The Multi-Component Smoking Cessation Support Programme (McSCSP) is effective in patients with severe mental disorder without gender differences. / El programa multicomponente de apoyo para el cese del tabaquismo (McSCSP) es efectivo en pacientes con trastorno mental grave sin diferencias de género.

High prevalence of smoking in people with severe mental disorders (SMD) contributes to their medical morbidity and reduced life expectancy. Despite the evidence of gender differences in smoking cessation, few studies have tested those differences among people with SMD. This is a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to examine gender differences in the efficacy, safety and tolerability of a Multi-Component Smoking Cessation Support Programme (McSCSP). The results showed that there were no significant differences in short- (males 44.9% vs females 57.7%, chi-square = 1.112, p = 0.292) or long-term efficacy (week 24: males 40.8%, females 42.3%, chi-square = 0.016, p = 0.901; week 36: males 36.7%, females 38.5%, chi-square = 0.022, p = 0.883) between gender, neither controlled by diagnosis or treatment. Regarding safety and tolerability, there was significant increase in abdominal perimeter in males [from 105.98 (SD 13.28) to 108.52 (SD 14.01), t = -3.436, p = 0.002)], but not in females. However, there were no significant gender differences in adverse events (constipation, abnormal/vivid dreams, nausea/vomiting or skin rash/redness around patch site). In conclusion, we have demonstrated that is effective and safe to help either male or female patients with stabilized SMD to quit smoking. However, it might be a tendency in females to respond better to varenicline treatment in the short-term. Future research with larger samples is required to more clearly determine whether or not the there are differences, in addition to their reliability and robustness.

La elevada prevalencia del tabaquismo en personas con trastorno mental grave (TMG) contribuye a su morbilidad médica y reduce su esperanza de vida. A pesar de la existencia de diferencias de género en el cese del tabaquismo, pocos estudios han evaluado esas diferencias en personas con TMG. Este es un ensayo multicéntrico de seguimiento prospectivo, no aleatorizado, abierto de 9 meses para examinar las diferencias de género en la eficacia, seguridad y tolerabilidad de un programa multicomponente de apoyo para el cese del tabaquismo (McSCSP). Los resultados mostraron que no hubo diferencias de género significativas en la eficacia a corto (hombres 44,9% vs mujeres 57,7%, chi cuadrado = 1,112, p = ,292) ni a largo plazo (semana 24: hombres 40,8%, mujeres 42,0.3%, chi cuadrado = 0.016, p = ,901; semana 36: hombres 36,7%, mujeres 38,5%, chi cuadrado = 0,022, p = ,883), incluso controlando por diagnóstico o tratamiento.  Con respecto a la seguridad y la tolerabilidad, hubo un aumento significativo en el perímetro abdominal en los hombres [de 105,98 (DT 13,28) a 108,52 (DT 14,01), t = -3,436, p = ,002)], pero no en las mujeres. Sin embargo, no hubo diferencias de género significativas en los eventos adversos (estreñimiento, sueños anormales/vívidos, náuseas/vómitos o erupción cutánea/enrojecimiento alrededor de la zona del parche). En conclusión, hemos demostrado que es efectivo y seguro ayudar a los hombres y mujeres con TMG estabilizados a dejar de fumar.  Sin embargo, podría haber una tendencia en las mujeres a responder mejor al tratamiento con vareniclina a corto plazo. Se requiere investigación futura con muestras más amplias para determinar con más claridad la existencia de diferencias, además de la fiabilidad y robustez.

As We Were and as We Should Be, Combined Exercise Training in Adults with Schizophrenia: CORTEX-SP Study Part I.

