Developing an international scoring system for a consensus-based social cognition measure: MSCEIT-managing emotions.

BACKGROUND: Measures of social cognition are increasingly being applied to psychopathology, including studies of schizophrenia and other psychotic disorders. Tests of social cognition present unique challenges for international adaptations. The Mayer-Salovey-Caruso Emotional Intelligence Test, Managing Emotions Branch (MSCEIT-ME) is a commonly-used social cognition test that involves the evaluation of social scenarios presented in vignettes. METHOD: This paper presents evaluations of translations of this test in six different languages based on representative samples from the relevant countries. The goal was to identify items from the MSCEIT-ME that show different response patterns across countries using indices of discrepancy and content validity criteria. An international version of the MSCEIT-ME scoring was developed that excludes items that showed undesirable properties across countries. RESULTS: We then confirmed that this new version had better performance (i.e. less discrepancy across regions) in international samples than the version based on the original norms. Additionally, it provides scores that are comparable to ratings based on local norms. CONCLUSIONS: This paper shows that it is possible to adapt complex social cognitive tasks so they can provide valid data across different cultural contexts.

Latent structure of cognition in schizophrenia: a confirmatory factor analysis of the MATRICS Consensus Cognitive Battery (MCCB).

BACKGROUND: The number of separable cognitive dimensions in schizophrenia has been debated. Guided by the extant factor analytic literature, the NIMH Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative selected seven cognitive domains relevant to treatment studies in schizophrenia: speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. These domains are assessed in the MATRICS Consensus Cognitive Battery (MCCB). The aim of this study was to conduct a confirmatory factor analysis (CFA) of the beta battery of the MCCB to compare the fit of the MATRICS consensus seven-domain model to other models in the current literature on cognition in schizophrenia. METHOD: Using data from 281 schizophrenia outpatients, we compared the seven correlated factors model with alternative models. Specifically, we compared the 7-factor model to (a) a single-factor model, (b) a three correlated factors model including speed of processing, working memory, and general cognition, and (c) a hierarchical model in which seven first-order factors loaded onto a second-order general cognitive factor. RESULTS: Multiple fit indices indicated the seven correlated factors model was the best fit for the data and provided significant improvement in model fit beyond the comparison models. CONCLUSIONS: These results support the assessment of these seven cognitive dimensions in clinical trials of interventions to improve cognition in schizophrenia. Because these cognitive factors are separable to some degree, it is plausible that specific interventions may have differential effects on the domains.

MCCB cognitive profile in Spanish first episode schizophrenia patients.

The objective of the study was to examine the cognitive profile of Spanish patients with a first episode of schizophrenia (FESz) and to compare that to the profile of patients with a chronic schizophrenia (CSz) and non-psychiatric (NP) control subjects. The study included 106 FESz, 293 CSz, and 210 NP, assessed with the Spanish version of the MATRICS Consensus Cognitive Battery (MCCB). The MCCB cognitive profile in a Spanish sample of FESz was similar to the cognitive profile of CSz with some discrepancies in select domains. The scores of both patient samples were about 1-2 SD below the scores of non-psychiatric control subjects.

The MCCB impairment profile in a Spanish sample of patients with schizophrenia: Effects of diagnosis, age, and gender on cognitive functioning.

The MATRICS Consensus Cognitive Battery (MCCB) was administered to 293 schizophrenia outpatients and 210 community residents in Spain. Our first objective was to identify the age- and gender-corrected MCCB cognitive profile of patients with schizophrenia. The profile of schizophrenia patients showed deficits when compared to controls across the seven MCCB domains. Reasoning and Problem Solving and Social Cognition were the least impaired, while Visual Learning and Verbal Learning showed the greatest deficits. Our second objective was to study the effects on cognitive functioning of age and gender, in addition to diagnosis. Diagnosis was found to have the greatest effect on cognition (Cohen's d>0.8 for all MCCB domains); age and gender also had effects on cognitive functioning, although to a lesser degree (with age usually having slightly larger effects than gender). The effects of age were apparent in all domains (with better performance in younger subjects), except for Social Cognition. Gender had effects on Attention/Vigilance, Working Memory, Reasoning and Problem Solving (better performance in males), and Social Cognition (better performance in females). No interaction effects were found between diagnosis and age, or between diagnosis and gender. This lack of interactions suggests that age and gender effects are not different in patients and controls.

Patterns of manual dominance in patients with neuroleptic-induced movement disorders.

