNRS, LAPSCO, 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
| | - 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
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12
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Yang M, Gao S, Zhang X. Cognitive deficits and white matter abnormalities in never-treated first-episode schizophrenia. Transl Psychiatry 2020; 10:368. [PMID: 33139736 PMCID: PMC7608674 DOI: 10.1038/s41398-020-01049-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is viewed as a core symptom of schizophrenia (SCZ), but its pathophysiological mechanism remains unclear. White matter (WM) disruption is considered to be a central abnormality that may contribute to cognitive impairment in SCZ patients. However, few studies have addressed the association between cognition and WM integrity in never-treated first-episode (NTFE) patients with SCZ. In this study, we used the MATRICS Consensus Cognitive Battery (MCCB) to evaluate cognitive function in NTFE patients (n = 39) and healthy controls (n = 30), and associated it with whole-brain fractional anisotropy (FA) values obtained via voxel-based diffusion tensor imaging. We found that FA was lower in five brain areas of SCZ patients, including the cingulate gyrus, internal capsule, corpus callosum, cerebellum, and brainstem. Compared with the healthy control group, the MCCB's total score and 8 out of 10 subscores were significantly lower in NTFE patients (all p < 0.001). Moreover, in patients but not healthy controls, the performance in the Trail Making Test was negatively correlated with the FA value in the left cingulate. Our findings provide evidence that WM disconnection is involved in some cognitive impairment in the early course of SCZ.
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Affiliation(s)
- Mi Yang
- grid.54549.390000 0004 0369 4060The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China ,grid.54549.390000 0004 0369 4060School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, China ,The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Shan Gao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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13
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Xiu MH, Lang X, Chen DC, Cao B, Kosten TR, Cho RY, Shi H, Wei CW, Wu AS, Zhang XY. Cognitive Deficits and Clinical Symptoms with Hippocampal Subfields in First-Episode and Never-Treated Patients with Schizophrenia. Cereb Cortex 2020; 31:89-96. [PMID: 32901269 DOI: 10.1093/cercor/bhaa208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Memory dysfunction and associated hippocampal disturbances play crucial roles in cognitive impairment of schizophrenia. To examine the relationships between cognitive function and the hippocampal subfields (HSs) in first-episode never-treated (FENT) schizophrenia patients, the HSs were segmented in 39 FENT patients and 30 healthy controls using a state-of the-art automated algorithm. We found no significant differences in any HSs between the patients and controls. However, multivariate regression analysis showed that the left cornu ammonis 1 (CA1), left hippocampal tail, left presubiculum, and right molecular layer contributed 40% to the variance of the PANSS negative symptom score. After adjusting for sex, age, education, and intracranial volume, the partial correlation analysis showed that the volumes of left CA1, CA3, CA4, molecular layer, granule cell layer and both left and right subiculum were negatively correlated with the MATRICS consensus cognitive battery (MCCB) Hopkins Verbal Learning Test (HVLT). Multiple regression analysis showed that the left CA1 and CA3 hippocampal abnormalities contributed 66% to the variance of the HVLT. Our results suggest no detectable HS deficits were found in FENT schizophrenia patients. However, the HSs may be involved in the symptoms and cognitive deficits of schizophrenia patients in the early phase of their illness.
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Affiliation(s)
- Mei Hong Xiu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, 03000, China
| | - Da Chun Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| | - Thomas R Kosten
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Hui Shi
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Chang Wei Wei
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - An Shi Wu
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
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14
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Song J, Liu D, Zhang M, Wang H, Tan S. Intermittent theta burst stimulation (iTBS) combined with working memory training to improve cognitive function in schizophrenia: study protocol for a randomized controlled trial. Trials 2020; 21:683. [PMID: 32727539 PMCID: PMC7387875 DOI: 10.1186/s13063-020-04563-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Working memory deficit is one of the most critical complex cognitive impairments in schizophrenia. Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant therapy, but not still unsatisfactory. Intermittent theta burst stimulation (iTBS), which has recently been used in clinical practice, may have faster and stronger effects comparing the traditional model (10-Hz high-frequency rTMS). A large number of studies have showed that rTMS, especially iTBS, can enhance the neural plasticity of the brain, and cognitive training can improve the cognitive function of schizophrenia. Is there any facilitation effect of iTBS add on cognitive training (such as working memory training, WMT) on cognitive function enhancement in schizophrenia is still unknown. METHODS/DESIGN The proposed study is designed of a double-center, double-blinded, randomized controlled trial that will include 200 schizophrenia patients between 18 and 45 years of age. The patients will be randomized to four groups, i.e., the study group (iTBS+WMT), WMS control group (iTBS+ Simple Response Training (SRT)), iTBS control group (sham iTBS+WMT), and placebo control (sham iTBS+SRT). The patients will receive 3 min 20 s of real or sham stimulation, followed by a short 1-2-min rest and 40 min of WMT training or SRT immediately. Neuropsychological and clinical symptom assessments, with functional and structural MRI, will be performed on baseline, post-treatment, and 3- and 6-month follow-up periods. The primary outcome is cognitive function measured by the MATRICS Consensus Cognitive Battery (MCCB). The secondary outcomes are changes in neuroplasticity, as measured by MRI and other behavioral assessments. DISCUSSION The aim of our study is to explore the facilitation effects of iTBS added on WMT in improving cognitive function of schizophrenia. That means, patients with schizophrenia will benefit more in cognitive function improvement from the combination training mode of "preheating (iTBS stimulation changes the neural activity of working memory-related brain regions) and ironning (working memory training)." And the long-term effects of this combined training model will be assessed at a 6-month follow-up period. In case of a significant improvement of working memory with a prolonged effect, the iTBS combined with WMT protocol could be considered as a first-line clinical protocol in schizophrenia treatment. More broadly, the potential for increased universality and efficiency of rTMS with the iTBS model to enhance the neural plasticity of the brain should have a more positive effect on cognitive function in schizophrenia. TRIAL REGISTRATION chictr.org.cn ChiCTR1900023405 . Registered on 25 May 2019.