INTRODUCTION: Given the health benefits and the role of exercise as an anti-inflammatory adjuvant program, this study aimed to determine the effectiveness of a combined exercise program on cardiorespiratory fitness (CRF), body composition, and biochemical levels in adults with schizophrenia (SZ) characterized at baseline as metabolically unhealthy overweight with low CRF. METHODS: Participants diagnosed with SZ ( n = 112, 41.3 ± 10.4 yr, 28.7% women) were randomly assigned into a treatment-as-usual control group ( n = 53) or a supervised exercise group ( n = 59, 3 d·wk -1 ). Each combined exercise session consisted of both a low-volume high-intensity interval training (<10 min of high-intensity time per session) and a resistance circuit-training program. All variables were assessed before and after the intervention (20 wk). For the assessment of CRF, a peak cardiopulmonary exercise test on a cycle ergometer was used. RESULTS: After the intervention, participants from the exercise group ( n = 51) showed increases in CRF ( P < 0.001) through peak oxygen uptake (L·min -1 ; Δ = 17.6%; mL·kg -1 ·min -1 , Δ = 19.6%) and the metabolic equivalent of task (Δ = 19%), with no significant changes ( P > 0.05) in body composition and biochemical variables. However, the treatment-as-usual group ( n = 38) did not show any significant change in the study variables ( P > 0.05). Between-group significant differences ( P ≤ 0.05) were observed in CRF, first ventilatory threshold, and heart rate peak after the intervention period, favoring the exercise group. CONCLUSIONS: This study demonstrated that a supervised combined exercise program in people with SZ helps to maintain body composition values and improve CRF levels. This could lead to an important clinical change in the characterization from metabolically unhealthy overweight to a metabolically healthy overweight population. Hence, exercise should be considered a co-adjuvant program in the treatment of the SZ population.

The course of the schizophrenia and its impact on cognition: a review of literature.

There has been increasing interest about cognition in schizophrenia during recent years. The greater focus of the investigators has been focused greater interest on the relation of cognitive deterioration with positive and negative symptoms, and functionality. However very few studies, if any, have specifically focused on the course of cognition in schizophrenic patients throughout the years. Those who have attempted to answer this question have done so by comparing cross-sectional studies of patients at different stages of their disease. Only a minority have used a longitudinal methodology in their studies. This article reviews a total of 31 cross-sectional and 43 longitudinal studies published in patients with a diagnosis of schizophrenia. The diversity of criteria and methods used significantly limits the conclusions that can be drawn. After a comprehensive review of the literature on this topic, the authors have come to the conclusion that there are two opposite trends: 1) Cognition in schizophrenia follows a progressive decline over the years of evolution of the disease (a conclusion predominant in studies with cross-sectional methodology) and 2) Cognition in schizophrenia remains stable once it appears during the first stages of the disease (a conclusion predominant in longitudinal studies). The authors conclude that the question about the likely decline of cognition in schizophrenia cannot be answered due to the lack of rigorous and thorough follow-up studies.

An explanatory model of quality of life in schizophrenia: the role of processing speed and negative symptoms.

INTRODUCTION: Improving the quality of life of patients with schizophrenia is a major goal in managing this devastating disorder, but agreement is lacking about the factors that predict quality of life (QoL) over the course of the disorder. METHODS: We examined 165 hospitalized patients with schizophrenia in this study. We included measures for psychiatric (PANSS, insight and affective symptoms) and cognitive symptoms. Confirmatory factor analysis established a cognitive structure composed of the following six factors: attention, processing speed, verbal memory, fluency, working memory and executive functioning. Quality of life was assessed using the Heinrichs-Hanlon-Carpenter Scale. RESULTS: Age, duration of illness, presence of more severe negative symptoms and most cognitive factors correlated significantly with QoL indicators. Regression analysis showed that processing speed (PS) was by far the most important cognitive factor that predicted QoL. Moreover, the interaction between PS and negative symptoms, patient age and executive functions modified the effect of PS on QoL. Finally, positive symptoms and other socio-demographic data were not related to QoL in the current study. CONCLUSIONS: Our findings suggest that PS and negative symptoms predict QoL in schizophrenia.