To explore the association between patterns of manual dominance and extrapyramidal symptoms we examined 32 chronic schizophrenic inpatients at Camarillo State Hospital for signs of tardive dyskinesia (TD) and neuroleptic-induced parkinsonism (NIP) using clinical rating scales (Abnormal Involuntary Movement Scale and Columbia Unified Parkinsons Disease Rating Scale) and specialized electromechanical instruments. Manual dominance was assessed using an eight-item hand preference demonstration test. Patients were divided into dextral (consistent use of right hand) and nondextral (any use of the left hand) groups. Dextrals showed a higher prevalence of TD than nondextrals on clinical rating measures (p less than 0.01). Orofacial ultrasound measures of TD revealed a similar association between TD and handedness. The two handedness groups did not differ on either the clinical or electromechanical measures of NIP. Interestingly, 28 of the 32 patients showed greater left than right facial movement. It is hypothesized that patients with more standard patterns of manual dominance may be at higher risk for TD than those with atypical patterns.

Risperidone vs. haloperidol on reaction time, manual dexterity, and motor learning in treatment-resistant schizophrenia patients.

BACKGROUND: The present study compared the effects of risperidone vs. haloperidol on reaction time, manual dexterity, and two types of motor learning in a sample of treatment-resistant schizophrenia patients. METHODS: Fifty-six DSM-III-R diagnosed schizophrenia inpatients participated in a randomized, double-blind comparison of risperidone vs. haloperidol. Measures of reaction time, manual dexterity, motor sequence learning, and gross motor learning were administered at baseline, after 4 weeks of fixed-dose medication, and after 4 weeks of flexible-dose medication. RESULTS: The results indicated that patients receiving risperidone showed greater improvement in reaction time and manual dexterity than patients receiving haloperidol. After covarying symptom changes and movement disorder ratings, the results remained significant. The two treatment groups did not differ on either measure of motor learning. CONCLUSIONS: The differences in performance in reaction time and manual dexterity may be due to a specific beneficial effect of risperidone, as opposed to a general reduction in extrapyramidal symptom liability, compared to haloperidol.

Does risperidone improve verbal working memory in treatment-resistant schizophrenia?

OBJECTIVE: Treatment efficacy in schizophrenia is typically defined in terms of symptom reduction. However, new antipsychotic medications could potentially have an impact on aspects of disability, such as neurocognitive deficits. The authors evaluated the effects of risperidone on verbal working memory, a memory component of theoretical interest because of its link to prefrontal activity and of practical interest because of its link to psychosocial rehabilitation. METHOD: Verbal working memory of 59 treatment-resistant schizophrenic patients was assessed as part of a randomized, double-blind comparison of treatment with risperidone and haloperidol. Verbal working memory was measured under both distracting and nondistracting conditions at baseline and after 4 weeks of both fixed- and flexible-dose pharmacotherapy. RESULTS: Risperidone treatment had a greater beneficial effect on verbal working memory than haloperidol treatment across testing conditions (with and without distraction) and study phases (fixed and flexible dose). The treatment effect remained significant after the effects of benztropine cotreatment, change in psychotic symptoms, and change in negative symptoms were controlled. Neither benztropine status nor symptom changes were significantly related to memory performance. CONCLUSIONS: Treatment with risperidone appears to exert a more favorable effect on verbal working memory than treatment with a conventional neuroleptic. The beneficial effect appears to be due, at least partially, to a direct effect of the drug, possibly through antagonism of the 5-HT2A receptor. Results from this study suggest that pharmacotherapeutic efficacy in schizophrenia treatment could be broadened to include impact on neurocognitive abilities.

Risperidone versus haloperidol for perception of emotion in treatment-resistant schizophrenia: preliminary findings.

Currently, little is known about the pharmacological effects of the new generation of antipsychotic medications on perception of emotion in schizophrenia. The present study was designed to compare the effects of risperidone versus haloperidol on the ability to perceive emotion in 20 treatment-resistant schizophrenia patients, using a double-blind design. Measures of emotion perception included a facial emotion identification test (still photographs presented on videotape), a voice emotion identification test (audiotape), and an affect perception test (brief interpersonal vignettes presented on videotape). These measures were administered during the final week of baseline and after 8 weeks of double-blind medication. Risperidone treatment produced a greater effect on patients' ability to perceive emotion compared with haloperidol treatment. Additionally, all patients who received risperidone demonstrated improvement in performance between baseline and retest, compared with four of the nine patients who received haloperidol. When changes in positive symptoms were statistically controlled, the results remained significant. These findings suggest that resperidone may facilitate patients' ability to accurately perceive emotion, an effect which may be mediated either directly by risperidone's pharmacological action or perhaps indirectly by its influence on basic neurocognition.

Monetary reinforcement and Wisconsin Card Sorting performance in schizophrenia: why show me the money?