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Affiliation(s)
- Jiaqi Song
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, 100096, China
| | - Dan Liu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, 100096, China
| | - Meng Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, 100096, China
| | - Huiqiu Wang
- Department of Psychiatry Rehabilitation, Anning Hospital, Shenyang, 110164, Liaoning, China
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, 100096, China.
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15
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Advances in the Conceptualization and Study of Schizophrenia in Later Life: 2020 Update. Clin Geriatr Med 2020; 36:221-236. [DOI: 10.1016/j.cger.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Zhu X, Fan H, Fan F, Zhao Y, Tan Y, Yang F, Wang Z, Xue F, Xiao C, Li W, Li Z, Ma L, Zou Y, Tan S. Improving social functioning in community-dwelling patients with schizophrenia: a randomized controlled computer cognitive remediation therapy trial with six months follow-up. Psychiatry Res 2020; 287:112913. [PMID: 32203751 DOI: 10.1016/j.psychres.2020.112913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 11/20/2022]
Abstract
Computerized cognitive remediation therapy (CCRT) has been found to generally improve cognition among patients with schizophrenia, but its effect on functioning has not been extensively studied. This study addressed this gap in the literature by investigating the effect of CCRT and its long-term efficacy among community-dwelling patients with schizophrenia. 157 Chinese patients with schizophrenia were recruited from communities and randomized to CCRT (n = 78) or treatment as usual (TAU; n = 79) groups for 12 weeks with 4-5 sessions per week. Neurocognition, functioning, and symptoms of participants were assessed at baseline, after treatment, and at the 6 month follow-up. The CCRT group showed significantly greater improvements than the TAU group regarding the MATRICS Consensus Cognitive Battery (MCCB) total score and social cognition score. Significant cognitive benefits for functioning were observed (Personal and Social Performance scale, PSP). Moreover, improvement of the MCCB total score mediated a positive effect on functional capacity (UCSD Performance-based Skills Assessment, UPSA), and mediated decreases in negative symptoms across both groups. CCRT improved social functioning and general cognitive functioning among community-dwelling patients with schizophrenia. These improvements persisted for 6 months after treatment. CCRT also led to improvements in functioning and symptom severity by modulating cognitive functioning.
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Affiliation(s)
- Xiaolin Zhu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China
| | - Fengmei Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China
| | - Yanli Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China
| | - Yunlong Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China
| | - Fen Xue
- Beijing Dongcheng District Institute of Mental Health Care, Beijing 100027, PR. China
| | - Cunli Xiao
- Pingan Hospital of Xicheng District, Beijing 100023, PR. China
| | - Wenxiu Li
- Beijing Haidian District Institute of Mental Health Prevention, Beijing 100193, PR. China
| | - Zhiwu Li
- Nanyuan Hospital of Fengtai District, Beijing 10076, PR. China
| | - Liang Ma
- The third Hospital of Chaoyang District, Beijing 100121, PR. China
| | - Yizhuang Zou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China.
| | - Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR. China.
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17
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Rodriguez-Toscano E, López G, Mayoral M, Lewis S, Lees J, Drake R, Arango C, Rapado-Castro M. A longitudinal comparison of two neurocognitive test batteries in patients with schizophrenia and healthy volunteers: Time effects on neuropsychological performance and their relation to functional outcome. Schizophr Res 2020; 216:347-356. [PMID: 31813804 DOI: 10.1016/j.schres.2019.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/21/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is a major unmet need in the treatment of schizophrenia. Over the last decade, the MATRICS Consensus Cognitive Battery (MCCB) has been used to assess the effects of novel treatments for cognitive impairment in schizophrenia. However, other cognitive-neuroscience-based cognitive batteries, such as the Cambridge Neuropsychological Test Automated Battery (CANTAB) have been suggested as an alternative to the MCCB. Although both batteries purport to assess cognitive function in psychosis, no previous study has attempted to examine their validity longitudinally and the potential overlap between the two batteries over time. The aim of the current study was to assess the relationship between the MCCB and the CANTAB in the longitudinal assessment of cognitive impairment in schizophrenia. A sample of 39 stable schizophrenia outpatients and 18 controls completed the MCCB and the CANTAB battery at baseline, and at 2, 4 and 8-weeks follow-up. Correlation analyses and a mixed-model repeated measures approach were used. We found no significant effect of time in the MCCB. In contrast, for the CANTAB a significant effect of time consistent with practice effects for the attention domain in the control group and for the visual learning, reasoning and problem-solving, and social cognition domains in patients, with subjects performing better at follow-up. In particular, a significant time ∗ battery interaction was found for those cognitive domains. These findings suggest there are specific differences across cognitive tests to assess cognitive impairments in schizophrenia and that measures derived from the CANTAB appear to be more prone to practice effects in these patients.