Cognitive performance and smoking in first-episode psychosis: the self-medication hypothesis.

The self-medication hypothesis attempts to explain the extraordinary high levels of cigarette smoking in schizophrenia; patients may smoke in an attempt to reduce their cognitive deficits, symptoms, or the side effects of antipsychotics. In a previous report, we detected beneficial performance in attention and working memory in patients with first-episode psychosis who smoked compared to non-smoking patients soon after stabilization. In the present study, we examine differences in the course of those deficits 12 months after the initiation of antipsychotic treatment. We also explore the association between smoking and symptoms and side effects of medication. Neuropsychological assessments were performed at baseline, month 6 and month 12 using a computerized battery that included measures of sustained attention (Continuous Performance Test CPT-O), selective attention (Stroop interference task) and working memory (CPT-XO). Patients met the criterion of fitting in the same smoking category throughout the study: non-smoker (n = 15; 0 cigarettes/day) and smoker (n = 26; >15 cigarettes/day). The non-smoking patients showed significant cognitive improvements, whereas smoking patients lost their superior baseline performance, which was probably obtained through nicotinic stimulation, at the 6- and 12-month assessments due to a static course of deficits. Smokers did not obtain any cognitive benefit after instauration of treatment and worsen their symptoms over the first year. These results suggest that smoking may constitute a marker of a more severe illness. Smoking was not associated with fewer extrapyramidal side effects. Smoking might improve attention and working memory to a similarly modest extent as atypical antipsychotics and could reflect an effort to ameliorate these cognitive dysfunctions previous to treatment instauration.

Cross-Validation of Predictive Equation for Cardiorespiratory Fitness by Modified Shuttle Walk Test in Adults with Schizophrenia: A Secondary Analysis of the CORTEX-SP Study.

Cardiorespiratory fitness (CRF) can be direct or estimated from different field tests. The Modified Shuttle Walk Test (MSWT) is suitable for all levels of function, allowing a peak response to be elicited. Therefore, we aimed (1) to validate the equation presented in the original study by Singh et al. for evaluating the relationship between MSWT with peak oxygen uptake (VO2peak) in adults with schizophrenia (SZ), (2) to develop a new equation for the MSWT to predict VO2peak, and (3) to validate the new equation. Participants (N = 144, 41.3 ± 10.2 years old) with SZ performed a direct measurement of VO2peak through a cardiopulmonary exercise test and the MSWT. A new equation incorporating resting heart rate, body mass index, and distance from MSWT (R2 = 0.617; adjusted R2 = 0.60; p < 0.001) performs better than the Singh et al. equation (R2 = 0.57; adjusted R2 = 0.57; p < 0.001) to estimate VO2peak for the studied population. The posteriori cross-validation method confirmed the model's stability (R2 = 0.617 vs. 0.626). The findings of the current study support the validity of the new regression equation incorporating resting heart rate, body mass index, and distance from MSWT to predict VO2peak for assessment of CRF in people with SZ.

Verbal fluency in schizophrenia: does cognitive performance reflect the same underlying mechanisms in patients and healthy controls?

Verbal fluency is impaired in patients with schizophrenia, but the association with other cognitive domains remains unclear. Forty-seven patients with schizophrenia (DSM-IV) and 47 controls matched by age, gender, years of education, and vocabulary (Wechsler Adult Intelligence Scale-III) were assessed in terms of sociodemographic, clinical, and cognitive variables. Healthy controls performed significantly better than patients with schizophrenia in all cognitive measures. However, the way these cognitive domains were related differed across groups. Semantic fluency (SF) and phonological fluency (PF) were predicted by working memory (WM) in patients with schizophrenia, whereas the predictor in the healthy controls was processing speed (PS). Moreover, after dividing the sample of patients according to their performance on fluency tests, we found that a worse performance on SF or PF was predicted by WM. However, for patients with a better performance on fluency, the pattern was similar to that of healthy controls. Cognition may show a different pattern of interaction in schizophrenia, with less impaired patients showing a closer pattern to healthy controls. Therefore, we suggest that, depending on the severity of cognitive deficits, performance on neuropsychological tests may not reflect the same underlying mechanisms.

