Subjective cognitive dysfunction in first-episode and chronic schizophrenic patients

Subjective cognitive complaints and relations to objective cognitive performance among Lebanese patients with schizophrenia

BACKGROUND

Patients with schizophrenia have a particularly low level of insight into their illness compared to people with other mental health disorders. The objectives of the study were to evaluate: 1) subjective cognitive complaints in individuals with schizophrenia in comparison with health controls, 2) the relation between subjective cognitive complaint (SCC) and objective cognitive performance in the patients group, and 3) factors related to cognitive complaint, such as depression, insight, autonomy, and psychological symptoms.

METHODS

Cross-sectional study was conducted between July 2019 and March 2020 enrolled 120 patients with schizophrenia disorders, selected from the Psychiatric Hospital of the Cross (HPC) - Lebanon and 60 healthy controls. The Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS) was used to measure people living with schizophrenia perception of their cognitive impairment, while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate their cognitive functioning.

RESULTS

A significant difference was found between schizophrenia patients and healthy controls in all neurocognition and SASCCS tests. The hierarchical regression analysis showed that the BACS total score (Beta = -.06, p = .04), the PANSS general psychopathology (Beta = .29, p = .003), higher depression (Beta = .75, p = .003) were significantly associated with higher SCC. However, higher autonomy (Beta = - 6.35, p = .001) was significantly associated with lower SCC. A Structural equation model showed that the two most contributing variables were general psychopathology (Standardized Beta (SB): .33, p < 0.001) and autonomy (SB: -.29, p < 0.001).

CONCLUSION

A significant proportion of patients with schizophrenia could estimate their cognitive impairment. It also showed a positive correlation between depression and activity of daily living with SCC, suggesting that this aspect should be investigated alongside the clinical symptoms when a patient with schizophrenia presents with SCC.

Prediction of Self-Report Cognitive Function for the Symptomatic Remission in Schizophrenia Treated with Amisulpride: a Multicenter, 8-Week Case-Control Study

This study aimed to determine whether self-report cognitive function is a predictor of symptomatic remission in amisulpride-treated schizophrenia. Patients with DSM-IV schizophrenia diagnoses who received amisulpride treatment, were recruited. Each patient received amisulpride with a flexible-dose strategy of 400-800 mg daily for eight weeks. Remission was defined by a shorter version of the Positive and Negative Symptom Scale(PANSS)criteria, which includes six items (PANSS-6) with scores of less than three in each item(criteria A) or total six scores of less than fourteen(criteria B). Three hundred and three patients completed the study in 15 hospitals in China. By criteria A, 244 (80.5%) achieved symptomatic remission at endpoint, and 258 (85.1%) by criteria B. Duration of illness (DOI) (criteria A: t = 2.31, P = 0.025,criteria B:t = 2.24,p = 0.026) and perceived deficits questionnaire at baseline (PDQ20 Day0) (criteria A: t = 3.32, P = 0.001,criteria B:t = 2.76,p = 0.006) in remission groups were less than that in non-remission groups. Logistic regression analysis took into account sex, age, age-onset, DOI, and PDQ20(Day0), and showed that PDQ20(Day0) was a predictor for symptomatic remission in criteria A (B = - 0.02, P = 0.014) and criteria B (B = - 0.03, P = 0.005). The odds ratio (OR) of achieving remission will be reduced by 2% in criteria A and 3% in criteria B. There were no significant differences in gender composition, age, BMI, education level, age-onset, a daily dose of amisulpride and the percentage of PDQ20 Improvement between remission and nonremission in criteria A or criteria B. Receiver operating characteristic(ROC) curves were found for PDQ20(Day0) to define the precise scores to predict remission of schizophrenia (criteria A:AUC = 0.614, S.E. = 0.041, 95% CI = 0.535-0.694, p = 0.007; criteria B:AUC = 0.633, S.E. = 0.045, 95% CI = 0.545-0.721, p = 0.005). Our data suggest that an early self-report cognitive function in amisulpride-treated schizophrenia is important in predicting for symptomatic remission, the fewer scores of PDQ20 at baseline mean the patients have less daily cognitive difficulty, the more likely the patient is to achieve symptomatic remission.