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Affiliation(s)
- Elisa Rodriguez-Toscano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Experimental Psychology, Faculty of Psychology, Universidad Complutense Madrid, Spain.
| | - Gonzalo López
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Maria Mayoral
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Shon Lewis
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Greater Manchester Mental Health NHS Trust, UK
| | - Jane Lees
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Greater Manchester Mental Health NHS Trust, UK
| | - Richard Drake
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Greater Manchester Mental Health NHS Trust, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
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18
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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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19
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Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study. J Affect Disord 2019; 256:164-175. [PMID: 31176189 DOI: 10.1016/j.jad.2019.05.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/14/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder. METHODS We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder. RESULTS Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively. LIMITATIONS Because of the cross-sectional design of this study, measures of association do not imply causal associations. CONCLUSIONS Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.
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20
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The Optimal Length of Hospitalization for Functional Recovery of Schizophrenia Patients, a Real-World Study in Chinese People. Psychiatr Q 2019; 90:661-670. [PMID: 31327081 DOI: 10.1007/s11126-019-09658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study investigated the relationship between the activities of daily living and the length of hospitalization to determine the optimal length of hospitalization for patients with schizophrenia. We collected information from all schizophrenia patients discharged in Peking University Huilongguan Clinical Medical School from January 1, 2015 to December 31, 2015. A total of 1967 patients were enrolled in this study. The Chinese version of the modified Barthel index (MBI-C) was used to assess patients' actual performance on activities of daily living. We used the paired samples t-test to compare MBI-C scores at admission and discharge and performed correlation analysis to find the trend of MBI-C change with length of hospitalization. The average length of hospitalization was 73.3 ± 42.2 days. There were significant differences between the MBI-C scores at the time of discharge from hospital compared with those at the time of admission to the hospital (93.4 ± 11.2 vs. 88.7 ± 11.8; P < 0.001). Taking the length of hospitalization as the grouping boundary value, the correlation analysis of the subgroup found that below a minimum of 20 days, the improvement in the MBI-C scores increased with the increase of length of hospitalization, and above a maximum of 50 days, the improvement in the MBI-C scores decreased with the increase of length of hospitalization. The optimal length of hospitalization for patients with schizophrenia may lie between 20 and 50 days, with regard to the recovery of daily living function.
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21
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Brain structure, cognition, and brain age in schizophrenia, bipolar disorder, and healthy controls. Neuropsychopharmacology 2019; 44:898-906. [PMID: 30635616 PMCID: PMC6461913 DOI: 10.1038/s41386-018-0298-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 12/24/2022]
Abstract
Schizophrenia and bipolar disorder (BD) may be disorders of accelerated aging. Direct comparison of healthy aging populations with schizophrenia and BD patients across the adult lifespan may help inform this theory. In total, 225 individuals (91 healthy controls, 81 schizophrenia, 53 euthymic BD) underwent 3T T1-weighted magnetic resonance imaging, diffusion tensor imaging, and cognitive testing. We analyzed associations among age, diagnosis, and cognition with cortical thickness and fractional anisotropy (FA) using general linear models. We then assessed "brain age" using a random forest algorithm, which was also assessed in an independent sample (n = 147). Participants with schizophrenia had lower cortical thickness and FA compared with the other two groups, most prominently in fronto-temporal circuitry. These brain changes were more evident in younger participants than in older ones, yet were associated with cognitive performance independent of diagnosis. Predicted age was 8 years greater than chronological age in individuals with schizophrenia in the first sample and 6 years greater in the second sample. Predicted and chronological age were not different in BD. Differences in brain circuitry are present from illness onset most prominently in schizophrenia and to a lesser extent in BD. These results support a non-progressive "early hit" hypothesis/etiology of illness in the major psychoses. Brain age differences support the hypothesized early aging mechanism in schizophrenia but not in BD.
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22
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Kelly S, Guimond S, Lyall A, Stone WS, Shenton ME, Keshavan M, Seidman LJ. Neural correlates of cognitive deficits across developmental phases of schizophrenia. Neurobiol Dis 2018; 131:104353. [PMID: 30582983 DOI: 10.1016/j.nbd.2018.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 11/21/2018] [Accepted: 12/20/2018] [Indexed: 12/28/2022] Open
Abstract
Schizophrenia is associated with cognitive deficits across all stages of the illness (i.e., high risk, first episode, early and chronic phases). Identifying the underlying neurobiological mechanisms of these deficits is an important area of scientific inquiry. Here, we selectively review evidence regarding the pattern of deficits across the developmental trajectory of schizophrenia using the five cognitive domains identified by the Research Domain Criteria (RDoC) initiative. We also report associated findings from neuroimaging studies. We suggest that most cognitive domains are affected across the developmental trajectory, with corresponding brain structural and/or functional differences. The idea of a common mechanism driving these deficits is discussed, along with implications for cognitive treatment in schizophrenia.