An outcome prediction model for schizophrenia: A structural equation modelling approach. / Modelo predictivo de la funcionalidad en la esquizofrenia: una aproximación desde el modelado de ecuaciones estructurales.

INTRODUCTION: Although it is well-known that several factors such as symptoms and cognition are related with functional outcome in schizophrenia, the complex nature of the disorder makes necessary to study their interaction by means of a more analytic method than simple linkages approaches. MATERIAL AND METHODS: One hundred and sixty-five patients with schizophrenia underwent a clinical evaluation (including clinical symptoms, insight, affective symptoms and premorbid adjustment). Neurocognition was represented by a 5-factor structure obtained by confirmatory factor analysis from a neurocognitive battery. The estimation for outcome was obtained throughout the DAS-WHO scale, and quality of life with the Quality of Life Scale. RESULTS: Using structural equation modeling (SEM), specifically measured-variable path analysis, a mediational model consisting of neurocognitive capacity linked to clinical symptoms and premorbid functioning showed good fit to the observed data (Satorra-Bentler χ2=604.83; RMSEA=.08; SRMR=.11; NNFI=.96; CFI=.97). Processing speed, verbal memory and premorbid functioning directly predicted outcome. Verbal fluency predicted outcome both directly and indirectly via negative symptoms. Executive functions, insight, affective symptoms, and additional cognitive data did not significantly contribute to the model. CONCLUSIONS: Results suggest that negative symptoms and premorbid functioning directly predict outcome, whereas cognitive factors show more complex interactions with negative symptoms and outcome. These results should be considered for new intervention strategies.

Processing speed mediates the relationship between verbal memory, verbal fluency, and functional outcome in chronic schizophrenia.

Verbal fluency and verbal memory have been reported to be diminished in patients with schizophrenia. These deficits could partially predict functional disability in this pathology. However, processing speed often mediates the relationship among cognitive processes in the disorder. Our goal was to analyse the influence of processing speed as mediator of the relation between verbal fluency-verbal memory and functional disability in chronic schizophrenia. We examined 90 hospitalized patients and 30 healthy controls (matched for gender, age and years of education). The neuropsychological battery included tests for verbal fluency, verbal memory, motor speed and processing speed. Outcome measures included Disability Assessment Schedule (DAS-WHO) and number of hospitalizations (NH). Results confirmed chronicity on clinical symptoms (PANSS total X=48.94+14.97 PANSS negative X=27.81+10.18, PANSS positive X=23.51+10.81) and impairment on functional disability (DAS-WHO X=13.62+4.28). As expected, verbal fluency was severely impaired in patients and significantly predicted functional outcome. Immediate and Delayed Verbal Memory were also severely impaired and predicted functional outcome. However, when processing speed was entered in the regression analyses the significance of verbal fluency and verbal memory decreased significantly. Sobel's equation was significant, suggesting full mediation. Our findings suggest that processing speed may be a central factor in the relation between cognitive symptoms and functional outcome in chronic schizophrenia.

Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial.