The Wisconsin Card Sorting Test (WCST) is a measure of concept formation and cognitive flexibility that has been associated with the integrity of the dorsolateral prefrontal cortex. Although patients show deficits on the WCST, training techniques that rely on enhanced instruction are often effective at improving performance, at least temporarily. The beneficial effects of monetary reinforcement alone, however, have not shown such clear-cut effects. Thirty-two schizophrenic inpatients were initially administered a computerized version of the WCST according to standard instructions and then assigned to one of four groups that differed by type of intervention. The level of reinforcement (high vs. low) and enhanced instruction (present vs. absent) were manipulated across the four groups. All patients received a repeat standard administration of the WCST at a 1-week follow-up. Although enhanced instruction showed an initial effect, performance gains fell off at the 1-week retest and approached baseline levels of performance. The level of reinforcement did not make a significant difference. The results indicate that the addition of enhanced verbal instruction yields a benefit, but that contingent monetary reinforcement does not. It appears that deficits on this test are not easily remediated by incentive manipulations.

A training procedure for remediating WCST deficits in chronic psychotic patients: an adaptation of errorless learning principles.

Although a number of studies have demonstrated that psychiatric patients' performance deficits on the Wisconsin Card Sorting Test (WCST) can be modified through intervention, relatively little evidence exists to support the long-term durability of training effects. The present study tested the effectiveness and durability of a training procedure based on errorless learning principles, and in addition sought to determine the effect of previously committed errors on training and post-training performance. Twenty-three chronic psychotic inpatients were randomly assigned to an Initial Error (n = 11) or No Initial Error (n = 12) group. The Initial Error group received two standard administrations of the WCST prior to training (where they were expected to commit many errors); the No Initial Error group had no prior exposure to the WCST. All subjects received training on the WCST which was followed by immediate, 1-, 2-, and 4-week post-tests. Results supported the effectiveness of training and the durability of effects, but previous error history showed no clear relationship to post-training performance.

Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"?

There has been a surge of interest in the functional consequences of neurocognitive deficits in schizophrenia. The published literature in this area has doubled in the last few years. In this paper, we will attempt to confirm the conclusions from a previous review that certain neurocognitive domains (secondary verbal memory, immediate memory, executive functioning as measured by card sorting, and vigilance) are associated with functional outcome. In addition to surveying the number of replicated findings and tallying box scores of results, we will approach the review of the studies in a more thorough and empirical manner by applying a meta-analysis. Lastly, we will discuss what we see as a key limitation of this literature, specifically, the relatively narrow selection of predictor measures. This limitation has constrained identification of mediating variables that may explain the mechanisms for these relationships.

Risperidone versus haloperidol on secondary memory: can newer medications aid learning?

The introduction of the new generation of antipsychotic medications for the treatment of schizophrenia has been accompanied by a growing interest in the neurocognitive effects of these drugs. The present study compared the effects of risperidone and haloperidol on secondary memory in a group of treatment-resistant schizophrenia patients. The study design included a baseline phase and two double-blind phases in which patients were randomly assigned to medication under two different dose conditions (fixed dose and flexible dose). Secondary memory was assessed at baseline, fixed-dose, and flexible-dose phases, using the California Verbal Learning Test (CVLT). Six measures were selected, which formed three factors (general verbal learning ability, retention, and learning strategy). Risperidone-treated patients showed greater improvement than haloperidol-treated patients in general verbal learning ability, a finding characterized by significant treatment effects on CVLT measures of learning acquisition, recall consistency, and recognition memory. After controlling for benztropine status, differences on the measures of learning acquisition and recall consistency remained significant, and differences in recognition memory weakened slightly (p = 0.07). No significant treatment effects were noted on retention or learning strategy. These findings suggest that risperidone may exert a facilitating effect on the acquisition of new verbal information, an effect that does not appear to be due to the activation of semantic encoding strategies.

Modification of performance on the span of apprehension, a putative marker of vulnerability to schizophrenia.

The present study examined the effectiveness of 2 types of intervention (contingent monetary reinforcement and enhanced instruction) on span of apprehension performance. Forty chronic schizophrenia inpatients (26 men, 14 women) received a 3- and 12-letter array version of the span of apprehension task 4 times: baseline, intervention, immediate posttest, and 1-week follow-up. All patients were randomly assigned to 1 of 4 groups that differed according to method of intervention: repeat administration, monetary reinforcement only, instruction only, and monetary reinforcement plus instruction. The combination of monetary reinforcement plus instruction yielded significantly greater improvement in span accuracy than the other methods of intervention. These findings suggest that performance on this putative vulnerability indicator can be modified through certain interventions.

Neuropsychological predictors of skills training for chronic psychiatric patients.

Measures of neuropsychological functioning were examined for their relationship to skills training ability. In a longitudinal design, 16 psychotic inpatients were followed during their involvement in a skills training program. The two training programs (Symptom Management and Medication Management) included daily 2-hour sessions over an 8-month period. Five clinical neuropsychological measures and three laboratory-based information processing measures were administered at baseline. The outcome variables included two measures of skill knowledge/ability and a measure of on-task behavior. Modest correlations were found between outcome measures and three types of predictors: serial verbal learning, susceptibility to distraction, and vigilance. These findings suggest that selected measures of neuropsychological functioning may help to target those cognitive abilities necessary for skill acquisition, and may aid in selecting patients most likely to benefit from skills training.