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Affiliation(s)
- Sinead Kelly
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Synthia Guimond
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William S Stone
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Matcheri Keshavan
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Larry J Seidman
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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23
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Maguire Á, Hargreaves A, Gill M. Coenzyme Q10 and neuropsychiatric and neurological disorders: relevance for schizophrenia. Nutr Neurosci 2018; 23:756-769. [PMID: 30537908 DOI: 10.1080/1028415x.2018.1556481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Mitochondrial dysfunction has been implicated in the pathophysiology of schizophrenia and other neuropsychiatric disorders. Though the exact mechanisms and clinical implications for this dysfunction are not fully determined, there is a hypothesis that deficiency in coenzyme Q10 (CoQ10) may contribute to mitochondrial impairments and be reflected in cognitive, affective, and energy disturbances in the disorders. CoQ10 is a critical component of the mitochondrial respiratory chain and an essential free radical scavenger, necessary for mitochondrial function. Here, we review the results of CoQ10 supplementation interventions for adults with various neurological and neuropsychiatric disorders and consider the therapeutic potential of CoQ10 supplementation for schizophrenia in light of these studies. Methods: A literature review of randomised controlled trials and open-label studies investigating the effect of CoQ10 as a single intervention in adults with neurological and neuropsychiatric disorders was conducted. Results: CoQ10 supplementation has some positive effects on fatigue, cognitive impairment and affective difficulties in several neurological and neuropsychiatric conditions with associated mitochondrial dysfunction. Discussion: CoQ10 may be of therapeutic value to schizophrenia given evidence of mitochondrial dysfunction in the disorder.
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Affiliation(s)
- Áine Maguire
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - April Hargreaves
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, National College of Ireland, Dublin, Ireland
| | - Michael Gill
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
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24
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Gagnon G, Kumar S, Maltais JR, Voineskos AN, Mulsant BH, Rajji TK. Superior memory performance in healthy individuals with subclinical psychotic symptoms but without genetic load for schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 13:7-11. [PMID: 30105212 PMCID: PMC6085406 DOI: 10.1016/j.scog.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- G Gagnon
- Department of Psychology, McGill University, Montreal, Canada.,McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
| | - S Kumar
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - J-R Maltais
- Department of Psychiatry, University of Sherbrooke, Sherbrooke, Canada
| | - A N Voineskos
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - B H Mulsant
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - T K Rajji
- Geriatric and Adult Neurodevelopmental Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Cohen CI, Murante T. A prospective analysis of the role of cognition in three models of aging and schizophrenia. Schizophr Res 2018; 196:22-28. [PMID: 28679478 DOI: 10.1016/j.schres.2017.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study uses longitudinal data from a sample of older adults with schizophrenia spectrum disorder (OAS) to examine the role of cognition in 3 models of aging and schizophrenia-accelerated aging, paradoxical aging, and heterogeneity of course-and their clinical relevance. METHODS The sample consisted of 103 community-dwelling persons aged 55 and over (mean=61years) with early-onset schizophrenia. Mean follow-up was 52.5months (range: 12-116months); 55% were men; 55% were white. We identified 21 potential predictor variables and used the Dementia Rating Scale (DRS) to assess cognition. RESULTS There were no significant differences in the DRS at baseline (T1) and follow-up (T2). However, 20%, 22% and 58% of persons exhibited >0.5 effect size increase or decrease, or no change in their DRS scores, respectively; 19% were rapid decliners (>-2.11pts/year) and 19% were rapid improvers (>+2.11pts/year). In multivariable analysis, there were 3 predictors of higher DRS (T2): DRS (T1), decline in anxiety score, and race (white). CONCLUSIONS The heterogeneity model best characterized the trajectory of cognition in later life. The accelerated aging model did not represent typical cognitive trajectories since most individuals were stable or improved. The heterogeneous trajectories made it difficult to generalize about cognition's role in the paradoxical aging model. Despite the paucity of predictors, our findings suggested that it may be clinically productive to enlist remediation strategies that target anxiety and cognition, and direct more attention to non-white OAS.
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Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Brooklyn, NY, United States.
| | - Tessa Murante
- SUNY Downstate Medical Center, Brooklyn, NY, United States
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Abstract
A crisis looms as research and clinical programs have not kept pace with dramatic increases in the number of older adults with schizophrenia. This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously.
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Depp CA, Moore RC, Perivoliotis D, Granholm E. Technology to assess and support self-management in serious mental illness. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489457 PMCID: PMC4969704 DOI: 10.31887/dcns.2016.18.2/cdepp] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The functional impairment associated with serious mental illness (SMI) places an immense burden on individuals and society, and disability often persists even after efficacious treatment of psychopathologic symptoms. Traditional methods of measuring functioning have limitations, and numerous obstacles reduce the reach and impact of evidence-based interventions developed to improve functioning in SMI. This review describes the potential of technological innovations for overcoming the challenges involved in both functional assessment and intervention in people with SMI. Ecological momentary assessment (EMA), which involves the repeated sampling of naturalistic behaviors and experiences while individuals carry out their daily lives, has provided a new window through which the determinants of day-to-day function in SMI can be observed. EMA has several advantages over traditional assessment methods and has in recent years evolved to use mobile-based platforms, such as text messaging and smartphone applications, for both assessment and promotion of self-management in people with SMI. We will review promising data regarding the acceptability, adherence, and efficacy of EMA-based mobile technologies; explore ways in which these technologies can extend the reach and impact of evidence-based psychosocial rehabilitative interventions in SMI; and outline future directions for research in this important area.
