Neurocognitive functioning in patients with first-episode schizophrenia: results of a prospective 15-year follow-up study.

To evaluate the course of neuropsychological impairment, patients with first-episode schizophrenia and healthy controls were assessed with a comprehensive test battery at the time of index treatment and after a 5- and 15-year follow-up period. Summary scores for verbal intelligence (VBI), spatial organization, verbal fluency, verbal learning, semantic memory, visual memory, delay/retention rate, short-term memory, visual-motor processing and attention (VSM) and abstraction/flexibility were constructed. Our results show that neurocognitive functioning is impaired already at the onset of schizophrenia and remains stable over the 15-year follow-up period with an improvement in VBI. With regard to the presence of a deficit syndrome, it became apparent that the group with a deficit syndrome showed a deterioration of neurocognitive functions during the follow-up period, most pronounced in VSM. On the other hand, the group without a deficit syndrome showed an improvement in neurocognitive functions at the 15-year follow-up, which exceeded the learning effects of healthy control subjects. Neurocognitive performance at index assessment strongly predicted the performance at the 15-year follow-up. Most likely due to the small sample size, there were only weak associations between treatment with different types of neuroleptics and neurocognitive performance.

[Neuropsychological deficits in the initial acute episode of schizophrenia. A comparison with chronic schizophrenic patients]. / Neuropsychologische Defizite bei ersterkrankten schizophrenen Patienten. Vergleich zu chronisch schizophrenen Patienten.

By administering an extensive battery of neuropsychological tests, cognitive performance of 66 patients with first episode schizophrenia, 49 patients with chronic schizophrenia and 40 healthy controls has been assessed in the areas of memory functions, speech and cognitive flexibility/abstraction. The three groups were comparable with regard to age, gender and education. Both patient groups showed a significant generalized neuropsychological impairment relative to controls. Patients with first episode were most impaired in visual motor processing and attention (VSM). Besides impairment in VSM, performance in abstraction/flexibility was significantly worse in chronic schizophrenics compared to first episode schizophrenics. Our findings suggest that neuropsychological functions are already impaired at the onset of the illness. Whether cognitive impairment in performance that is attributed to frontal dysfunctions is deteriorating during the course of the illness or is predicting an unfavourable course can only be answered by prospective follow-up studies.

Neuropsychological impairment and psychopathology in first-episode schizophrenic patients related to the early course of illness.

The objective of the present study was to explore whether the early course of illness including first onset of psychotic symptoms influences neuropsychological functioning and psychopathology in first-episode schizophrenics. Patients with a short prodromal period (n = 20) and patients with a long prodromal period (n = 20) and controls matched with regard to age, gender and education (n = 40) were administered a battery of standardized neuropsychological tests and psychopathological rating scales. The results indicate an overall difference in neuropsychological performance with the schizophrenic patients scoring lower than controls. Schizophrenic patients scored significantly lower in all subtests except in visual memory and abstraction/flexibility than controls. No significant difference between neuropsychological performance between patient samples was found. Psychopathology was more pronounced in the long prodromal period group rating higher on negative and affective symptoms compared with the short prodromal period group. The data suggests that neuropsychological deficits in first-episode schizophrenia are independent of the early course of schizophrenia, and although negative symptoms are associated with the length of the prodromal period, they do not imply greater neuropsychological impairment.

Are there gender differences in neuropsychological performance in patients with first-episode schizophrenia?

To investigate gender differences in neuropsychological (NP) functioning in first episode (FE) schizophrenia, consecutively recruited patients with FE schizophrenia (37 males, 29 females) and a subsample of these patients (20 males, 20 females), individually matched for gender, age, and education to healthy controls (20 males, 20 females) were compared on a battery of standardized neuropsychological tests. Women performed better than men in tests of verbal memory and learning, and men performed better than women in spatial organization. However, no differences were present between schizophrenic patients and controls, except that male and female schizophrenic patients showed the most pronounced impairment in visual motor processing, attention and verbal memory and learning. Our data suggest that gender does not appear markedly to modify the cognitive impairment characteristic of schizophrenia. However, they underline the necessity of controlling confounding factors on NP performance such as gender and education.

Contrasts in neuropsychological test profile between patients with first-episode schizophrenia and first-episode affective disorders.

Patients with first-episode (FE) schizophrenia (n = 27), unipolar depression (n = 10) and bipolar disorder (n = 17) and age- and gender-matched healthy control subjects (n = 27) were administered a battery of neuropsychological (NP) tests. FE schizophrenics performed significantly less well than patients with affective disorders in the area of visual motor processing and attention. Affective disorder patients without psychotic features did not perform significantly differently to controls. However, affective disorder patients with psychotic features performed as poorly as schizophrenics, with the most pronounced impairment in the area of visual motor processing and attention. Our data tentatively suggest the existence of a dichotomy in neuropsychological impairment, with psychotic patients showing similar neuropsychological deficits, while non-psychotic affective patients perform comparably to controls.