This study examined the efficacy of an integrative cognitive remediation program (REHACOP) in improving cognition and functional outcome in patients with schizophrenia. The program combines cognitive remediation, social cognitive intervention, and functional skills training. Few studies have attempted this approach. One hundred and eleven patients diagnosed with schizophrenia were randomly assigned to either the cognitive remediation group (REHACOP) or an active control group (occupational activities) for 4 months (three sessions per week, 90 min). Primary outcomes were change on general neurocognitive performance and social cognition, including theory of mind (ToM), emotion perception (EP), attributional style, and social perception (SP). Secondary outcomes included changes on clinical symptoms (Positive and Negative Syndrome Scale) and functional outcome (UCSD Performance-Based Skills Assessment and the Global Assessment of Functioning). The trial was registered with clinicaltrials.gov (NCT02796417). No baseline group differences were found. Significant differences were found in the mean change between the REHACOP group and control group in neurocognition ([Formula: see text]), SP ([Formula: see text]), ToM ([Formula: see text]), EP ([Formula: see text]), negative symptoms ([Formula: see text]), emotional distress ([Formula: see text]), Global Assessment of Functioning ([Formula: see text]), and UCSD Performance-Based Skills Assessment ([Formula: see text]). The combination of cognitive remediation, social cognitive intervention, and functional skills training demonstrated statistically significant and clinically meaningful changes in neurocognition, social cognition, negative, and functional disability.

It is feasible and effective to help patients with severe mental disorders to quit smoking: An ecological pragmatic clinical trial with transdermal nicotine patches and varenicline.

Despite the proven association between smoking and high rates of medical morbidity and reduced life expectancy in people with severe mental disorders (SMD), their smoking rates do not decline as they do in the general population. We carried out a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to investigate the clinical efficacy, safety and tolerability of a 12-week smoking cessation programme for patients with SMD in the community under real-world clinical conditions. Eighty-two adult outpatients with schizophrenic/bipolar disorder smoking ≥15 cigarettes/day were assigned by shared decision between doctors and patients to transdermal nicotine patches (TNP) [36(46.2%)] or varenicline [39(50%)]. Short-term efficacy: The 12-week 7-day smoking cessation (self-reported cigarettes/day=0 and breath carbon monoxide levels≤9ppm) prevalence was 49.3%, without statistically significant differences between medications (TNP 50.0% vs varenicline 48.6%, chi-square=0.015, p=1.000). Long-term efficacy: At weeks 24 and 36, 41.3 and 37.3% of patients were abstinent, with no statistically significant differences between treatments. Safety and Tolerability: no patients made suicide attempts/required hospitalization. There was no worsening on the psychometric scales. Patients significantly increased weight [TNP 1.1(2.8) vs varenicline 2.5(3.3), p=0.063], without significant changes in vital signs/laboratory results, except significant decreases in alkaline phosphatase and low-density lipoprotein-cholesterol levels in the varenicline group. Patients under varenicline more frequently presented nausea/vomiting (p<0.0005), patients under TNP experienced skin reactions more frequently (p=0.002). Three patients under varenicline had elevated liver enzymes. In conclusion, we have demonstrated that in real-world clinical settings it is feasible and safe to help patients with stabilized severe mental disorders to quit smoking.

Improvements in negative symptoms and functional outcome after a new generation cognitive remediation program: a randomized controlled trial.

Cognitive remediation improves cognition in patients with schizophrenia, but its effect on other relevant factors such as negative symptoms and functional outcome has not been extensively studied. In this hospital-based study, 84 inpatients with chronic schizophrenia were recruited from Alava Hospital (Spain). All of the subjects underwent a baseline and a 3-month assessment that examined neurocognition, clinical symptoms, insight, and functional outcome according to the Global Assessment of Functioning (GAF) scale and Disability Assessment Schedule from World Health Organization (DAS-WHO). In addition to receiving standard treatment, patients were randomly assigned either to receive neuropsychological rehabilitation (REHACOP) or to a control group. REHACOP is an integrative program that taps all basic cognitive functions. The program included experts' latest suggestions about positive feedback and activities of daily living in the patients' environment. The REHACOP group showed significantly greater improvements at 3 months in the areas of neurocognition, negative symptoms, disorganization, and emotional distress compared with the control group (Cohen's effect size for these changes ranged from d = 0.47 for emotional distress to d = 0.58 for disorganization symptoms). The REHACOP group also improved significantly in both the GAF (d = 0.61) and DAS-WHO total scores (d = 0.57). Specifically, the patients showed significant improvement in vocational outcomes (d = 0.47), family contact (d = 0.50), and social competence (d = 0.56). In conclusion, neuropsychological rehabilitation may be useful for the reduction of negative symptoms and functional disability in schizophrenia. These findings support the integration of neuropsychological rehabilitation into standard treatment programs for patients with schizophrenia.