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Affiliation(s)
- Colin A Depp
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Dimitri Perivoliotis
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Eric Granholm
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
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Joseph J, Kremen WS, Franz CE, Glatt SJ, van de Leemput J, Chandler SD, Tsuang MT, Twamley EW. Predictors of current functioning and functional decline in schizophrenia. Schizophr Res 2017; 188:158-164. [PMID: 28139356 PMCID: PMC5529271 DOI: 10.1016/j.schres.2017.01.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 12/19/2022]
Abstract
Positive, negative, and cognitive symptoms of schizophrenia may affect functional outcomes. However, these factors alone do not account for a large percentage of variance in outcomes. We investigated demographic, cognitive, symptom, and functional capacity predictors of current functional status in 280 outpatients with schizophrenia or schizoaffective disorder. Functional decline over the lifespan was also examined in a subset of participants. Stepwise regressions modeled predictors of current functional status and functional decline as measured by the Assessment of Lifespan Functioning Attainment (ALFA). ALFA functional domains included paid employment, independence in living situation, romantic relationships, close friendships, and recreational engagement. More severe depressive symptoms were consistently associated with worse current community integration (lower levels of close friendships and recreational engagement). Better working memory performance was associated with higher rates of current paid employment. There were no consistent modifiable predictors of decline in functioning, but women reported less functional decline in the domains of employment and close friendships than men. Better cognitive performance was associated with less decline in living independence and romantic relationships, but more decline in paid employment and recreational engagement. Increased assessment and treatment of comorbid depressive symptoms may improve functional outcomes in people with schizophrenia.
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Affiliation(s)
- Jamie Joseph
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - William S Kremen
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Carol E Franz
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Stephen J Glatt
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory, Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, 3710 Neuroscience Research Building, Syracuse, NY 13210, USA
| | - Joyce van de Leemput
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Sharon D Chandler
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Ming T Tsuang
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Institute for Genomic Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Elizabeth W Twamley
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Norlin Bagge E, Esbjörnsson E, Sunnerhagen KS. Cognitive screening and behavioural observation of functional ability in patients with multiple episode schizophrenia: an exploratory study. BMJ Open 2017; 7:e014783. [PMID: 28645961 PMCID: PMC5623419 DOI: 10.1136/bmjopen-2016-014783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the usability of a neuropsychological screening instrument and two observation scales of everyday behaviour to describe cognitive and functional capacity of patients with multiepisode schizophrenia and considerable care needs, who frequently refuse to participate in cognitive testing or performance-based functional measurement. SETTING One psychiatric unit specialised in severe mental illness at the Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS Patients were included consecutively from date of admission to the unit. INCLUSION CRITERIA age 18-65 years, International Classification of Diseases 10 diagnoses F20.0-F20.9 (schizophrenia) or F25.0-F25.9 (schizoaffective disorder) since at least 5 years. EXCLUSION CRITERIA acute serious psychotic episodes or physical illness, alcohol or drug abuse during the year before the study, diagnosed cerebral disorder at admission to the unit, and insufficient ability to speak Swedish. 64 patients filled the criteria and 19 accepted participation: 14 males, 5 females, median age 56 years. OUTCOME MEASURES Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) scores, measured by a psychologist; Frontal Systems Behaviour Scale (FrSBe) Family Version and Functional Independence Measure (FIM) V.4.0 scores, measured by nursing staff. Non-parametric statistics were consistently applied to process the data. RESULTS Failure analysis showed differences regarding gender and subdiagnoses between participants and non-participants. All participants had BNIS scores indicating cognitive dysfunction. FrSBe group medians showed apathy and executive problems, indicating possible frontal lobe disturbance. FIM showed dependency on others for linguistic and social communication, everyday problem solving, and remembering persons and daily routines. Correlations between FrSBe and FIM (p≤0.01) suggested executive dysfunction being crucial to explain difficulties in performing activities of daily functioning. CONCLUSIONS Indications of considerable cognitive and functional difficulties found among the participants suggestedthat the instruments are clinically applicable for tentative assessment of cognitive and functional ability among patients with multiepisode schizophrenia and considerable care needs.
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Affiliation(s)
- Eva Norlin Bagge
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Neuroscience and Rehabilitation, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Esbjörnsson
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
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Benoit A, Bowie CR, Lepage M. Is cognitive insight relevant to functional capacity in schizophrenia? Schizophr Res 2017; 184:150-151. [PMID: 28069313 DOI: 10.1016/j.schres.2016.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Audrey Benoit
- Prevention and Early Intervention Program for Psychoses (PEPP - Montreal), Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada; UQAM, Psychology Department, C.P. 8888 Succursale Centre-ville, Montreal, Quebec H3C 3P8, Canada.
| | - Christopher R Bowie
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON K7L 3N6, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, ON M5T 1R8, Canada.
