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Journal Cover Schizophrenia Research : Cognition
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  This is an Open Access Journal Open Access journal
     ISSN (Print) 2215-0013
     Published by Elsevier Homepage  [2563 journals]
  • The evolution of illness phases in schizophrenia: A non-parametric item
           response analysis of the Positive and Negative Syndrome Scale

    • Abstract: Publication date: Available online 24 April 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Anzalee Khan , Jean Pierre Lindenmayer , Mark Opler , Mary E. Kelley , Leonard White , Michael Compton , Zimeng Gao , Philip D. Harvey
      Background The Positive and Negative Syndrome Scale (PANSS) assesses multiple domains of schizophrenia. Evaluation of each of these domains was conducted to assess differences in the characteristics of psychopathology and their relative predominance in sub-populations. Method Subjects (N=1,832) with DSM-IV schizophrenia were represented in three sub-populations: First Episodes, n=305, Chronic Inpatients, n=694, and Ambulatory Outpatients, n=833. Nonparametric Item Response Analysis (IRT) was performed with Option Characteristic Curves (OCC), Item Characteristic Curves (ICC), slopes and item biserial correlation. Items were characterized as Very Good, Good, or Weak based on specified operational criteria for item selection. Results First episode patients were represented by negative, disorganized hostility and anxiety. Some negative domain items (Poor Rapport, Passive/Apathetic Social Withdrawal) and most positive domain items were scored as Weak. For chronic inpatients, all items of the anxiety domain and some items of the positive domain (Suspiciousness/Persecution, Stereotyped Thinking, Somatic Concerns) were Weak; for all other domains, items were Very Good or Good. For ambulatory outpatients, most items in the anxiety and hostility domain were scored as Weak. The majority of PANSS items were either Very Good or Good at assessing the overall illness severity: chronic inpatients (73.33%, 22 items), first episodes (60.00%, 18 items), and only 46.67% (14 items) in the ambulatory group. Conclusion Findings confirm differences in symptom presentation and predominance of particular domains in subpopulations of schizophrenia. Identifying symptom domains characteristic of subpopulations may be more useful in assessing efficacy endpoints than total or subscale scores.


      PubDate: 2014-04-28T21:18:53Z
       
  • A longitudinal examination of the moderating effects of symptoms on the
           relationship between functional competence and real world functional
           performance in Schizophrenia

    • Abstract: Publication date: Available online 26 April 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Michael W. Best , Maya Gupta , Christopher R. Bowie , Philip D. Harvey
      Background Many individuals with schizophrenia experience remission of prominent positive symptoms but continue to experience impairments in real world functioning. Residual negative and depressive symptoms may have a direct impact on functioning and impair patients' ability to use the cognitive and functional skills that they possess (competence) in the real world (functional performance). Methods One hundred thirty-six individuals (100 men, 36 women) with schizophrenia were classified as having primarily positive symptoms, primarily negative symptoms, primarily depressive symptoms, or undifferentiated symptom profiles. Performance based measures of cognition and adaptive and interpersonal functional competence were used, along with ratings of real world behavior by high contact clinicians. Assessments were performed at baseline and at an 18-month follow-up. Results The relationships between neurocognition and capacity/performance were not moderated by symptom group ps>.091; neurocognition predicted capacity and performance for all groups ps<.001. The relationship between adaptive competence and adaptive performance was moderated by symptom group, ps<.01, such that baseline competence only predicted future performance ratings for participants with primarily positive or undifferentiated symptoms, and not for individuals with primarily negative or depressive symptoms. This same moderation effect was found on the relationship between interpersonal competence and interpersonal performance, ps<.002. Conclusions Residual negative and depressive symptoms are distinct constructs that impede the use of functional skills in the real world. Depressive symptoms are often overlooked in schizophrenia but appear to be an important factor that limits the use of functional ability in real world environments.


      PubDate: 2014-04-28T21:18:53Z
       
  • The course and correlates of everyday functioning in schizophrenia

    • Abstract: Publication date: Available online 26 March 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Abraham Reichenberg , Concetta Feo , Davide Prestia , Christopher R. Bowie , Thomas L. Patterson , Philip D. Harvey
      Previously institutionalized older patients with schizophrenia show changes in cognitive and functional capacity over time. This study examined changes in real-world functioning in a sample of people with schizophrenia who varied in their history of long-term institutionalization and related changes in real world functioning to changes in cognition and functional capacity over the follow-up period. Older patients with schizophrenia (n=111) were examined with assessments of cognitive functioning, functional capacity, clinical symptoms, and everyday functioning. They were then followed up to 45 months and examined up to two times. Mixed-model regression was used to examine changes in real-world functioning in social, everyday living, and vocational domains over the follow-up period and identify potential predictors of change. Everyday functioning worsened over time in all three domains. Although length of longest hospitalization predicted worsening, this influence was eliminated when the course of functional capacity was used to predict the course of everyday functioning. For both vocational and everyday living domains, as well as the composite score on functional status, worsening in performance based measures of everyday functioning and social competence predicted worsening in real world functioning. Changes in negative symptoms further predicted worsening in the everyday living domain. Worsening in everyday functioning is found in people with schizophrenia and those with a history of greater chronicity and severity of illness seem more affected. These influences seem to be expressed through worsening in the ability to perform everyday functional skills. Potential causes of these changes and implications for reducing these impairments are discussed.


