Article

Auditory Working Memory Impairments in Individuals at Familial High Risk for Schizophrenia

Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
Neuropsychology (Impact Factor: 3.43). 05/2012; 26(3):288-303. DOI: 10.1037/a0027970
Source: PubMed

ABSTRACT The search for predictors of schizophrenia has accelerated with a growing focus on early intervention and prevention of psychotic illness. Studying nonpsychotic relatives of individuals with schizophrenia enables identification of markers of vulnerability for the illness independent of confounds associated with psychosis. The goal of these studies was to develop new auditory continuous performance tests (ACPTs) and evaluate their effects in individuals with schizophrenia and their relatives.
We carried out two studies of auditory vigilance with tasks involving working memory (WM) and interference control with increasing levels of cognitive load to discern the information-processing vulnerabilities in a sample of schizophrenia patients, and two samples of nonpsychotic relatives of individuals with schizophrenia and controls. Study 1 assessed adults (mean age = 41), and Study 2 assessed teenagers and young adults age 13-25 (M = 19).
Patients with schizophrenia were impaired on all five versions of the ACPTs, whereas relatives were impaired only on WM tasks, particularly the two interference tasks that maximize cognitive load. Across all groups, the interference tasks were more difficult to perform than the other tasks. Schizophrenia patients performed worse than relatives, who performed worse than controls. For patients, the effect sizes were large (Cohen's d = 1.5), whereas for relatives they were moderate (d = ~0.40-0.50). There was no age by group interaction in the relatives-control comparison except for participants <31 years of age.
Novel WM tasks that manipulate cognitive load and interference control index an important component of the vulnerability to schizophrenia.

Full-text

Available from: William Kremen, May 28, 2015
0 Followers
 · 
143 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The familial ("genetic") high-risk (FHR) paradigm enables assessment of individuals at risk for schizophrenia based on a positive family history of schizophrenia in first-degree, biological relatives. This strategy presumes genetic transmission of abnormal traits given high heritability of the illness. It is plausible, however, that adverse environmental factors are also transmitted in these families. Few studies have evaluated both biological and environmental factors within a FHR study of adolescents.
    Schizophrenia Research 05/2014; 157(1-3). DOI:10.1016/j.schres.2014.04.015 · 4.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stimulants are the primary treatment for ADHD. Psychotherapy may augment pharmacologic treatment. In this article, we discuss strategies psychotherapists may use in working with teenagers and adults, including individuals who reject medications or take them suboptimally. Individuals with ADHD often have other psychiatric issues, including affective or cognitive comorbidities. Having ADHD does not protect people from the difficulties of life, and psychotherapy can help to disentangle "ADHD" from other issues. A psychotherapist knowledgeable about ADHD assessment can improve diagnostic precision. Psychotherapy can integrate forms of treatment in which the central goal is increasing mastery and competence of the individual.
    Child and Adolescent Psychiatric Clinics of North America 10/2014; 23(4). DOI:10.1016/j.chc.2014.05.013 · 2.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sleep dysfunction is a pervasive symptom in schizophrenia, yet little is known regarding the extent to which problematic sleep is present prior to illness onset. Results from an online database search targeting genetic high-risk, clinical high-risk, and retrospective studies of patients with schizophrenia prior to onset suggest that abnormalities in sleep dysfunction precede schizophrenia onset. Further, a host of proximal factors such as neural structures, endocrine function, and cognitive performance holds promise for improving our conceptualization of sleep dysfunction. However, support is preliminary, and extensive new research in this area is essential. Drawing from this review, a neurodevelopmental diathesis–stress model is posited to highlight potential research targets and mechanisms through which vulnerability, biological/psychosocial stress, and adolescent neuromaturational factors may contribute to both sleep dysfunction and development of psychosis in at-risk youth.
    Clinical Psychology Science and Practice 09/2013; 20(3). DOI:10.1111/cpsp.12041 · 2.92 Impact Factor