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses (PEPP - Montreal), Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada; UQAM, Psychology Department, C.P. 8888 Succursale Centre-ville, Montreal, Quebec H3C 3P8, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
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van Liempt S, Dols A, Schouws S, Stek ML, Meesters PD. Comparison of social functioning in community-living older individuals with schizophrenia and bipolar disorder: a catchment area-based study. Int J Geriatr Psychiatry 2017; 32:532-538. [PMID: 27121916 DOI: 10.1002/gps.4490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Preserved social functioning is of utmost importance for older individuals living in the community to maintain independency. However, in patients with schizophrenia or bipolar disorder, it remains unclear which factors influence social functioning in later life. METHODS In a catchment area-based study in Amsterdam, The Netherlands, 120 older (>60 years) community-living patients with schizophrenia (n = 73) and with bipolar disorder (n = 47) were included. Clinical interviews on social functioning and psychometric measurements were applied. RESULTS Patients with schizophrenia scored lower on all social measures (social functioning, social participation, network size, availability of confidants) compared with their peers with bipolar disorder. In patients with schizophrenia, lower social functioning was associated with having more negative symptoms and depressive symptoms. Age of onset was also associated with social functioning in schizophrenia, with higher scores in very late-onset schizophrenia-like psychosis. Unfavourable social functioning in patients with bipolar disorder was associated with lower cognitive functioning. Furthermore, in both groups, social functioning was not related to age, having offspring or the presence of a partner. CONCLUSIONS In community-living older patients, schizophrenia has a more disruptive effect on social functioning than bipolar disorder, except in those with a very late-onset schizophrenia-like psychosis. Minimizing residual depressive symptoms and optimizing cognitive functioning may be targets for improving social functioning and independent-living in older patients with severe mental illness. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Annemiek Dols
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Max L Stek
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul D Meesters
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Murante T, Cohen CI. Cognitive Functioning in Older Adults With Schizophrenia. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:26-34. [PMID: 31975837 DOI: 10.1176/appi.focus.20160032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cognitive deficits are thought to be a core feature in schizophrenia and have been found to be strongly associated with impairments in functioning. It is estimated that more than 70% of patients with schizophrenia have cognitive impairment. The aim of this article is to critically review the emerging literature on cognition in older adults with schizophrenia. Specifically, we address the following questions: Are there differences in cognitive functioning between older adults with schizophrenia and their healthy age peers as well as with younger people with schizophrenia? What are the factors associated with cognitive deficits and their interaction over time? What are the life course trajectories of cognitive deficits, especially in later life? Are older adults with schizophrenia more likely to develop dementia, and, if so, does it differ from other dementias? Are there pharmacological and psychosocial interventions that can successfully treat cognitive deficits in older adults with schizophrenia?
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Affiliation(s)
- Tessa Murante
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
| | - Carl I Cohen
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
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Rajji TK, Mulsant BH, Nakajima S, Caravaggio F, Suzuki T, Uchida H, Gerretsen P, Mar W, Pollock BG, Mamo DC, Graff-Guerrero A. Cognition and Dopamine D 2 Receptor Availability in the Striatum in Older Patients with Schizophrenia. Am J Geriatr Psychiatry 2017; 25:1-10. [PMID: 27745822 PMCID: PMC5164861 DOI: 10.1016/j.jagp.2016.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/01/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the impact of reducing the dose of antipsychotics on cognition and dopaminergic D2 receptor availability in the whole striatum, and identify their relationship in patients with schizophrenia aged 50 years or older. DESIGN Open-label prospective PET [11C]-raclopride study. SETTING A tertiary care center outpatient setting. PARTICIPANTS Thirty-seven clinically stable participants with schizophrenia or schizoaffective disorder, aged 50 years or greater, and having been treated with olanzapine or risperidone monotherapy at the same dose for at least 6 months. INTERVENTION Gradual reduction in their olanzapine or risperidone daily dose of up to 40%. MEASUREMENTS Clinical and cognitive assessments, and [11C]-raclopride PET to determine D2 receptor availability at baseline and after the dose reduction. Main outcome measures were overall cognition and D2 receptor availability in whole striatum. RESULTS Reducing the antipsychotic dose resulted in an increase in D2 receptor availability in the whole striatum and an association between D2 receptor availability and overall cognition despite lack of change in the latter. There was also an association between change in D2 receptor availability and change in overall cognition. CONCLUSIONS Our findings suggest that optimizing D2 receptor availability by reducing antipsychotic dose allows this system to contribute more significantly to cognitive function in patients with schizophrenia. This uncovered association could be harnessed by cognitive-enhancing interventions.