Perception of emotion and neurocognitive functioning in schizophrenia: what's the link?

In schizophrenia, relatively little is known about the association between deficits in emotion perception and basic neurocognitive functioning. The present study examined perception of emotion and a discrete set of neurocognitive functions in 28 treatment-resistant schizophrenic patients. Measures of emotion perception included a facial emotion identification test (still photographs presented on videotape), a voice emotion identification test (audiotape), and an affect perception test (brief interpersonal vignettes presented on videotape). Measures of neurocognitive functioning were selected based on hypothesized relationships to perception of emotion. These measures included: (a) Span of Apprehension task, a measure of early visual processing, visual scanning, and iconic read-out; (b) Degraded-Stimulus Continuous Performance Test, a measure of visual vigilance; and (c) Digit Span Distractibility Test, a measure of immediate or working memory. Among these measures, performance on the Span of Apprehension strongly correlated with performance on all three emotion perception tasks. The associations between perception of emotion and the other two measures were in the same direction, but were significantly smaller than those of the Span of Apprehension. These findings implicate the importance of early perceptual processing (i.e. visual scanning) in the ability of schizophrenic individuals to perceive emotion.

Neurocognitive impairments associated with ambiguous handedness in the chronically mentally ill.

One form of atypical handedness, ambiguous handedness, is found in roughly one-quarter of chronic schizophrenic patients. Despite its prevalence, relatively little is known about the neurocognitive underpinnings of ambiguous handedness. In the present study we examined the performance of ambiguous (n = 19) and non-ambiguous (n = 39) handed chronically mentally ill inpatients on selected measures of verbal learning, motor learning and manual dexterity. The results revealed that ambiguous handers were more impaired than non-ambiguous handers in verbal learning, but not motor learning. Group differences in manual dexterity were significant for the entire sample, but not when analyses were limited to males. These findings suggest that impairments in verbal learning may be linked to the pathogenesis of ambiguous handedness in chronic psychiatric patients.

Cognitive functioning in first-episode schizophrenia: MATRICS Consensus Cognitive Battery (MCCB) Profile of Impairment.

BACKGROUND: Although many studies have assessed cognitive functioning in first-episode schizophrenia (FESz), the pattern and severity of impairment across cognitive domains remain unclear. Moreover, few studies have directly compared the pattern of cognitive performance between FESz and chronic schizophrenia (CSz). In this study we examined the cognitive impairment profile in FESz using a standardized neurocognitive battery (MATRICS Consensus Cognitive Battery; MCCB). METHODS: MCCB data were compared from 105 FESz patients, 176 CSz patients and 300 non-psychiatric (NP) participants. Mixed model analysis evaluated group differences in MCCB profiles and relative strengths and weaknesses in the MCCB profiles of patients. Clinical implications of MCCB performance were also examined; we compared the proportion of participants from each group who exhibited clinically-significant global cognitive impairment based on the MCCB Overall Composite score. RESULTS: FESz and CSz showed impaired performance across all MCCB domains relative to NP. With the exception of relative preservation of working memory and social cognition in FESz, the MCCB domain scores were similar in FESz and CSz. The distribution of impairment on the Overall Composite score did not significantly differ between FESz and CSz; compared to NP, both patient groups were overrepresented in moderate and severe impairment categories. CONCLUSION: The pattern, magnitude, and distribution of severity of impairment in FESz were similar to that observed in CSz. However, early in the illness, there may be relative sparing of working memory and social cognition.

The MATRICS consensus cognitive battery (MCCB): co-norming and standardization in Spain.

The MATRICS Consensus Cognitive Battery (MCCB), developed by the National Institute of Mental Health (NIMH) Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative, has been recommended as the standard battery for clinical trials of cognition-enhancing interventions for schizophrenia. Normative data for the MCCB has been previously obtained in the U.S. Extrapolation of these normative data to different countries may be problematic due to the translation of the different tests, as well as potential cultural influences. We present the process of obtaining normative data for the MCCB in Spain with administration of the battery to a general community standardization sample. In addition, we examine the influence of age, gender, and educational level on test performance. The MCCB was administered to a total sample of 210 healthy volunteers, at three Spanish sites. For each site, recruitment of the sample was stratified according to age, gender, and educational level. Our findings indicate significant age, gender, and education effects on the normative data for the MCCB in Spain, which are comparable to those effects described for the original standardized English version in the U.S. The fact that the normative data are comparable, and that the variables age, gender, and education have a similar influence on performance, supports the robustness of the MCCB for use in different countries.