Neurological soft signs in schizophrenia: assessment and correlates.

A German version of the Neurological Evaluation Scale (NES) was administered to 143 schizophrenic patients, 45 of them being severly chronic and disabled. Seventy-eight alcohol-dependent inpatients and 57 healthy volunteers were tested as control groups. Neurological soft signs (NSS) were rated with convincing agreement. Schizophrenic patients are more impaired on all scales than healthy controls. The chronic, severly disabled schizophrenic patients are more impaired compared with the main group of schizophrenic patients and both control groups. A significant difference between the main group of schizophrenic patients and alcohol-dependent patients was only found for the subscale "Motor Coordination". Compared with healthy controls the alcohol-dependent patients show a higher NES total score. The NES total score was related to the relative width of the third ventricle. Total score and subscales were correlated consistently with the level of cognitive functioning as measured by the Raven Standard Progressive Matrices and various neuropsychological tests presumably sensitive to dysfunctions of the prefrontal cortex. The NSS were related to positive as well as to negative symptoms, the correlations with negative symptoms being confined to items of "Cognitive Disorganization". This close association of psychomotor and cognitive dysfunctions may be seen as related to the frequently discussed dysfunctions of the prefrontal cortex or the neurointegrative deficit postulated by Meehl.

Neuropsychological impairment in first-episode and chronic schizophrenic patients.

Patients with first-episode (FE) schizophrenia (n = 40), with chronic schizophrenia (n = 40) and healthy controls (n = 40) matched for age, gender, education and parental socioeconomic status were administered a battery of standardized neuropsychological (NP) tests. Both patient groups showed generalized impairment relative to controls and the most pronounced deficits in visual-motor processing and attention (VSM). Compared with FE patients, chronic schizophrenics performed worse in VSM and abstraction/flexibility. Our findings suggest that NP deficits are fundamental manifestations of the illness, and that mainly frontally based dysfunctions are more prominent in chronic, kraepelinian patients.

Electrodermal and vascular orienting response in schizophrenic patients: relationship to symptoms and medication.

Peripheral indicators of autonomic nervous system activity, including electrodermal activity and finger-pulse volume, were investigated in 100 schizophrenic inpatients. Healthy siblings of the patients and healthy subjects matched for age and gender served as control groups. Acoustic stimuli (70 dB) were presented and orienting response (OR) parameters were determined independently for the two response systems. The relationship of both OR measures to negative symptoms and medication was studied. The two OR measures were found to be not interrelated, i.e. most of the subjects were discordant with regard to presence or absence of their OR in the two different response systems. The electrodermal, but not the vascular OR, differed between patients and control groups. Among patients receiving medication with anticholinergic effects there were significantly more electrodermal nonresponders than among patients without such medication. There was no indication that electrodermal nonresponders show more negative symptoms or generally more severe psychopathology than electrodermal responders.

[Drug management and therapy resistance. A cross-sectional study of schizophrenic patients in a large psychiatric hospital]. / Medikamentöses Management und Therapieresistenz. Eine Querschnittsuntersuchung schizophrener Patienten in einem psychiatrischen Grosskrankenhaus.

In a cross-sectional study 473 schizophrenic patients of a great psychiatric hospital were served. It was looked for differences in patients' characteristics and pharmacotherapy according to the therapeutic-functional structure of the hospital (admission-Unit, sociotherapeutic and long-time wards). Differences in drug-management became evident on basis of a regimen, which applies high doses (number of psychotropic drugs, chlorpromacin-units) in general, despite recommendations in the literature. The treatment refractory patients in the long-time wards are found to be heterogeneous and the authors suggest alternative pharmacological and psychosocial interventions.

[Full inpatient versus partial inpatient psychiatric after-care--a comparative retrospective study]. / Vollstationäre versus halbstationäre psychiatrische Anschlussbehandlung--Eine vergleichende retrospektive Studie.

In a retrospective study 80 inpatients (Sociotherapy, Therapeutic Community) were compared to 160 outpatients (80 patient Day Clinic, 80 patients Night Clinic). With a mean treatment duration of 4-5 1/2 month a significant decrease was found for each group in the frequency and duration of further hospital admissions after end of therapy. Day and Night Clinic patients tending to a better outcome than the inpatients. Advantages of the Day and Night Clinic are seen e.g. in a higher degree of acceptance by patients and family doctors, disadvantages in the increased rate of suicide found in our sample.

[Inpatient rehabilitation of chronic schizophrenic patients with a behavior therapy token reinforcement program]. / Stationäre Rehabilitation chronisch schizophrener Patienten mit einem verhaltenstherapeutischen Münzverstärkerprogramm.

The efficacy of a token economy system was assessed in a study involving 76 chronic schizophrenics who were inpatients during a treatment period of four years. The interrelations between therapeutic success on the one hand, and socio-economic as well as course of disease-related factors on the other were studied, including psychopathology and the efficacy of token economy.