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Affiliation(s)
- Tarek K. Rajji
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Benoit H. Mulsant
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shinichiro Nakajima
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Fernando Caravaggio
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Takefumi Suzuki
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroyuki Uchida
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Philip Gerretsen
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Wanna Mar
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Bruce G. Pollock
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - David C. Mamo
- Department of Psychiatry, Faculties of Medicine and Health Science, University of Malta, Msida, Malta
| | - Ariel Graff-Guerrero
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
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Kumar S, Mulsant BH, Tsoutsoulas C, Ghazala Z, Voineskos AN, Bowie CR, Rajji TK. An optimal combination of MCCB and CANTAB to assess functional capacity in older individuals with schizophrenia. Int J Geriatr Psychiatry 2016; 31:1116-23. [PMID: 27428251 DOI: 10.1002/gps.4547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/08/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Cognitive deficits predict functional capacity in patients with schizophrenia including in late life. The MATRICS Consensus Cognitive Battery (MCCB) and the Cambridge Neuropsychological Test Automated Battery (CANTAB) are widely used to assess cognition in this population. The aim of this study was to determine a minimal set of subtests across the two batteries that would be strongly associated with functional capacity in older patients with schizophrenia. METHODS Sixty participants age 50 years or older with a diagnosis of schizophrenia or schizoaffective disorder and 30 control participants were enrolled. Cognition was assessed using the MCCB and the CANTAB. Functional capacity was assessed using the USCD Performance-based Skills Assessment (UPSA). Stepwise linear regressions were performed to determine the best set of cognitive tests associated with functional capacity. RESULTS UPSA total score was negatively correlated with age and positively correlated with education and the MCCB global score. Most of the MCCB domains and subtests, and several of the CANTAB subtests correlated with UPSA total score. In the regression model, MCCB global score accounted for 42.5% of UPSA variance. In contrast, a combination of only four subtests (processing speed and verbal learning from the MCCB, and affective information processing and working memory from the CANTAB) accounted for 60% of UPSA variance. CONCLUSIONS Performance on MCCB and CANTAB is strongly associated with functional capacity in older patients with schizophrenia. A selective combination of MCCB and CANTAB subtests may be as effective in assessing functional capacity in late life schizophrenia. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sanjeev Kumar
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada. .,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Benoit H Mulsant
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Zaid Ghazala
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Aristotle N Voineskos
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Christopher R Bowie
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Tarek K Rajji
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
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Kar SK, Jain M. Current understandings about cognition and the neurobiological correlates in schizophrenia. J Neurosci Rural Pract 2016; 7:412-8. [PMID: 27365960 PMCID: PMC4898111 DOI: 10.4103/0976-3147.176185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Schizophrenia is a severe mental disorder. Cognitive deficits are one of the core features of schizophrenia. Multiple domains of cognition (executive function, attention/vigilance, working memory, verbal fluency, visuospatial skills, processing speed, and social cognition) are affected in patients with schizophrenia. Deficits in cognition led to impairment in the real world functioning. Identifying the cognitive deficits and early intervention is required for better functional outcome. This review focuses on conceptual understanding of cognition with its neurobiological correlates in schizophrenia and its different clinical implications.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Meha Jain
- District Mental Health Program, National Health Mission, Raebareli, Uttar Pradesh, India
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Tsoutsoulas C, Mulsant BH, Kalache SM, Kumar S, Ghazala Z, Voineskos AN, Butters MA, Menon M, Rajji TK. The influence of medical burden severity and cognition on functional competence in older community-dwelling individuals with schizophrenia. Schizophr Res 2016; 170:330-5. [PMID: 26724896 DOI: 10.1016/j.schres.2015.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/08/2015] [Accepted: 12/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cognition predicts functional competence among individuals with schizophrenia across the lifespan. However, as these individuals age, increasing levels of medical burden may also contribute to functional deficits both directly and indirectly through cognition. Thus, we assessed the relationship among, cognition, medical burden, and functional competence in older individuals with schizophrenia. METHODS We analyzed data obtained from 60 community-dwelling participants with schizophrenia and 30 control participants aged 50 or above. Cognition was assessed using the MATRICS Consensus Cognitive Battery (MCCB), functional competence was assessed using the USCD Performance-Based Skills Assessment (UPSA), and medical burden was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Group differences were assessed using independent samples t-tests or chi-square tests. Mediation analyses using bootstrapping techniques were used to assess whether cognition mediated the effects of medical burden on functional competence. RESULTS Participants with schizophrenia had higher levels of medical burden, cognitive deficits, and functional impairments. In participants with schizophrenia, cognition, but not medical burden, predicted functional competence after adjusting for age, education, gender, clinical symptoms, and anticholinergic burden of medications. In control participants, cognition and medical burden both predicted functional competence after adjusting for age, education, and gender. Further, cognition was found to fully mediate the association between medical burden and functional competence in control participants. CONCLUSION Cognition is a robust predictor of functional competence among older individuals with schizophrenia, regardless of medical burden. Cognitive deficits associated with schizophrenia may mask any further cognitive impairment associated with medical burden and its impact on function.
