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Vita A, Nibbio G, Barlati S. Conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. Psychiatry Res 2024; 340:116126. [PMID: 39128169 DOI: 10.1016/j.psychres.2024.116126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
Cognitive impairment represents one of the core features of schizophrenia, involves both neurocognition and social cognition domains, and has a significant negative impact on real-world functioning. The present review provides a framework for the conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. In this conceptualization, primary cognitive impairment can be defined as a consequence of the neurobiological alterations that underlie psychopathological manifestations of the disorder, while secondary cognitive impairment can be defined as the results of a source issue that has a negative impact on cognitive performance. Sources of secondary cognitive impairment are frequent in people with schizophrenia and include several different factors, such as positive and negative symptoms, depressive symptoms, autistic symptoms, pharmacotherapy, substance abuse, metabolic syndrome, social deprivation, and sleep disorders. It can be hypothesized that secondary cognitive impairment may be improved by effectively resolving the source issue, while primary cognitive impairment may benefit from dedicated treatment. Further research is required to confirm this hypothesis, to better characterize the distinction between primary and secondary cognitive impairment in a clinical and in a neurobiological perspective, and to evaluate the impact of systematically assessing and treating secondary cognitive impairment.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Sholler DJ, Stutz SJ, Fox RG, Boone EL, Wang Q, Rice KC, Moeller FG, Anastasio NC, Cunningham KA. The 5-HT 2A Receptor (5-HT 2AR) Regulates Impulsive Action and Cocaine Cue Reactivity in Male Sprague-Dawley Rats. J Pharmacol Exp Ther 2019; 368:41-49. [PMID: 30373886 PMCID: PMC6290084 DOI: 10.1124/jpet.118.251199] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/25/2018] [Indexed: 01/25/2023] Open
Abstract
Impulsivity and the attentional orienting response to cocaine-associated cues (cue reactivity) promote relapse in cocaine-use disorder (CUD). A time-dependent escalation of cue reactivity (incubation) occurs during extended, forced abstinence from cocaine self-administration in rats. The investigational serotonin (5-HT) 5-HT2A receptor (5-HT2AR) antagonist/inverse agonist M100907 suppresses impulsive action, or the inability to withhold premature responses, and cocaine-seeking behaviors. The present preclinical study was designed to establish the potential for repurposing the Food and Drug Administration-approved selective 5-HT2AR antagonist/inverse agonist pimavanserin as a therapeutic agent to forestall relapse vulnerability in CUD. In male Sprague-Dawley rats, pimavanserin suppressed impulsive action (premature responses) measured in the 1-choice serial reaction time (1-CSRT) task, similarly to M100907. We also used the 1-CSRT task to establish baseline levels of impulsive action before cocaine self-administration and evaluation of cue reactivity (lever presses reinforced by the discrete cue complex previously paired with cocaine delivery). We observed an incubation of cocaine cue reactivity between day 1 and day 30 of forced abstinence from cocaine self-administration. Baseline levels of impulsive action predicted incubated levels of cocaine cue reactivity in late abstinence. We also found that baseline impulsive action predicted the effectiveness of pimavanserin to suppress incubated cue reactivity in late abstinence from cocaine self-administration at doses that were ineffective in early abstinence. These data suggest that integration of clinical measures of impulsive action may inform refined, personalized pharmacotherapeutic intervention for the treatment of relapse vulnerability in CUD.
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Affiliation(s)
- Dennis J Sholler
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - Sonja J Stutz
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - Robert G Fox
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - Edward L Boone
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - Qin Wang
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - Kenner C Rice
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - F Gerard Moeller
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - Noelle C Anastasio
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
| | - Kathryn A Cunningham
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas (D.J.S., S.J.S., R.G.F., N.C.A., K.A.C.); Department of Statistical Sciences and Operations Research, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (E.L.B., Q.W.); Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Bethesda, Maryland (K.C.R.); and Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia (F.G.M.)
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Caldiroli A, Serati M, Orsenigo G, Caletti E, Buoli M. Age at Onset and Social Cognitive Impairment in Clinically Stabilized Patients with Schizophrenia: An Ecological Cross-Sectional Study. IRANIAN JOURNAL OF PSYCHIATRY 2018; 13:84-93. [PMID: 29997653 PMCID: PMC6037576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Purposes of the present study were to assess the social cognitive impairment in schizophrenia and to detect if some clinical variables (particularly age at onset) are predictive of general/social cognitive deficit in schizophrenia patients. Method: Thirty-five clinically stabilized schizophrenia outpatients were assessed by the Brief Assessment of Cognition in Schizophrenia (BACS) and by Torralva's social cognition battery. Binary logistic models were performed to find an eventual association between continuous clinical variables and cognitive test failures. The total sample was divided in groups according to dichotomous variables (gender, diagnostic subtypes and type of abuse) and the presence of cognitive deficits was compared between groups by χ2 tests. Results: An earlier age at onset was found to be predictive of frontal cognitive impairment (Tower of London p=0.038, OR=0.702). Female gender was more probably associated with mistakes at MET-HV (χ2= 4.80, p=0.05, phi=0.40) and HOTEL tests (χ2= 5.25, p=0.04, phi=0.4) than male one. Cannabis abusers showed more frequently deficits on verbal fluency (χ2= 9.35, p=0.04, phi=0.52) and executive functioning (Tower of London) (χ2= 11.67, p=0.02, phi=0.58) than alcohol/cocaine ones. Conclusion: Female patients with an early age at onset and cannabis abuse seem to have the worst general and social cognitive profile among patients suffering from schizophrenia.
