Goldberg TE, Gold JM, Greenberg R, Griffin S, Schulz SC, Pickar D et al. Contrasts between patients with affective disorders and patients with schizophrenia on a neuropsychological test battery. Am J Psychiatry 150: 1355-1362

Clinical Brain Disorders Branch, NIMH Neuroscience Center at St. Elizabeths, Washington, DC 20032.
American Journal of Psychiatry (Impact Factor: 12.3). 10/1993; 150(9):1355-62. DOI: 10.1176/ajp.150.9.1355
Source: PubMed


This study was designed to ascertain the degree and specificity of cognitive impairments in patients with schizophrenia and patients with affective disorders.
Cognitive function was assessed with a neuropsychological test battery in consecutively admitted patients with schizophrenia (N = 57), unipolar depression (N = 29), and bipolar disorder (N = 16).
The performance of the schizophrenic group was significantly below that of the groups with affective disorders on measures of attention and psychomotor speed, verbal and visual memory, and problem solving and abstraction. IQ was lower in the schizophrenic group and appeared to have deteriorated from a normal premorbid level that was not different from that of the affective disorder groups, as determined by the Wide Range Achievement Test--Revised reading test, a putative measure of premorbid intelligence. When IQ was controlled, differences between the groups in problem solving and visual memory remained. Psychiatric symptoms had a larger impact on test performance in the affective disorder groups than in the schizophrenic group.
These results suggest that patients with schizophrenia perform systematically worse on cognitive measures than patients with affective disorders, which is consistent with their generally poorer outcome. The results also indicate that schizophrenia and affective disorders are qualitatively distinguishable in neuropsychological terms, given differences in apparent intellectual deterioration, profiles of cognitive impairment, and associations between cognitive performance and psychopathology.

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    • "It has been argued that the presence of psychomotor disturbances is important for the diagnostic assessment of affective disorder subtypes (Parker et al., 1994; Grunze et al., 2010), and also that they appear to persist beyond the acute phases of the illness (Bora et al., 2007). Two common methods of objectively assessing psychomotor disturbances are reaction time tests and the Trail Making Test (Goldberg et al., 1993; Gaudino et al., 1995). There are few brain-imaging studies of psychomotor disturbances . "
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    ABSTRACT: We hypothesized that psychomotor disturbances in patients with bipolar disorder are associated with morphometric changes in functionally specific regions of the basal ganglia and thalamus. We used structural magnetic resonance imaging and vertex-based morphometry to investigate whether psychomotor performance is associated with changes in volume and shape in euthymic subjects with bipolar disorder (n=27) compared with matched healthy controls (n=27). We saw no significant differences between age- and sex-matched groups in motor performance. We found a statistically significant group difference in the shape of the right putamen in the absence of psychomotor disturbances. There was an association between shape and motor performance in controls that was lacking in patients. We conclude that euthymic subjects with bipolar disorder without psychomotor disturbances show shape changes in regions of the right putamen that contribute to executive functions and motor function. It may be that other brain regions sustain the psychomotor functions that produce nearly identical motor performance in both groups.
    Psychiatry Research: Neuroimaging 03/2014; 221(3). DOI:10.1016/j.pscychresns.2014.01.007 · 2.42 Impact Factor
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    • "Bipolar disorder (BD) and schizophrenia (SZ) have long been considered as two distinct disorders; for example, BD and SZ often differ in their clinical course, associated levels of functional impairment , and response to medications (Goldberg et al., 1993; Gourovitch et al., 1999). Although the Kraepelinian dichotomy classifies BD and SZ as distinct entities, this concept has recently been challenged (Craddock and Owen, 2005), convergent evidence increasingly suggests that BD and SZ have overlapping features, such as symptomatology , persistent neurocognitive deficits, and shared susceptibility genes that frequently co-occur within relatives (Murray et al., 2004; Kato et al., 2005; Benes, 2007;Owen et al., 2007; Schretlen et al., 2007; Maier, 2008). "
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    ABSTRACT: Structural magnetic resonance imaging (MRI) studies have provided evidence for corpus callosum (CC) white matter abnormalities in bipolar disorder (BD) and schizophrenia (SZ). These findings include alterations in shape, volume, white matter intensity and structural integrity compared to healthy control populations. Although CC alterations are implicated in both SZ and BD, no study of which we are aware has investigated callosal subregion differences between these two patient populations. We used diffusion tensor imaging (DTI) to assess CC integrity in patients with BD (n=16), SZ (n=19) and healthy controls (HC) (n=24). Fractional anisotropy (FA) of CC subregions was measured using region of interest (ROI) analysis and compared in the three groups. Significant group differences of FA values were revealed in five CC subregions, including the anterior genu, middle genu, posterior genu, posterior body and anterior splenium. FA values of the same subregions were significantly reduced in patients with SZ compared with HC. FA values were also significantly reduced in patients with BD compared to the HC group in the same subregions, excepting the middle genu. No significant difference was found between patient groups in any region. Most of the alterations in CC subregions were present in both the BD and SZ groups. These results imply an overlap in potential pathology, possibly relating to risk factors common to both disorders. The one region that differed between patient groups, the middle genu area, may serve as an illness marker and is perhaps involved in the different cognitive impairments observed in BD and SZ.
    11/2013; 221(1). DOI:10.1016/j.pscychresns.2013.10.007
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    • "A meta-analysis comparing cognitive deficits in patients with schizophrenia and bipolar disorder who had similar clinical and demographic characteristics demonstrated the impairments in schizophrenia to be, on average, 0.5 standard deviations greater than those in bipolar disorder.18) Importantly, cognitive performance in schizophrenia appears to be stable across fluctuations in illness symptoms, while deficits in affective disorders are more closely tied to clinical state.10,17) In a study of patients with psychosis, only those who had bipolar disorder had improvements in cognitive function with the resolution of the psychosis while those with schizophrenia performed at the same level cognitively regardless of changes in psychotic symptoms.19) "
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    ABSTRACT: Cognitive deficits in schizophrenia are pervasive, severe, and largely independent of the positive and negative symptoms of the illness. These deficits are increasingly considered to be core features of schizophrenia with evidence that the extent of cognitive impairment is the most salient predictor of daily functioning. Unfortunately, current schizophrenia treatment has been limited in addressing the cognitive deficits of the illness. Alterations in neuroplasticity are hypothesized to underpin these cognitive deficits, though preserved neuroplasticity may offer an avenue towards cognitive remediation. Key neuroplastic principles to consider in designing remediation interventions include ensuring sufficient intensity and duration of remediation programs, "bottom-up" training that proceeds from simple to complex cognitive processes, and individual tailoring of remediation regimens. We discuss several cognitive remediation programs, including cognitive enhancement therapy, which embrace these principles to target neurocognitive and social cognitive improvements and which havebeen demonstrated to be effective in schizophrenia. Future directions in cognitive remediation research include potential synergy with pharmacologic treatment, non-invasive stimulation techniques, and psychosocial interventions, identification of patient characteristics that predict outcome with cognitive remediation, and increasing the access to these interventions in front-line settings.
    Clinical Psychopharmacology and Neuroscience 12/2012; 10(3):125-35. DOI:10.9758/cpn.2012.10.3.125
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