Article

Neuropsychological impairments in deficit vs nondeficit forms of schizophrenia

Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore.
Archives of General Psychiatry (Impact Factor: 13.75). 11/1994; 51(10):804-11. DOI: 10.1001/archpsyc.1994.03950100052005
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ABSTRACT Previous studies have suggested that functional impairments of the frontal and parietal lobes are related to the deficit symptoms of schizophrenia. The purpose of the current study was to examine whether neuropsychological measures of frontal and parietal lobe function differentiated deficit from nondeficit patients. Neuropsychological measures of temporal lobe function were used as contrast measures.
The performance of 18 deficit and 21 nondeficit schizophrenic patients was examined on neuropsychological measures of executive, visuospatial, and memory functions, selected on the basis of their association with lesions of either the frontal, parietal, or temporal lobes. The results from the schizophrenic subgroups were compared with the results on the same measures obtained from 30 normal controls.
Deficit patients performed more poorly than nondeficit patients on two frontal lobe measures, the Stroop Color-Word Interference and Trails Making B tests, and one parietal lobe measure, the Mooney Faces Closure Test. There were no differences in performance on the temporal lobe measures between the two groups. Both groups performed more poorly on the tests than the normal controls.
The results suggest that deficit patients may have greater performance impairments on neuropsychological measures associated with frontal and parietal neuropsychological abnormalities.

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    • "nostic criteria for " deficit schizophrenia " , i . e . , those with primary and clinically stable negative symptoms ( Carpenter et al . , 1988 ; Kirkpatrick et al . , 2001 ) . Patients with deficit schizophrenia typically fall 1 SD below nondeficit schizo - phrenia patients and 2 SD below healthy controls on standard neuro - psychological tests ( Buchanan et al . , 1994 ; Cohen et al . , 2007 ) ; however , it remains to be seen whether patients meeting clinical criteria for deficit schizophrenia are more likely to fail effort tests than nondeficit patients ."
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    ABSTRACT: There is some evidence that insufficient effort may be common in schizophrenia, posing significant threats to the validity of neuropsychological test results. Low effort may account for a significant proportion of variance in neuropsychological test scores and the generalized cognitive deficit that characterizes the disorder. The current study evaluated clinical predictors of insufficient effort in schizophrenia using an embedded effort measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI). Participants were 330 patients meeting DSM-IV-TR criteria for schizophrenia, schizoaffective disorder, or another psychotic disorder who received a battery of neuropsychological tests, including: Wechsler Test of Adult Reading (WTAR), Wechsler Abbreviated Scale of Intelligence (WASI), and RBANS. Clinical assessments designed to measure functional outcome and symptoms were also obtained. Results indicated that 9.4% of patients failed the EI. Patients who failed had lower full-scale, verbal, and performance IQ, as well as poorer performance on RBANS domains not included in the EI (immediate memory, language, and visuospatial/construction). Patients who failed the EI also displayed poorer community-based vocational outcome, greater likelihood of having “deficit schizophrenia” (i.e., primary and enduring negative symptoms), and increased severity of positive symptoms. Regression analyses revealed that insufficient effort was most significantly predicted by a combination of low IQ, negative symptoms, and positive symptoms. Findings suggest that although insufficient effort may be relatively uncommon in schizophrenia, it is associated with important clinical outcomes. The RBANS EI may be a useful tool in evaluating insufficient effort in schizophrenia.
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    • "A second potential explanation is that participants in this study exhibited a low rate of primary negative symptoms. Individuals with pronounced primary negative symptoms, commonly referred to as the deficit syndrome (Carpenter et al., 1988), tend to show higher rates of neurocognitive and social cognitive impairments than those who display mostly secondary negative symptoms (Buchanan et al., 1994; Galderisi et al., 2002). Although the distinction between primary and secondary negative symptoms was not assessed here, all participants in this sample had to agree to take part in a twoyear therapeutic intervention as part of a longitudinal study of vocational outcomes. "
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    Schizophrenia Research 09/2014; 159(1). DOI:10.1016/j.schres.2014.08.005 · 4.43 Impact Factor
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    • "Dysfunction of the prefrontal cortex has been suggested as a presumed neural substrate associated with deficit schizophrenia (Delamillieure et al. 2000, 2004; Gonul et al. 2003). In particular, dysfunction of prefrontal cortex is associated with both negative symptoms and executive dysfunctions within this subtype of patients (Buchanan et al. 1997; Stolar et al. 1994). Although the conclusions drawn from this literature are still controversial (Goghari, 2011; Benoit et al. 2012), most studies report that dorsal prefrontal cortex functioning is associated with the negative dimensions of apathy and poor 'volition' (Taylor et al. 2004; Kimhy et al. 2006; Barch & Dowd, 2010). "
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