Theoretical Modeling of Cognitive Dysfunction in Schizophrenia by Means of Errors and Corresponding Brain Networks

The current evidence of cognitive disturbances and brain alterations in schizophrenia does not provide the plausible explanation of the underlying mechanisms. Neuropsychological studies outlined the cognitive profile of patients with schizophrenia, that embodied the substantial disturbances in perceptual and motor processes, spatial functions, verbal and non-verbal memory, processing speed and executive functioning. Standardized scoring in the majority of the neurocognitive tests renders the index scores or the achievement indicating the severity of the cognitive impairment rather than the actual performance by means of errors. At the same time, the quantitative evaluation may lead to the situation when two patients with the same index score of the particular cognitive test, demonstrate qualitatively different performances. This may support the view why test paradigms that habitually incorporate different cognitive variables associate weakly, reflecting an ambiguity in the interpretation of noted cognitive constructs. With minor exceptions, cognitive functions are not attributed to the localized activity but eventuate from the coordinated activity in the generally dispersed brain networks. Functional neuroimaging has progressively explored the connectivity in the brain networks in the absence of the specific task and during the task processing. The spatio-temporal fluctuations of the activity of the brain areas detected in the resting state and being highly reproducible in numerous studies, resemble the activation and communication patterns during the task performance. Relatedly, the activation in the specific brain regions oftentimes is attributed to a number of cognitive processes. Given the complex organization of the cognitive functions, it becomes crucial to designate the roles of the brain networks in relation to the specific cognitive functions. One possible approach is to identify the commonalities of the deficits across the number of cognitive tests or, common errors in the various tests and identify their common "denominators" in the brain networks. The qualitative characterization of cognitive performance might be beneficial in addressing diffuse cognitive alterations presumably caused by the dysconnectivity of the distributed brain networks. Therefore, in the review, we use this approach in the description of standardized tests in the scope of potential errors in patients with schizophrenia with a subsequent reference to the brain networks.

Self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia

BACKGROUND

We investigated self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia in order to shed light on the clinical correlates of subjective cognitive deficits in schizophrenia.

METHODS

Seventy outpatients with schizophrenia were evaluated. Patients' self-perceived cognitive deficits, internalized stigma, and subjective quality of life were assessed using the Scale to Investigate Cognition in Schizophrenia (SSTICS), the Internalized Stigma of Mental Illness Scale (ISMI), and the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), respectively. Correlation and regression analyses controlling for the severity of symptoms of schizophrenia were performed, and a mediation analysis was conducted to examine the hypothesis that internalized stigma mediates the relationship between self-perceived cognitive deficits and subjective quality of life.

RESULTS

Pearson's partial correlation analysis showed significant correlations among the SSTICS, ISMI, and SQLS-R4 scores (P<0.01). Multiple regression analysis showed that the SSTICS and ISMI scores significantly predicted the SQLS-R4 score (P<0.01). Mediation analysis revealed that the strength of the association between the SSTICS and SQLS-R4 scores decreased from β=0.74 (P<0.01) to β=0.56 (P<0.01), when the ISMI score was statistically controlled. The Sobel test revealed that this difference was significant (P<0.01), indicating that internalized stigma partially mediated the relationship between self-perceived cognitive deficits and quality of life.

CONCLUSION

The present study indicates that self-perceived cognitive deficits are significantly associated with internalized stigma and quality of life. Furthermore, internalized stigma was identified as a partial mediator of the relationship between self-perceived cognitive deficits and quality of life. These findings suggest that clinicians should be aware that patients with schizophrenia experience significantly greater self-stigma when they suffer subjective cognitive deficits, and that this may further compromise their quality of life.

Psychosis Incident Cohort Outcome Study (PICOS). A multisite study of clinical, social and biological characteristics, patterns of care and predictors of outcome in first-episode psychosis. Background, methodology and overview of the patient sample

AIMS

This paper aims at providing an overview of the background, design and initial findings of Psychosis Incident Cohort Outcome Study (PICOS).

