Negative Symptoms and Cognitive Deficits: What Is the Nature of Their Relationship?

Department of Psychiatry, Mt. Sinai School of Medicine, New York, NY, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 05/2006; 32(2):250-8. DOI: 10.1093/schbul/sbj011
Source: PubMed


Negative symptoms and cognitive deficits in schizophrenia share many features and are correlated in their severity on a cross-sectional
basis. The question arises as to the nature of this relationship: are these symptoms the same, caused by the same factor (or
factors); or is the nature of their relationship determined by other factors, such as definitional issues and common correlates?
In this article we provide a conceptual overview for addressing this question and provide a selective review of the literature
on the cross-sectional and longitudinal relationships between these two features of the illness. We describe 4 different models
of the “true” relationship between these variables. Some data suggest that the relationship between these variables is determined
by the definition of negative symptoms employed and that, in general, the correlation is moderate at the most. Further, path
modeling suggests the possibility, to be addressed with later research, that correlations between negative and cognitive symptoms
and everyday functional outcomes may influence the observed correlations between these variables. Thus, we conclude that negative
and cognitive symptoms may be separable, if not conceptually independent, domains of the illness and that it might be possible
to develop treatments that target negative symptoms and cognitive deficits independently.

Download full-text


Available from: Christopher Bowie, Dec 24, 2014
  • Source
    • "Himelhoch et al., 1996; Collins et al., 1997; Daban et al., 2002; Minzenberg et al., 2003; Lucas et al., 2004; Rund et al., 2004), while meta-analyses have generally found small to moderate correlations between negative and cognitive symptoms (Nieuwenstein et al., 2001; Dibben et al., 2009; Dominguez Mde et al., 2009; Ventura et al., 2009). These two domains have been described as separable although not conceptually independent, and models in which negative symptoms and cognitive dysfunction may have related etiologies, overlapping definitions or measurements, or shared correlations with distal outcomes have been proposed (Harvey et al., 2006). Some of the inconsistent findings regarding the relationship between negative and cognitive schizophrenic symptoms may be related to different factors that could influence this relationship, or to methodological issues. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous studies have generally found a relationship between negative and cognitive symptoms in schizophrenia. The present study investigated the relationship between the 5 PANSS factors of a recent consensus model developed by NIMH researchers, and cognitive performance as assessed with the MATRICS Consensus Cognitive Battery (MCCB) in 80 patients with schizophrenia using correlation and regression analyses. The PANSS Cognitive factor showed a small to moderate significant association with MCCB Speed of processing, Working memory, Verbal learning, the Neurocognitive composite score, and the Overall composite score. Notably, however, no relationship was found between the PANSS Negative factor and any of the MCCB scores. The Positive, Excited and Depressed factors also did not show associations with the MCCB. These results highlight the need for refined assessment instruments and support the relative independence of cognition from other domains of psychopathology, including negative symptoms, in patients with schizophrenia.
    10/2015; DOI:10.1016/j.psychres.2015.09.022
  • Source
    • "Our finding of no significant association between neurocognitive function and risks for hospitalizations provides evidence of discriminant validity for our findings and reconfirms the separation of neurocognitive performance and its correlates from clinical symptoms and their treatment with antipsychotic medications (Bowie and Harvey, 2005). The lack of prediction of hospitalization associated with negative symptoms further underscores their separation in functional importance from psychosis, as persistent negative symptoms tend to be more associated with social functioning and quality of life to a greater extent than with psychosis (Harvey et al., 2006). Second, multiplying these estimates by estimates of the national cost per day (night) for schizophrenia hospitalizations, a 10-point reduction in PANSS total scores would be expected to reduce three-month costs by $192 and one-year costs by $1135. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about the effect of treatment-related changes in Positive and Negative Syndrome Scale (PANSS) schizophrenia severity scores on the risk for subsequent hospitalization. We used limited-access data from the Clinical Antipsychotic Trials of Intervention Effectiveness Project Schizophrenia Trial (CATIE Sz) to evaluate the relationship between baseline and changes in PANSS clinical symptom scores and risks for subsequent psychiatric hospitalization. Reductions in PANSS total scores during a three-month period were associated with a significantly lower risk for psychiatric hospitalization (OR, 0.78, 95% CI, 0.72 to 0.84, p<0.001 for 10 point reductions). Ten-point reductions in PANSS total score during three months reduced predicted number of psychiatric hospitalizations by 0.02 (95% CI, 0.012 to 0.027) and nights in the hospital by 0.24 (95% CI, 0.07 to 0.41). Maintenance of this reduction for a year is expected to reduce psychiatric hospitalizations by 0.10 (95% CI, 0.08 to 0.13) and nights hospitalized by 1.4 (95% CI, 0.9 to 1.9). A 10-point reduction in PANSS total score was associated with a savings in psychiatric hospitalization cost of $192 over three months and $1135 over a year. Reductions in PANSS total scores significantly reduced risks for psychiatric hospitalizations, total number of psychiatric hospitalizations, total nights for psychiatric admissions, and the costs of these hospitalizations. These data highlight the benefits of symptom control on the direct costs of care in schizophrenia. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 06/2015; 166(1-3). DOI:10.1016/j.schres.2015.05.021 · 3.92 Impact Factor
  • Source
    • "The evidence is mounting that, even in first episode patients, negative symptoms are often a core feature. Like cognitive deficits, negative symptoms have prognostic importance, are associated with poor functioning, and have been shown to have their onset prior to the emergence of positive symptoms (Harvey et al., 2006). Despite their central role in the illness, negative symptoms have proven to be resistant to psychopharmalogical treatment with currently available medications. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Understanding the longitudinal course of negative symptoms, especially in relationship to functioning, in the early phase of schizophrenia is crucial to developing intervention approaches. The course of negative symptoms and daily functioning was examined over a 1-year period following a recent onset of schizophrenia and at an 8-year follow-up point. The study included 149 recent-onset schizophrenia patients who had a mean age of 23.7 (SD=4.4)years and mean education of 12.9 (SD=2.2)years. Negative symptom (BPRS and SANS) and functional outcome (SCORS) assessments were conducted frequently by trained raters. After antipsychotic medication stabilization, negative symptoms during the first outpatient year were moderately stable (BPRS ICC=0.64 and SANS ICC=0.66). Despite this overall moderate stability, 24% of patients experienced at least one period of negative symptoms exacerbation. Furthermore, entry level of negative symptoms was significantly associated with poor social functioning (r=-.34, p<.01) and work/school functioning (r=-.25, p<.05) at 12months, and with negative symptoms at the 8-year follow-up (r=.29, p<.05). Early negative symptoms are fairly stable during the first outpatient year, are predictors of daily functioning at 12months, and predict negative symptoms 8years later. Despite the high levels of stability, negative symptoms did fluctuate in a subsample of patients. These findings suggest that negative symptoms may be an important early course target for intervention aimed at promoting recovery. Copyright © 2014 Elsevier B.V. All rights reserved.
    Schizophrenia Research 12/2014; 161(2-3). DOI:10.1016/j.schres.2014.10.043 · 3.92 Impact Factor
Show more