Effectiveness of a multi-component Smoking Cessation Support Programme (McSCSP) for patients with severe mental disorders: study design.

Only a few studies have examined the efficacy and safety of smoking cessation programmes in patients with mental disorders. The aim of this paper is to describe in detail the methodology used in the study as well as the Multi-component Smoking Cessation Support Programme in terms of pharmacological treatments and psychological interventions. An open-label 9-month follow-up study was conducted in Spain. A total of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled. Treatment consisted of a programme specifically developed by the research team for individuals with severe mental disorders. The programme consisted of two phases: (1) weekly individual motivational therapy for 4-12 weeks, and (2) a 12-week active treatment phase. During this phase, at each study visit patients received a one- or two-week supply of medication (transdermal nicotine patches, varenicline or bupropion) with instructions on how to take it, in addition to group psychotherapy for smoking cessation. Evaluations were performed: (1) at the time of enrollment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders.

[REHACOP: a cognitive rehabilitation programme in psychosis]. / REHACOP: programa de rehabilitacion cognitiva en psicosis.

INTRODUCTION: In this work we present REHACOP, a programme of cognitive rehabilitation in psychosis. MATERIALS AND METHODS: The foundation of the REHACOP programme (its structure, materials, aims, work methodology and means of implementation) are described in detail. RESULTS AND CONCLUSIONS: This new therapeutic tool is presented with the aim of being of use to guide professionals who seek to design an intervention of this kind in samples of patients with schizophrenia or other pathologies.

[Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme]. / Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP.

INTRODUCTION: Neuropsychological rehabilitation in schizophrenia is a recent development and few studies have been conducted to determine its effectiveness in samples of a Spanish population. Specific therapeutic programmes have recently been designed, like REHACOP, which is a programme of cognitive rehabilitation in psychosis. This study aims to test the effectiveness of REHACOP in samples of patients with schizophrenia in a Spanish population in different phases of the disease. PATIENTS AND METHODS: Seventy-six patients were recruited and randomly assigned to either an experimental REHACOP group or a control group. The REHACOP group took part in three structured sessions held weekly for a period of three months, while the control group attended occupational therapy sessions with the same frequency and intensity. Both groups received standard additional treatment according to their course and progress. All the patients were evaluated before and after the intervention on attention, language, learning and memory, processing speed and executive functions. RESULTS: The REHACOP group offered significant improvements, with respect to the control group, in all the cognitive functions that were explored including attention, visuomotor integration, learning and memory or executive functions. Likewise, the REHACOP group showed a significant clinical and emotional improvement compared to the control group, as well as additional gains in their capacity for insight into the disease. CONCLUSIONS: The data from this study suggest that REHACOP can be an effective programme of intervention for bringing about improvements in the neuropsychological deterioration of patients with schizophrenia, regardless of the degree of impairment and the stage of progress of the disease.

[Attention deficits and response to drug therapy in patients with treatment-resistant schizophrenia: results through confirmatory factor analysis]. / Déficit atencionales y respuesta al tratamiento farmacológico en pacientes con esquizofrenia resistente al tratamiento: Resultados mediante análisis factorial confirmatorio.