      PubDate: 2014-04-01T06:15:02Z
       
  • Qualitative analysis of interviews of future non-affective psychotic
           disorder patients and non-psychiatric controls: preliminary results

    • Abstract: Publication date: Available online 20 March 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Katya Rubinstein , Rivka Tuval-Mashiach , Ortal Bhuknik-Atzil , Suzanne Fund , Abraham Reichenberg , Eyal Fruchter , Mark Weiser
      Background Previous research has shown that people with psychotic disorders have impaired functioning prior to the onset of the illness. The goal of this study is to obtain a detailed, in depth, analysis of the characteristics of premorbid impairment. Methods In this study we examined summaries of interviews with 20 male adolescents who were later diagnosed with non-affective psychotic disorders and compared them to interviews conducted with 20 matched controls without psychiatric disorders. The current study applied a qualitative analysis, performed in the following stages: each interview was read thoroughly by two blinded raters with no a-priori hypothesis, and then key themes and statements were identified and organized into meaningful domains. Afterwards, the frequency of each item was calculated and comparisons between the groups were performed. Results Future non-affective psychotic disorder patients were more likely to be described as strange or different, be involved in violent behavior, experience difficulties in educational functioning and peer integration, deal with problems in everyday functioning and have an avoidant interpersonal conflict resolution style in comparison with matched controls without psychiatric disorders. In addition, future patients experienced more stressful life events and dealt with these stressors more poorly in comparison with controls. Conclusions The findings of this unique historical-prospective qualitative analysis of interviews performed before the onset of psychosis, confirmed previous findings of premorbid abnormality of future non-affective psychosis patients. Using qualitative analysis enabled obtaining a more in-depth understanding of the real-life experience of the premorbid period among patients with non-affective psychotic disorders.


      PubDate: 2014-04-01T06:15:02Z
       
  • Cognition in schizophrenia: Past, present, and future

    • Abstract: Publication date: Available online 20 March 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Michael F. Green , Philip D. Harvey
      Schizophrenia Research: Cognition will serve an important function – a place where interests converge and investigators can learn about the recent developments in this area. This new journal will provide rapid dissemination of information to people who will make good use of it. In this initial article, we comment globally on the study of cognition in schizophrenia: how we got here, where we are, and where we are going. The goal of this first article is to place the study of cognition in schizophrenia within a historical and scientific context. In a field as richly textured as ours it is impossible to hit all the important areas, and we hope the reader will forgive our omissions. Phrased in cognitive terms, our limited presentation of the past is a matter of selective memory, the present is a matter of selective attention, and the future is a matter of selective prospection. This broad introduction emphasizes that cognition in schizophrenia provides clues to pathophysiology, treatment, and outcome. In fact, the study of cognitive impairment in schizophrenia has become wholly intertwined with the study of schizophrenia itself.


      PubDate: 2014-04-01T06:15:02Z
       
  • A novel, online social cognitive training program for young adults with
           schizophrenia: A pilot study

    • Abstract: Publication date: Available online 12 March 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Mor Nahum , Melissa Fisher , Rachel Loewy , Gina Poelke , Joseph Ventura , Keith H. Nuechterlein , Christine I. Hooker , Michael F. Green , Michael M. Merzenich , Sophia Vinogradov
      Background Pervasive social cognition deficits are evident early in the course of schizophrenia and are directly linked to functional outcome, making them an important target for intervention. Here, we tested the feasibility of use, and initiated the evaluation of efficacy, of a novel, neuroplasticity-based online training program (SocialVille) in young adults with schizophrenia. Methods Schizophrenia patients (n=17) completed 24 hours of online SocialVille game play either from home or at a clinic, over a 6–10 week period. We examined training feasibility, gains on the SocialVille exercises relative to matched healthy controls (n=17), and changes on measures of social cognition, social functioning, global functioning and motivation. Results Subjects adhered to training requirements, and rated SocialVille in the medium to high range in satisfaction, enjoyment, and ease of use. Subjects demonstrated significant, large improvements on the speeded SocialVille tasks, and small to moderate improvements on the working memory tasks. Post-training performance on the SocialVille tasks were similar to initial performance of the healthy controls. Subjects also showed improvements on standard measures of social cognition, social functioning, and motivation. No improvements were recorded for emotion recognition indices of the MSCEIT, or on quality of life scales. Conclusion This study provides an initial proof of concept for online social cognition training in schizophrenia. This form of training demonstrated feasibility and resulted in within-subject gains in social functioning and motivation. This pilot study represents a first step towards validating this training approach; randomized controlled trials, now underway, are designed to confirm and extend these findings.


