Inferential-reasoning impairment in schizophrenia-spectrum disorders.

The performance of 15 participants with schizophrenia-spectrum disorders (SCZ) on an inferential-reasoning task was compared with that of 15 healthy-control participants (HC). The SCZ group showed poorer inferential reasoning than HCs, independent of their negative or positive symptoms. These findings are consistent with previous research showing deficits of reasoning in schizophrenia, and indicate that this deficit is independent of severity of delusions.

Brain injury after carotid revascularization: outcomes, mechanisms, and opportunities for improvement.

BACKGROUND: The most worrisome complication of carotid revascularization is neurologic injury, typically manifesting as a perioperative stroke. However, patients undergoing these procedures are at risk for a broad spectrum of neurologic injury. We sought to perform a systematic review of neurologic injury after carotid revascularization to guide future quality improvement efforts focused on reducing potentially preventable events. METHODS: Using a specified search strategy, we evaluated the mechanisms of neurologic injury, the measurement of neurobehavioral outcomes, and use of neuroimaging to evaluate carotid revascularization outcomes, and the application of these techniques in current registries and clinical trials of carotid revascularization. RESULTS: We found that neurologic injury after carotid revascularization results from three broad etiologies: atheroembolic, thrombotic, and hypo/hyperperfusion. Broad variation exists across studies examining neurobehavioral outcomes. Of the 47 studies examining the effect of carotid endarterectomy on neurobehavioral functioning, 25 found that some aspect of cognition improved, 12 revealed no change in cognition, and 10 revealed declines in some aspect of cognition. There is a wide variation in the measurement of neurologic outcomes in clinical registries and trials. In reviewing 13 industry-sponsored registries of carotid artery stenting and 10 randomized trials of carotid endarterectomy and carotid artery stenting, registries were less likely to use validated neurologic assessment scales, independent neurologic examinations, and neuroimaging to establish outcomes than randomized trials. CONCLUSIONS: Despite a considerable body of evidence, there is a lack of consensus in determining optimal strategies for the assessment and characterization of neurologic injury and its effect on neurobehavioral outcomes after carotid revascularization, especially among industry-sponsored trials. As a result, rates of neurologic outcomes varied considerably across studies, registries, and clinical trials. Future efforts to correlate neuroimaging with cognitive outcomes may offer insight into methods to decrease neurologic injury after carotid revascularization.

Nonclinical obsessive-compulsive symptoms and executive functions in schizophrenia.

The impact of nonclinical obsessive-compulsive symptoms (OCS) on neuropsychological functioning in schizophrenia has received little investigation. The authors evaluated whether severity and subtype of OCS are associated with executive functioning in schizophrenia. Twenty-nine patients with schizophrenia and 32 healthy comparison subjects completed questionnaire and performance-based measures of executive functioning. Overall OCS severity in patients was associated with poorer monitoring and cognitive flexibility. Obsessing, hoarding, and checking were related to poorer executive functioning in daily life. Performance-based scores showed few correlations with OCS. Findings indicate that severity of nonclinical OCS subtypes contributes to the heterogeneity of executive functions in schizophrenia.