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Affiliation(s)
| | | | | | | | - Massimiliano Buoli
- Corresponding Author: Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F, Sforza 35, 20122, Milan, Italy. Tel.: +39-02-55035983, Fax: +39-02-55033190, E-mail:
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Wojtalik JA, Barch DM. An FMRI study of the influence of a history of substance abuse on working memory-related brain activation in schizophrenia. Front Psychiatry 2014; 5:1. [PMID: 24478729 PMCID: PMC3896871 DOI: 10.3389/fpsyt.2014.00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/03/2014] [Indexed: 11/18/2022] Open
Abstract
There has been little investigation of the effects of past substance abuse (SA) on working memory (WM) impairments in schizophrenia. This study examined the behavioral and neurobiological impact of past SA (6 months or longer abstinence period) on WM in schizophrenia. Thirty-seven schizophrenia patients (17 with past SA and 20 without) and 32 controls (12 with past SA and 20 without) completed two versions of a two-back WM task during fMRI scanning on separate days. Analyses focused on regions whose patterns of activation replicated across both n-back tasks. Schizophrenia patients were significantly less accurate than controls on both n-back tasks. No main effects or interactions with past SA on WM performance were observed. However, several fronto-parietal-thalamic regions showed an interaction between diagnostic group and past SA. These regions were significantly more active in controls with past SA compared to controls without past SA. Schizophrenia patients with or without past SA either showed no significant differences, or patients with past SA showed somewhat less activation compared to patients without past SA during WM. These results suggest robust effects of past SA on WM brain functioning in controls, but less impact of past SA in schizophrenia. This is consistent with previous literature indicating less impaired neurocognition in schizophrenia with SA.
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Affiliation(s)
- Jessica A Wojtalik
- Department of Psychiatry, Washington University School of Medicine , St. Louis, MO , USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine , St. Louis, MO , USA ; Department of Psychology, Washington University in St. Louis , St. Louis, MO , USA ; Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine , St. Louis, MO , USA
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Wobrock T, Falkai P, Schneider-Axmann T, Hasan A, Galderisi S, Davidson M, Kahn RS, Derks EM, Boter H, Rybakowski JK, Libiger J, Dollfus S, López-Ibor JJ, Peuskens J, Hranov LG, Gaebel W, Fleischhacker WW. Comorbid substance abuse in first-episode schizophrenia: effects on cognition and psychopathology in the EUFEST study. Schizophr Res 2013; 147:132-139. [PMID: 23537477 DOI: 10.1016/j.schres.2013.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 11/17/2022]
Abstract
UNLABELLED Studies and meta-analyses investigating the influence of substance use disorder (SUD) (substance abuse or dependence) on psychopathology and neurocognitive function in schizophrenia patients have revealed controversial results. Most studies did only have small samples and did not focus exclusively on first-episode schizophrenia patients. METHOD In a post-hoc analysis of the European First Episode Schizophrenia Trial (EUFEST) psychopathology and cognitive performances of patients with (FE-SUD, N=119, consisting of N=88 patients with persisting SUD at baseline and N=31 patients with previous SUD) and without SUD (FE-non-SUD, N=204) were compared at baseline and 6 months follow-up. Neurocognitive assessment included the Rey Auditory Verbal Learning Test (RAVLT); Trail Making Tests A and B (TMT), Purdue Pegboard and Digit-Symbol Coding. RESULTS In total 31.1% of patients reported SUD, and 22.2% of patients used cannabis. There were no significant differences between patients with and without SUD concerning PANSS scores, extrapyramidal motor symptoms or neurocognitive measures except better performance in psychomotor speed (TMT-A, p=0.033, Cohen's d=0.26) in patients with SUD at 6 months follow-up. Interestingly, SUD patients with ongoing substance use at follow-up showed elevated positive symptoms (PANSS positive score, p=0.008, Cohen's d=0.84) compared to those who abstained. PANSS scores at baseline were increased in patients with an onset of SUD before the age of 16 years. In addition we found a correlation between longer duration of cannabis use and higher cognitive performance as well as reduced symptom improvement and more extrapyramidal motor symptoms in patients with higher frequency of cannabis consumption. CONCLUSIONS FE-SUD and FE-non-SUD show similar psychopathology and neuropsychological performances at baseline and during the first 6 months of antipsychotic treatment.
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Affiliation(s)
- T Wobrock
- Department of Psychiatry and Psychotherapy, University Medical Centre, Georg-August-University, Göttingen, Germany; Centre of Mental Health, Darmstadt-Dieburg Clinics, Groß-Umstadt, Germany.
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - S Galderisi
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - M Davidson
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
| | - R S Kahn
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - E M Derks
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - H Boter
- Department of Epidemiology (unit HTA), University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - J Libiger
- Department of Psychiatry, University Hospital Hradec Kralove, Czech Republic
| | - S Dollfus
- Department of Adult Psychiatry, Centre Hospitalier Universitaire, Centre Esquirol, Caen, France
| | - J J López-Ibor
- Institute of Psychiatry and Mental Health, San Carlos Clinical University Hospital of Madrid, Spain
| | - J Peuskens
- University Psychiatric Centre, Katholieke Universiteit Leuven, Campus St. Jozef Kortenberg, Leuven, Belgium
| | - L G Hranov
- Department of Psychiatry, University Hospital of Neurology and Psychiatry, St. Naum, Sofia, Bulgaria
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany
| | - W W Fleischhacker
- Department of Psychiatry, Department of Biological Psychiatry, Medical University of Innsbruck, Austria
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