Identification of clinically meaningful relationships among cognition, functionality, and symptoms in subjects with schizophrenia or schizoaffective disorder

Janssen Research & Development, LLC, Titusville, NJ, USA. Electronic address: .
Schizophrenia Research (Impact Factor: 3.92). 12/2012; 143(2). DOI: 10.1016/j.schres.2012.11.031
Source: PubMed


Cognitive impairment in schizophrenia and schizoaffective disorder is a major determinant of disability. This study explored the relationships among cognitive functioning, clinical symptoms, overall functionality, and demographic characteristics.

This was a post hoc analysis of a 52-week, prospective, randomized, double-blind study (N=323) comparing 2 doses of risperidone long-acting injectable (RLAI) in stable subjects with schizophrenia or schizoaffective disorder. Cognitive evaluations were performed and standardized using a healthy age- and sex-matched comparison group. Simple and multiple regression models were used to identify relationships among neurocognitive composite scores (NCS), clinical symptom end points (Positive and Negative Syndrome Scale [PANSS] total and factor scores), overall functionality (Personal and Social Performance [PSP] score), and demographics.

A simple regression model identified significant relationships between the NCS at end point and PANSS total score, PANSS disorganized thoughts factor score, functioning (PSP) and age. A 1-point decrease on PANSS total score and PANSS disorganized thoughts factor score corresponded to an increase in NCS of 0.126-point, and 0.81-point increases, respectively. A 1-point increase on the PSP corresponded to a 0.186-point increase in the NCS T-score. Among the demographic variables, only age correlated significantly with cognition (10-year increase in age corresponded to 1.1-point decrease in NCS T-score) in a multiple regression model.

Improved cognition was associated with beneficial changes in functional status and clinical symptoms (particularly disorganization symptoms) in subjects with schizophrenia/schizoaffective disorder. Older subjects showed less overall cognitive improvement. Improved cognitive and functional outcome is correlated with symptom improvements in RLAI-treated patients with schizophrenia.

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    • "Indeed, patients with schizophrenia exhibited impaired ability for theme identification, which was closely related to social anhedonia (Oh et al., 2014). Since social anhedonia brings on social dysfunctions (Pandina et al., 2013), this cascade of deficits in patients with schizophrenia can cause enormous trouble to social adjustment. Given this background, the present study was designed to elucidate the neural basis of deficits in abstract thinking in patients with schizophrenia using a theme-identification task. "
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    ABSTRACT: Abnormal abstract thinking is a major cause of social dysfunction in patients with schizophrenia, but little is known about its neural basis. In this study, we aimed to determine the characteristic abstract thinking-related brain responses in patients using a task reflecting social situations. We conducted functional magnetic resonance imaging while 16 patients with schizophrenia and 16 healthy controls performed a theme-identification task, in which various emotional pictures depicting social situations were presented. Compared with healthy controls, the patients showed significantly decreased activity in the left frontopolar and right orbitofrontal cortices during theme identification. Activity in these two regions correlated well in the controls, but not in patients. Instead, the patients exhibited a close correlation between activity in both sides of the frontopolar cortex, and a positive correlation between the right orbitofrontal cortex activity and degrees of theme identification. Reduced activity in the left frontopolar and right orbitofrontal cortices and the underlying aberrant connectivity may be implicated in the patients' deficits in abstract thinking. These newly identified features of the neural basis of abnormal abstract thinking are important as they have implications for the impaired social behavior of patients with schizophrenia during real-life situations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    08/2015; DOI:10.1016/j.pscychresns.2015.08.007
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    • "Subjects with schizophrenia and other psychotic disorders may suffer from negative, positive, affective and cognitive symptoms, which may coexist in a multidimensional syndrome (Van Os et al 2010). Of all the different symptom dimensions of psychosis, cognitive impairment plays a crucial role in the functional outcome of the illness (Pandina et al., 2013). Alterations in cognitive functioning appear before the onset of psychotic symptoms (Davidson et al., 1999; Reichenberg et al., 2005). "
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    ABSTRACT: Subjects with a psychotic disorder show mild to moderate cognitive impairment, which is an important determinant of functional outcome. The underlying biological process of cognitive impairment in psychosis is unclear. We aimed to explore whether hypothalamic-pituitary-thyroid axis hormones or thyroid autoimmunity modulate cognitive functioning in subjects with early psychosis. We studied 70 patients with a psychotic disorder (<3years of illness) and a control group of 37 healthy subjects (HS). Plasma levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and thyroid-peroxidase (TPO-Abs) and thyroglobulin antibodies (TG-Abs) were determined. Cognitive assessment was performed with the MATRICS Cognitive Consensus Cognitive Battery. We also explored the relationship between thyroid variables and cognition in three subgroups of psychotic patients: psychosis not otherwise specified, affective psychosis (bipolar disorder or schizoaffective disorder) and non-affective psychosis (schizophrenia or schizophreniphorm disorder). In patients with early psychosis, higher FT4 levels (but not TSH or thyroid antibodies) were associated with better cognitive performance in attention/vigilance and overall cognition. The relationship between FT4 levels and the attention/vigilance domain remained significant in a multivariate analysis after adjusting for education level, age, gender, substance use, and benzodiazepine and antipsychotic treatments. We did not find a significant association between FT4 and cognitive performance in HS. In the exploratory analysis by psychotic subtypes, subjects with affective psychosis had increased FT4 levels and better cognitive profile than those with non-affective psychosis. Our study suggests that FT4 levels are associated with cognitive abilities (attention/vigilance and overall cognition) in individuals with early psychosis. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 05/2015; 166(1-3). DOI:10.1016/j.schres.2015.04.030 · 3.92 Impact Factor
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    • "Moreover, we found a negative correlation between abstract thinking ability and severity of social anhedonia. This is in line with a previous finding of the significant relationship between abstract thinking and negative symptoms in schizophrenia [44]. Considering that deficits in abstract thinking may make it difficult to perform social behaviors [2,45] and that problems in social behavior may be a stressful condition triggering the emergence of anhedonia [46], it makes sense that impaired abstract thinking can contribute to social anhedonia as well. "
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    ABSTRACT: Effective integration of visual information is necessary to utilize abstract thinking, but patients with schizophrenia have slow eye movement and usually explore limited visual information. This study examines the relationship between abstract thinking ability and the pattern of eye gaze in patients with schizophrenia using a novel theme identification task. Twenty patients with schizophrenia and 22 healthy controls completed the theme identification task, in which subjects selected which word, out of a set of provided words, best described the theme of a picture. Eye gaze while performing the task was recorded by the eye tracker. Patients exhibited a significantly lower correct rate for theme identification and lesser fixation and saccade counts than controls. The correct rate was significantly correlated with the fixation count in patients, but not in controls. Patients with schizophrenia showed impaired abstract thinking and decreased quality of gaze, which were positively associated with each other. Theme identification and eye gaze appear to be useful as tools for the objective measurement of abstract thinking in patients with schizophrenia.
    Behavioral and Brain Functions 04/2014; 10(1):13. DOI:10.1186/1744-9081-10-13 · 1.97 Impact Factor
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