METHODS

PICOS is a large multi-site population-based study on first-episode psychosis (FEP) patients attending public mental health services in the Veneto region (Italy) over a 3-year period. PICOS has a naturalistic longitudinal design and it includes three different modules addressing, respectively, clinical and social variables, genetics and brain imaging. Its primary aims are to characterize FEP patients in terms of clinical, psychological and social presentation, and to investigate the relative weight of clinical, environmental and biological factors (i.e. genetics and brain structure/functioning) in predicting the outcome of FEP.

RESULTS

An in-depth description of the research methodology is given first. Details on recruitment phase and baseline and follow-up evaluations are then provided. Initial findings relating to patients' baseline assessments are also presented. Future planned analyses are outlined.

CONCLUSIONS

Both strengths and limitations of PICOS are discussed in the light of issues not addressed in the current literature on FEP. This study aims at making a substantial contribution to research on FEP patients. It is hoped that the research strategies adopted in PICOS will enhance the convergence of methodologies in ongoing and future studies on FEP.

Subjective and Objective Cognitive Dysfunction in Schizophrenia - is there a Link?

Cognitive dysfunction is a well recognized symptom of schizophrenia, as well as patients having poor insight into their illness. The subjective scale to investigate cognition in schizophrenia (SSTICS) is one of several scales that have been developed to study subjective cognitive dysfunction and has been compared to patients’ objective cognitive level. A literature search was performed using PubMed, psychINFO, Web of Science, and cross-referencing to find 26 articles which used 14 different subjective cognitive dysfunction scales to investigate the relationship between subjective and objective measures of cognition in schizophrenia. Although the majority of studies using the SSTICS found significant correlations between subjective and objective measures of cognition, the findings from the other scales were less clear. From this review, the issue of whether or not schizophrenic patients have good cognitive insight remains unsure. However, due to the heterogeneous nature of the study designs and their outcome measures, continued work in this area with consistency on these points is necessary; on the path to better provide management options for a very debilitating component of this illness.

Prevalence and intensity of basic symptoms among cannabis users: an observational study

BACKGROUND

It is difficult to establish whether people who are prone to psychosis are drawn to cannabis use or whether cannabis use truly increases the incidence of psychotic experiences.

OBJECTIVES

The aim of our study was to evaluate, in a sample of healthy high school and university students, the presence and level of subjective experiences (SEs) and their relation to cannabis use.

METHODS

A total of 502 voluntary subjects were recruited; an anamnestic interview was administered to obtain socio-demographic information, cannabis use data, and psychiatric familial history. SEs were assessed using the Italian version of the Frankfurt Complaint Questionnaire (FCQ).

RESULTS

One hundred and fourteen subjects declared the use of cannabis: 20.5% smoked more than 1 joint per week, and 71.9% used cannabis for a period of more than 1 year. Cannabis users did not differ from the cannabis-free group in any of the 10 FCQ dimensions. Higher FCQ total scores were found in cannabis users with a familial history of psychiatric disorders respective to those without a psychiatric load (p<.05).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

In our study, SE intensity was not influenced by the use of cannabis. With regard to familial data, this is the first study to explore the relationship between SE and the presence of psychiatric problems in first-degree relatives. The association between FCQ intensity and psychiatric familial load may confirm the independence of these phenomena from the use of cannabis.

Subjective rating of working memory is associated with frontal lobe volume in schizophrenia

BACKGROUND

Patients with schizophrenia commonly show deficits in working memory on objective neuropsychological measures, and brain imaging studies have documented neural abnormalities during performance of working memory tasks. It remains unclear to what extent such patients are able to accurately gauge the integrity of their working memory in their daily lives.

AIMS

We evaluated the relationship between subjective rating of working memory integrity in daily life and volumes of the frontal, temporal, and parietal lobes in patients with schizophrenia.

METHODS

Participants included 29 patients with schizophrenia and 26 healthy comparison subjects. Participants completed a structural magnetic resonance imaging (MRI) scan, the Self Report form of the Behavioral Rating Inventory of Executive Function - Adult version (BRIEF-A), and Digit Span Backwards as an objective measure of working memory. Lobar volumes were obtained using an automated processing package and adjusted for total intracranial volume.

RESULTS

The patient group reported worse working memory in daily life, and performed worse on Digit Span Backwards, than the comparison group. Within the patient group, poorer working memory in daily life was associated with smaller left and right frontal lobe volumes. Shorter backwards digit span was associated with smaller left frontal and left and right temporal lobe volumes.