      PubDate: 2014-04-01T06:15:02Z
       
  • Virtual reality functional capacity assessment in schizophrenia:
           Preliminary data regarding feasibility and correlations with cognitive and
           functional capacity performance

    • Abstract: Publication date: Available online 12 March 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Stacy A. Ruse , Philip D. Harvey , Vicki G. Davis , Alexandra S. Atkins , Kolleen H. Fox , Richard S.E. Keefe
      Introduction Assessment of functional capacity is an intrinsic part of determining the functional relevance of response to treatment of cognitive impairment in schizophrenia. Existing methods are highly and consistently correlated with performance on neuropsychological tests, but most current assessments of functional capacity are still paper and pencil simulations. We developed a computerized virtual reality assessment that contains all of the components of a shopping trip. Methods We administered the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) to 54 healthy controls and to 51 people with schizophrenia to test its feasibility. Dependent variables for the VRFCAT included time to completion and errors on 12 objectives and the number of times that an individual failed to complete an objective. The MATRICS Consensus Cognitive Battery (MCCB) and a standard functional capacity measure, the UCSD Performance-Based Skills Assessment-Brief (UPSA-B), were administered to the patients with schizophrenia. Results Patients with schizophrenia performed more poorly than healthy controls on 10/11 of the time variables, as well as 2/12 error scores and 2/12 failed objectives. Pearson correlations for 7 of 15 VRFCAT variables with MCCB composite scores were statistically significant. Conclusion These results provide support for the possibility of computerized functional capacity assessment, but more substantial studies are required.


      PubDate: 2014-04-01T06:15:02Z
       
  • Economic considerations of cognition and functional outcomes in patients
           with schizophrenia: A systematic literature review

    • Abstract: Publication date: Available online 18 February 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Nicolas Furiak , Amy Duhig , Julie Myers , Amber Pitts , Steven Hass , Robert Klein
      Background The primary focus of research in schizophrenia has been on the positive symptoms, with findings that clearly establish their economic burden. More recently, research has expanded to focus on another core symptom of schizophrenia, namely cognitive impairments. While this work has established the adverse impact of cognitive impairments associated with schizophrenia (CIAS) on functional outcomes, their relationship to the economic impact of schizophrenia has not been systematically evaluated. Objective The aim of this research was to perform a systematic literature review identifying evidence that evaluates: 1) the economic impact of CIAS and its treatments, including health-state utilities, and 2) the economic evidence associated with improvements in the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery and the University of California Performance Skills Assessment (UPSA). Method A systematic search of articles published from January 1999–April 2013 was conducted. Studies reporting direct costs, indirect costs, and quality of life impacts of CIAS and costs of CIAS interventions were reviewed. Results Forty-three studies met inclusion criteria. Twenty-four focused on indirect costs (work-related outcomes) associated with cognitive impairments and 14 studies included residential status outcomes. Four studies concentrated on the direct cost of cognitive remediation therapy. Three studies reported quality of life outcomes, but none used health-state utilities. Eight studies focused on the UPSA and its relationship to community outcomes. Only two studies were cost-effectiveness analyses. Conclusions Despite the growing scientific literature relating CIAS to adverse outcomes, the translation of outcomes into economic outcomes is seldom reported. Should novel pharmacotherapies and/or psychosocial treatments require reimbursement from health authorities and/or other payers, many gaps warrant attention in order to demonstrate the economic value of these therapies.


      PubDate: 2014-04-01T06:15:02Z
       
  • The course of vocational functioning in patients with schizophrenia:
           Re-examining social drift

    • Abstract: Publication date: Available online 12 February 2014
      Source:Schizophrenia Research: Cognition
      Author(s): Gabriela Vargas , Martin Strassnig , Samir Sabbag , Felicia Gould , Dante Durand , Laura Stone , Thomas L. Patterson , Philip D. Harvey
      Vocational functioning is markedly impaired in people with schizophrenia. In addition to low rates of employment, people with schizophrenia have been reported to be underachieved compared to other family members. Among the causes of this vocational impairment may be cognitive deficits and other skills deficits, as well as social factors impacting on opportunities for employment. In this study, we examined two separate samples of people with schizophrenia who differed in their educational and social backgrounds. We compared personal and maternal education in people with schizophrenia attending an outpatient rehabilitation facility (n = 57) or receiving outpatient services at a VA medical center (n = 39). The sample as a whole showed evidence of decline in vocational status from their best job to their most recent job. Patients attending a rehabilitation facility had completed less education than their mothers, while the VA patients completed more. Differences between personal and maternal education predicted the difference in status between best and latest jobs in the sample as a whole. VA patients were more likely to be living independently and performed better on a measure of functional capacity than the rehabilitation sample. These data implicate vocational decline in schizophrenia and also suggest that this decline may originate prior to the formal onset of the illness. At the same time, vocational outcomes appear to be related to social opportunities.


      PubDate: 2014-04-01T06:15:02Z
       
 
 
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