Neuropsychological impairments in deficit vs

Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore.
Archives of General Psychiatry (Impact Factor: 14.48). 11/1994; 51(10):804-11. DOI: 10.1001/archpsyc.1994.03950100052005
Source: PubMed


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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Available from: Brian Kirkpatrick, Feb 16, 2015
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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.
    Full-text · Article · Jan 2015 · Schizophrenia Research
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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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    ABSTRACT: Intact neurocognition has been posited as a necessary, but not sufficient prerequisite for efficient social cognition and metacognition in schizophrenia. Disorganized symptoms likely play a prominent role in these cognitive processes, given the detrimental effects of disorganization on one's ability to synthesize discrete information into an organized whole. However, the relationship between disorganized symptoms and cognitive processes remains unclear. In this study, we examined whether disorganized symptoms: 1) exhibited stronger inverse relationships with cognitive processes than other symptoms, and 2) moderated links between neurocognition and a) social cognition, and b) metacognition. Trained raters assessed psychotic symptoms, neurocognition, social cognition, and metacognition in patients with schizophrenia from a Midwestern VA Medical Center (n=68) using validated, clinician-rated instruments. We observed significantly greater inverse associations with cognitive processes for disorganized compared to reality distortion symptoms; inverse associations with neurocognition and social cognition were significantly greater for disorganized than negative symptoms. Our hypotheses that disorganized symptoms would moderate relationships between neurocognition and a) social cognition, and b) metacognition were also supported. These findings highlight the importance of disorganized symptoms in elucidating links between neurocognition and social cognitive and metacognitive abilities. Future work should assess whether similar findings occur across the schizophrenia-spectrum, and investigate if targeting disorganization can ameliorate social cognitive and metacognitive impairments in schizophrenia.
    Full-text · Article · Sep 2014 · Schizophrenia Research
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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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    ABSTRACT: Aims. Heterogeneity of schizophrenia is known to be reflected in neuropsychological functioning of patients, but its expression in relatives is understudied. This study aims at exploring relationship between executive functioning and clinical profiles of first-degree relatives of patients who are classified as having or not having the deficit subtype of schizophrenia (DSRELs v. non-DSRELs), with the prediction of greater executive impairment in DSRELs. Methods. DSRELs (n = 15) and non-DSRELs (n = 40) were compared with community controls (CCs, n = 55) on executive functioning measured by the Wisconsin Card Sorting Test (WCST) and the phonemic verbal fluency (PVF), and clinical measures. Effects of psychopathology and intelligence quotient (IQ) measures were investigated to determine their association with executive performance. Results. DSRELs showed more executive dysfunction on WCST and poorer social functioning than CCs and more severe negative symptoms than non-DSRELs. Differences on WCST-categories achieved (WCST-CA) remained significant after adjustment for clinical confounders and IQ. WCST-CA was associated with apathy and paranoid ideation only within the DSREL subgroup. Conclusions. Executive functioning and negative symptoms are severely impaired in first-degree relatives of deficit syndrome patients, thus suggesting that some neurocognitive deficits in patients may be transmitted within families according to the pathophysiology of the probands.
    Full-text · Article · Apr 2013 · Epidemiology and Psychiatric Sciences
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