CONCLUSIONS

The significant relationship between frontal lobe volumes and subjective working memory in daily life provides some support for the validity of self report measures of cognitive functioning in patients with schizophrenia, and provides further evidence for a contribution of frontal lobe abnormality to executive dysfunction in the illness.

Cognitive functioning and negative symptoms in first episode schizophrenia: different patterns of correlates

Negative symptoms of schizophrenia have been related to disturbances of executive functions, memory, attention and motor functioning. The executive functions dimension comprises a variety of cognitive subprocesses, including speed of processing, flexibility and working memory. We independently analysed the relationship between different cognitive tasks and clinical symptoms (negative, positive and disorganized) in a sample of 126 first-episode patients with schizophrenia spectrum disorders. Negative symptoms were significantly associated with performance on executive-functions and motor coordination tasks. Within the executive functions domain only those tests that required speeded performance showed a significant association with the negative dimension. The widely described relationship between negative symptoms and executive impairments in schizophrenia appears to be mediated by likely dysfunctions in the speed of processing instead of by working memory impairment.

Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders

OBJECTIVE

The aim was to investigate the hypothesis that patients with first episode schizophrenic disorders have a more favorable treatment response than those with multiple episodes.

METHOD

A total of 400 inpatients from an ongoing multi-centre, follow-up program who fulfilled ICD-10 criteria for schizophrenic disorders (F2) were assessed at admission to and discharge from hospital using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

At admission, first episode patients (n = 121) showed higher levels of positive symptoms (PANSS positive subscore) and lower ones of negative symptoms (PANSS negative subscore) than multiple episode patients (n = 279), whereas the global disease severity (PANSS total score) was comparable. Analyses of covariance revealed that treatment response (adjusted symptom levels at discharge) was more favorable in first-episode patients, with respect to both positive and negative symptoms.

CONCLUSION

The results are compatible with the hypothesis that treatment response becomes less favorable during the course of schizophrenic illness. This finding might be associated with progressive neurobiological alterations.

[Subjective experience of a computer-assisted cognitive training by patients with schizophrenia]

Cognitive training is an important aim of treatment for patients with schizophrenia. However, computer-based cognitive training is still not widely used, and there are reservations concerning the use of computers in psychiatric treatment. In a multicentre study, 64 patients with schizophrenia were investigated before and after completing a 5-week course of computer-based cognitive training using the program Cogpack. In addition to self-rating of computer anxiety (CARS) and subjective well-being (SWN), patients underwent semistructured interviews evaluating attitudes towards the training. The training was rated as highly acceptable by patients and experienced as very effective. Patients' expectations of possible training effects were largely met. The training ranked high in patients' judgement compared with other treatments received. Besides improvement in cognitive function (primary effect), patients enjoyed the training and reported increased self-esteem and progress in using computers (secondary effects). Computer anxiety scores at onset of treatment did not exceed normal values. After completion of the training, these scores were significantly reduced and subjective well-being significantly increased.

Anomalies of subjective experience in schizophrenia and psychotic bipolar illness

OBJECTIVE

Contemporary psychopathology, as a result of behaviourally dominated epistemological stance, downplays anomalies of the patient's subjectivity. This neglect has probably deleterious consequences for research in the causes and the boundaries of the schizophrenia spectrum conditions. The purpose of this study is to explore frequency of qualitative, not-yet-psychotic, anomalies of subjective experience in patients with residual schizophrenia and psychotic bipolar illness in remission.

METHOD

The patients were examined with the Danish version of the Bonn Scale for the Assessment of Basic Symptoms (BSABS). Anomalies of experience were condensed into rational scales with good internal consistencies.

RESULTS

Diagnosis of schizophrenia was associated with elevated scores on the scales measuring perplexity (loss of immediate meaning), disorders of perception, disorders of self-awareness, and marginally so, disorders of cognition.

CONCLUSION

These findings, in conjunction with those from other, methodologically similar studies, suggest that certain anomalies of subjective experience aggregate significantly in schizophrenia. These experiential anomalies appear to be relevant for early differential diagnosis and therefore potentially useful in the preonset detection of the schizophrenia spectrum illness.