INTRODUCTION: There are no experimental data that demonstrate whether patients with neuroleptic-resistant schizophrenia differ or not in their pattern of neuropsychological functioning from patients with adequate drug response. METHOD: Fifty-two patients with drug-resistant psychosis (DRP) and 42 patients with schizophrenia not resistant to treatment (NDRP) were recruited following the criteria of Kane et al (1988). A sample of 45 healthy controls matched by age, sex and educational level was also recruited. The clinical evaluations used were the Positive and Negative Symptom Scale (PANSS), functional disability (WHO-DAS) and the Clinical Global Impression (CGI) scale. RESULTS: Through the use of confirmatory factor analysis, we obtained a latent cognitive structure of six cognitive factors: attention, processing speed, verbal memory, working memory, verbal fluency and executive functions. As expected, the control group performed better than the two patient groups (both DRP and NDRP) in all neuropsychological domains. Additionally, the DRP group scored significantly worse in attention than the NDRP group even though no differences between these two groups were found in age of disease onset, number of hospitalizations or length of hospitalization. From a clinical point of view, the DRP group showed greater severity of positive symptoms (p<0.01) and higher global deterioration (p<0.01), which did not translate into greater functional disability. CONCLUSIONS: The results obtained do not allow us to conclude that there is a specific neuropsychological profile in neuroleptic-resistant patients. The only differential parameter was performance in the attentional domain. Our findings better fit the hypothesis of a «clinical continuum¼ and differ from the categoric classification of this mental disorder.

Predictors of longitudinal changes in schizophrenia: the role of processing speed.

BACKGROUND: The main objective was to identify variables that predict functional disability in chronic schizophrenia over time. METHOD: We examined 95 hospitalized patients with schizophrenia (DSM-IV criteria) in a long-stage unit and 53 healthy controls (matched for age, gender, and years of education). Neuropsychological battery included tests for verbal memory, working memory, executive functioning, and processing speed. Functional disability was assessed at 6-month follow-up with the Disability Assessment Schedule after the neuropsychological and clinical assessment. The study was conducted from September 2005 to July 2008. RESULTS: Patient performance was significantly lower than that of the healthy comparison subjects on all neurocognitive variables (p < .001). Most, but not all, neurocognitive measures were significantly correlated with the patients' functional disability shown 6 months after admission to the study, including self-care management, vocational outcome, family contact, and social functioning. Results suggest that processing speed has a significant influence in these relationships. CONCLUSIONS: Processing speed plays an outstanding role in the relationship between neurocognitive symptoms and self-care, vocational outcome, and social functioning. Our data support the possibility of processing speed as the best longitudinal predictor of the level of autonomy in patients with chronic schizophrenia.

Course of cognitive functioning in first-episode psychosis: a comparison between schizophrenia and non schizophrenia psychosis.

AIMS: To describe the course of cognitive functioning in first-episode psychosis and to determine possible differences in the degree and trajectory of cognitive deficits between schizophrenia and non-schizophrenia first-episode psychosis. METHOD: We assessed attention, working memory, and executive functioning in 57 patients with first-episode psychosis both at baseline and at 1-year of follow-up. RESULTS: For the overall group, significant reductions were found in the percentage of omission and commission errors for the sustained attention task (p<0.001 and p=0.001, respectively), in the total time to complete the Stroop-I task (p<0.001), in the percentage of omission errors for the working memory task (p=0.001), and in the percentage of perseverative errors for the Wisconsin card sorting test (WCST; p<0.001), as well as a significant increase in the number of categories completed in the WCST (p<0.001). The remaining cognitive variables analyzed remained stable (4 of the 10 variables tested). The pattern of change was similar for patients with schizophrenia (n=20) and non-schizophrenia (n=37) in the areas of attention and working memory. For executive functioning, the non-schizophrenia group showed a more beneficial pattern of change. No significant differences were detected in cognitive performance among subgroups at baseline or at the 1-year follow-up. CONCLUSION: The course of cognitive deficits in first-episode psychosis showed significant improvements over the 1-year period in the areas of attention, working memory and executive functioning. Neuropsychological performance did not seem to be specific enough to distinguish between patients with schizophrenia and non-schizophrenia first-episode psychosis, at least during the first year.