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Affiliation(s)
- Christopher Tsoutsoulas
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Benoit H Mulsant
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sawsan M Kalache
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sanjeev Kumar
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Zaid Ghazala
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Aristotle N Voineskos
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Mahesh Menon
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tarek K Rajji
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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Golas AC, Kalache SM, Tsoutsoulas C, Mulsant BH, Bowie CR, Rajji TK. Cognitive remediation for older community-dwelling individuals with schizophrenia: a pilot and feasibility study. Int J Geriatr Psychiatry 2015; 30:1129-34. [PMID: 26250542 DOI: 10.1002/gps.4329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cognitive deficits are among the strongest predictors of function in individuals with schizophrenia. This relationship continues to be strong as these individuals grow older into their eight decade. Cognitive remediation (CR) improves cognition in individuals with schizophrenia. This study aims at assessing the feasibility and potential effect of CR in patients with schizophrenia 60 years of age or older. METHODS We adapted a CR protocol involving restorative and strategy-based methods over four cohorts of older outpatients with schizophrenia to target cognitive deficits associated with aging and schizophrenia. CR was provided in eight, 2-h weekly didactic sessions and online at-home exercises. Computerized drill and practice exercises were used with bridging to activities of daily life. Computer exercise selection and difficulty level parameters optimized adherence. Progression individually determined difficulty levels. We modified computer laboratory ergonomics to accommodate mobility needs. Participants were assessed at baseline and end-of-study using clinical and cognitive assessments. RESULTS Twenty-two participants enrolled: 18 (mean [SD] age: 69.8 [5.3]) completed CR. Mean (SD) global cognition T score from the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery was 27.7 (10) at baseline and 28.8 (9.7) at the completion of the study. These means are over 2 SD below the norms. The change in global cognition was not statistically significant (paired t(17) = -1.18, p = 0.25). CONCLUSIONS Our pilot study suggests that CR is well tolerated by most older outpatients with schizophrenia. Future studies need to assess whether increasing the frequency or the number of CR sessions leads to significant improvement in cognition.
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Affiliation(s)
- Angela C Golas
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sawsan M Kalache
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Christopher R Bowie
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychology and Psychiatry, Queen's University, Kingston, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Moore RC, Fazeli PL, Patterson TL, Depp CA, Moore DJ, Granholm E, Jeste DV, Mausbach BT. UPSA-M: Feasibility and initial validity of a mobile application of the UCSD Performance-Based Skills Assessment. Schizophr Res 2015; 164:187-92. [PMID: 25790903 PMCID: PMC4409538 DOI: 10.1016/j.schres.2015.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/17/2015] [Accepted: 02/22/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a tablet mobile application version of the UCSD Performance-Based Skills Assessment (UPSA-M), a widely used test for assessing functional capacity in schizophrenia and other neurocognitively impaired patient populations. METHODS The UPSA-M was developed for an iPad platform. Twenty-one middle-aged and older adults with schizophrenia and 13 healthy comparison (HC) participants completed a brief iPad tutorial, followed by the UPSA-M (full version, which includes all components of Brief UPSA-M) and a computer usage questionnaire. During a separate visit, patients with schizophrenia and HC participants completed the Brief UPSA (UPSA-B), and patients with schizophrenia completed a symptom inventory and brief neuropsychological screening battery. RESULTS The UPSA-M was feasible for use among middle aged and older adults with schizophrenia with no prior history of tablet usage. The UPSA-M was able to differentiate between schizophrenia and HC participants 80% of the time, and this differential ability increased to 87% with the UPSA-M Brief. Traditional UPSA scores, UPSA-B scores, and neuropsychological performance were related to UPSA-M scores, whereas symptoms of psychopathology, experience with tablet technology, or difficulties operating the device were not significantly associated with UPSA-M. CONCLUSIONS The UPSA-M performed just as well as the standard-of-practice version. These preliminary results indicate that the UPSA-M Brief has greater sensitivity than the full version of the UPSA-M, and carries the advantage of a shorter administration time. Overall, the UPSA-M appears to be a promising mobile tool to assess functional capacity.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Pariya L Fazeli
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA; VA San Diego Healthcare System, San Diego, CA, 92161, USA.
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Eric Granholm
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; VA San Diego Healthcare System, San Diego, CA, 92161, USA.
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
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Cohen AS, Mohr C, Ettinger U, Chan RCK, Park S. Schizotypy as an organizing framework for social and affective sciences. Schizophr Bull 2015; 41 Suppl 2:S427-35. [PMID: 25810057 PMCID: PMC4373637 DOI: 10.1093/schbul/sbu195] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Schizotypy, defined in terms of commonly occurring personality traits related to the schizophrenia spectrum, has been an important construct for understanding the neurodevelopment and stress-diathesis of schizophrenia. However, as schizotypy nears its sixth decade of application, it is important to acknowledge its impressively rich literature accumulating outside of schizophrenia research. In this article, we make the case that schizotypy has considerable potential as a conceptual framework for understanding individual differences in affective and social functions beyond those directly involved in schizophrenia spectrum pathology. This case is predicated on (a) a burgeoning literature noting anomalies in a wide range of social functioning, affiliative, positive and negative emotional, expressive, and social cognitive systems, (b) practical and methodological features associated with schizotypy research that help facilitate empirical investigation, and (c) close ties to theoretical constructs of central importance to affective and social science (eg, stress diathesis, neural compensation). We highlight recent schizotypy research, ie providing insight into the nature of affective and social systems more generally. This includes current efforts to clarify the neurodevelopmental, neurobiological, and psychological underpinnings of affiliative drives, hedonic capacity, social cognition, and stress responsivity systems. Additionally, we discuss neural compensatory and resilience factors that may mitigate the expression of stress-diathesis and functional outcome, and highlight schizotypy's potential role for understanding cultural determinants of social and affective functions.
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Affiliation(s)
- Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA;,*To whom correspondence should be addressed; Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70808, US; tel: 225-578-7017, fax: 225-578-4125, e-mail:
| | - Christine Mohr
- Institute of Psychology, University of Lausanne, Switzerland
| | | | - Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN
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