Span of apprehension deficits during the postpsychotic stages of schizophrenia. A replication and extension. Arch Gen Psychiatry
Thirty-five schizophrenic and 20 manic-depressive outpatients and 20 normal controls were administered a measure of visual information processing, the span of apprehension. The schizophrenic outpatients made significantly fewer correct detections of the target stimuli than did the manic-depressives and normal controls, particularly for conditions in which the target stimuli were embedded in four and nine irrelevant stimuli. A subgroup of schizophrenics produced the overall group differences. In a comparison of a subgroup of schizophrenics who showed impaired performance on the ten-letter array with the remaining schizophrenics, the ten-letter array appeared to be tapping processes that are independent of overall adjustment, the presence of particular symptoms, premorbid social adjustment, general demographic characteristics, and the presence of generalized performance deficits. The span of apprehension may be a marker for some subgroups of schizophrenia.
Available from: Paul H Lysaker
- "Other measures of attention such as the span of apprehension task have been linked to negative symptoms as well (Asarnow and MacCrimmon, 1981; Nuechterlein et al., 1986), though not unequivocally (Buchanan et al., 1997). Moreover, even in positive studies, the magnitude of correlations between negative symptoms and attention tend to be modest at best (Bozikas et al., 2004; Cohen and Docherty, 2004). "
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ABSTRACT: Research has suggested that negative symptoms in schizophrenia may be closely linked to impairments in schizophrenia. Research on the strength and nature of this association has been equivocal, however. One possible explanation is that there are two distinct groups of persons with negative symptoms: those with and those without attentional impairments. To examine this question we performed a cluster analysis on 99 adults with schizophrenia or schizoaffective disorder on the basis of their level of negative symptoms and performance on a continuous performance task. Four groups were found: low negative/relatively better attention (n=31), low negative/relatively poor attention (n=20), high negative/ relatively poor attention (n=28), and high negative/relatively better attention (n=20). To determine whether these groups differed meaningfully from one another, we next compared their performance on other assessments of positive symptoms, social function, self-esteem and stigma. A MANOVA found significant differences (Wilks' lambda F=3.2; p<.01) with the high negative/poor attention group having poorer self esteem and greater acceptance of stigma than the other three groups and the high negative/relatively better attention group having higher levels of positive symptoms than the other groups. Implications for research and treatment are discussed.
Available from: Shi-Kai Liu
- "Sustained attention deficits measured by the Continuous Performance Test (CPT) (Rosvold et al., 1956) have been considered as potential vulnerability indicators for schizophrenia (Chen and Faraone, 2000; Cornblatt and Keilp, 1994; Keri and Janka, 2004). They were demonstrated in schizophrenic patients across illness stages (Asarnow and MacCrimmon, 1981; Nuechterlein and Dawson, 1984) and remained relatively unchanged despite fluctuations in clinical symptoms, in contrast to those manifested by affective disorders (Liu et al., 2002; Nuechterlein et al., 1994). In addition, the performance deficits were not amendable to treatment with neuroleptics when more difficult CPT versions were used (Finkelstein et al., 1997; Hong et al., 2002; Liu et al., 2000). "
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ABSTRACT: This study examined the longitudinal patterns in the sustained attention deficits detected by the Continuous Performance Test (CPT) and the factors influencing such changes in consecutively admitted schizophrenia patients (n=224) followed up for 4-7 year. Exploratory growth mixture modeling analyses of subjects' CPT performances over successive follow-ups revealed that three major (accounting for 92.8%) plus one minor subgroups could be delineated. Subgrouping was then performed on a subsample of 104 subjects who had at least 3 times of CPT data. Based on subjects' adjusted z score of the test sensitivity index d' derived from comparing with a community sample, patients were divided into three subgroups: no impairment (-1), moderate impairment (-2.5 to -1), and severe impairment (< -2.5). The trajectory taken by individual patient was analyzed according to the initial subgroup status and subsequent changes, controlling for relevant basic and clinical characteristics. Both growth mixture modeling and subgroup status analyses found that around one third of those with severe impairment at baseline showed persistent severe impairment. Those with no impairment were stable and exhibited least tendency for further performance deterioration. Those with moderate impairment tended to fluctuate markedly, mainly towards the better rather than the worse. Previous subgrouping status and concurrent task-taking strategy predicted the performance subgroup status at follow-ups, while clinical symptoms and disease course factors did not. We concluded that there is substantial heterogeneity in schizophrenia patients' long term pattern in sustained attention deficits and those with severe impairment might represent a subgroup with stable vulnerability to schizophrenia.
Available from: Peter Gallagher
- "Martinez-Aran et al (2004) Jones et al (1994) Joffe et al (1988) Harmer et al (2002) Fleck et al (2005) Fleck et al (2003) Dixon et al (2004) Deckersbach et al (2004) Clark et al (2002) Asarnow et al (1981) Altshuler et al (2004) Addington & Addington (1997) 0 DL pooled effect size = 0.068009 (95% CI = -0.135686 to 0.271704) Fig. 3. Forest plot of individual and pooled random effects estimates of the standardised mean differences between bipolar patients and controls for years of education. "
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ABSTRACT: A number of studies have reported evidence of cognitive deficits in euthymic bipolar patients. Qualitative reviews of the literature have indicated impairments in executive functions and declarative memory are most consistently reported. However, not all primary studies conducted to date have had sufficient power to detect statistically significant differences and there have been few attempts to quantify the magnitude of impairments. This review aims to combine data from available studies to identify the profile of neuropsychological deficits in euthymic bipolar patients and quantify their magnitude.
Systematic literature review and meta-analysis.
Large effect sizes (d>or=0.8) were noted for aspects of executive function (category fluency, mental manipulation) and verbal learning. Medium effect sizes (0.5<or=d<0.8) were found for aspects of immediate and delayed verbal memory, abstraction and set-shifting, sustained attention, response inhibition, and psychomotor speed. Small effect sizes (0.2<or=d<0.5) were reported for verbal fluency by letter, immediate memory, and sustained attention.
Sufficient data were not available to investigate all domains. For example analyses did not include measures of visuospatial function.
Euthymic bipolar patients demonstrate relatively marked impairment in aspects of executive function and verbal memory. It is not yet clear whether these are two discrete areas of impairment or are related to one another. Future investigations should clarify the functional significance of deficits and indicate whether patients will benefit from ameliorative interventions.
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