Comparison of Visuospatial and Verbal Abilities in First Psychotic Episode of Schizophrenia Spectrum Disorder: Impact on Global Functioning and Quality of Life

Objectives: Deficit in visuospatial functions can influence both simple and complex daily life activities. Despite the fact that visuospatial deficit was reported in schizophrenia, research on visuospatial functions as an independent entity is limited. Our study aims to elucidate the impact of visuospatial deficit in comparison with verbal deficit on global functioning and quality of life in the first psychotic episode of schizophrenia spectrum disorder (FES). The significance of clinical symptoms and antipsychotic medication was also studied.

Methods: Thirty-six FES patients and a matched group of healthy controls (HC group) were assessed with a neuropsychological battery focused on visuospatial (VIS) and verbal (VERB) functions. Using multiple regression analysis, we evaluated the cumulative effect of VERB and VIS functions, psychiatric symptoms (PANSS) and antipsychotic medication on global functioning (GAF) and quality of life (WHOQOL-BREF) in the FES group.

Results: The FES group demonstrated significant impairment both in VIS and VERB cognitive abilities compared to the HC group. Antipsychotic medication did not significantly affect either VIS or VERB functioning. PANSS was not related to cognitive functioning, apart from the Trail Making Test B. In the FES group, the GAF score was significantly affected by the severity of positive symptoms and VERB functioning, explaining together 60% of GAF variability. The severity of negative and positive symptoms affected only the Physical health domain of WHOQOL-BREF. The degree of VERB deficit was associated with both Physical and Psychological health. Although we did not find any relation between VIS functioning, GAF, and WHOQOL-BREF, a paradoxical finding emerged in the Environment quality domain, where a worse quality of the environment was associated with better VIS functioning.

Conclusions: Our results suggest that the deficit in VIS functions is an integral part of cognitive deficit in schizophrenia spectrum disorders, rather than a side effect of symptomatology or antipsychotic medication. Moreover, VERB functioning was a better predictor of GAF and WHOQOL-BREF than VIS functioning. Given the findings of negative or missing effect of VIS deficit on WHOQOL-BREF and GAF, the accuracy of these measures in evaluating the impact of global cognitive deficit on everyday life in schizophrenia could be questioned.

Case report: Is verbal cognitive performance in bilingual neuropsychiatric patients test-language dependent?

Bilingualism (BL) is increasing around the world. Although BL has been shown to have a broad impact-both positive and negative-on language and cognitive functioning, cognitive models and standards are mainly based on monolinguals. If we take cognitive performance of monolinguals as a standard, then the performance of bilinguals might not be accurately estimated. The assessment of cognitive functions is an important part of both the diagnostic process and further treatment in neurological and neuropsychiatric patients. In order to identify the presence or absence of cognitive deficit in bilingual patients, it will be important to determine the positive and/or negative impact of BL properties on measured cognitive performance. However, research of the impact of BL on cognitive performance in neuropsychiatric patients is limited. This article aims to compare the influence of the language (dominant-L1, second-L2) used for assessment of verbal cognitive performance in two cases of bilingual neuropsychiatric patients (English/Czech). Despite the fact that the two cases have different diagnoses, similarities in working memory and verbal learning profiles for L1 and L2 were present in both patients. We expected L1 to have higher performance in all measures when compared with L2. This assumption was partially confirmed. As expected, verbal working memory performance was better when assessed in L1. In contrast, verbal learning showed the same or better performance in L2 when compared with L1. Verbal fluency and immediate recall results were comparable in both languages. In conclusion, the language of administration partially influenced verbal performance of bilingual patients. Whether the language itself influenced low performance in a given language or it was a result of a deficit requires further research. According to our results, we suggest that an assessment in both languages needs to be a component of reasonable cognitive assessment of bilingual patients.

Memory and medial temporal lobe structures in patients with schizophrenia and their siblings

Episodic retrieval is characterized by the subjective experience of remembering. Semantic memory, on the other hand, is a more structured record of facts, meanings, concepts and knowledge about the external world that we have acquired. The medial temporal lobe (MTL), especially the hippocampus and parahippocampal cortex, plays a central role in both types of memory process. Published studies suggested that individuals with schizophrenia have deficits in episodic and semantic memory, as well as structural abnormalities of the medial temporal lobe. However, it is not clear whether reported correlations reflect the impact of the disease state or that of underlying genetic influences contributing to the risk. To understand better etiology and effects of psychosis on the global brain structure and cognitive processing, relatives of individuals with schizophrenia can be studied. The aim of our study was to examine the association between abnormalities of the MTL, psychopathology, and memory impairment in schizophrenia. Study sample (n = 60) consisted of first episode schizophrenia patients, their non-psychotic siblings and matching control subjects. We used high-resolution magnetic resonance imaging and probabilistic algorithms for image analysis. Episodic and semantic memory was measured with neuropsychological tests. Our results showed differences in memory performance between the groups. Neuropsychological data were correlated with MRI findings. The results may provide insight into etiology of schizophrenia and its effects on cognition and help to identify neuroanatomical and cognitive endophenotypes of psychotic disorders.

Supported by the grant projects MH CR AZV 15-28998A, MEYS NPU4NUDZ: LO1611; Czech Science Foundation, grant No. 16-13093S; Institutional Support 00023001IKEM.

Disclosure of interest

The authors have not supplied their declaration of competing interest.