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Wisconsin card sorting performance predicts vocational outcome following psychiatric rehabilitation
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WISCONSIN CARD SORTING PERFORMANCE PREDICTS VOCATIONAL OUTCOME FOLLOWING PSYCHIATRIC REHABILITATION Judith Jaeger*, Stefanie Bems, Estelle Douglas Hillside Hospital, P.O. Box 38, Glen Oaks, NY 11004, USA Performance on the Wisconsin Card Sorting Test (WCST), a putative measure of executive functioning mediated by the frontal lobes, is frequently impaired in schizophrenia and in disabled patients with other psychiatric diagnoses. While the remediability of this deficit has been debated, the functional outcome significance of WCST performance has not been demonstrated. We
present preliminary analyses from a longitudinal followup study of consecutive discharges (N=24, 54% schizophrenics) from a clinic-affiliated psychiatric rehabilitation program examining the association between WCST performance upon discharge and outcome functioning 3 months iater. Vocational functioning at three months was significantly associated with baseline WCST indices (p’s ranging from .Ol to <.GOl) using both nonparametric outcome classifications (ANOVA) and SAS instrumental role ratings (Pearson r). Patients with poor outcomes made almost three times as many perseverative errors as those with good outcomes. Findings were unchanged when the sample was restricted to schizophrenia only and when covarying for WAIS-R Information and Vocabulary, BPRS at baseline or 3 months, age of onset or number of previous hospitalizations. Our results suggest that poor performance on the WCST may reflect an aspect of cognitive dysfunction which is essential for successful vocational outcome, independent of othq measures of illness severity, and a valid target for treatment.
LATE-LIFE SCHIZOPHRENIA: LATE-ONSET
EARLY- VERSUS
similar
on most clinical
and neuropsychological
measures,
and
both groups are cognitively more impaired than normal controls. There are, however, some interesting differences between LOS and EOS groups-e.g.,
greater impairment
on Wisconsin
Card Sorting
Test - in the EOS than LOS patients. Comment: We will discuss our findings from the view-point of factors that may be associated with a delayed onset of schizophrenia.
THE NEUROLOGICAL EVALUATION SCALE (NES): FACTOR ANALYSIS AND CLINICAL CORRELATES L.P. Kqer*, Beam-Goulet,
M.D. Bell, P.H. Lysaker, L. Bretmer, J.H. Krystal
J.P. Seibyl, J.L.
Schizophrenia Biological Res Cntr, West Haven VAMC, CT 06216, . Tn. “J‘4 Buchanan and Heinrichs introduced the NES, an examination for neurological soft signs. NES items were clustered into three subscales and “other items” on an a priori basis. These clusters appeared to be clinically relevant. The purpose of this study is to present fmdings of NBS factors and clinical correlates. Methods: The NES was administered to 82 stable patients meeting DSMIII-R criteria for schizophrenia or schizoaffective disorder who participated in vocational rehabilitation. A factor analysis was performed and Pearson correlation coefficients were calculated for relevant clinical variables. Results: Preliminary analysis suggests the existence of four factors. Factor 1, “Memory,” correlated significantly with positive and cognitive symptoms, WAIS Digit Symbol, IQ, and Wisconsin Card Sort perseverative errors (WCSPE). Factor 2, “Sensory-Motor Disinhibition,” correlated with deficit syndrome, concreteness, negative symptoms, and abnormal movements. Factor 3. “Comnlex Motor Tasks.” correlated with WCS-PE. Factor 4 comprising glabelar reflex, mirror movements, and right-left confusion correlated with age. Implications: These findings generally parallel the factor structure introduced by
Dilip V. Jeste*, M. Jackuelyn Harris, Julia Kuck, Lou Arm McAdamS, Robert K. Heaton
Buchanan-and He&&hs. The neurologic deficits of some scbizophrenic patients may arise from alterations in brain function that may have important clinical significance. The preliminary data
Veterans Affairs Med. Ctr., VI16A, 3350 LA Jolla Village Dr., San Diego, CA 92161, USA
suggests that WCS-PE may be due to two partly distinct domains of pathology, one most associated with memory (temporal lobe) and the other related to complex (frontal lobe) motor tasks.
Introduction: There have been few prospective, comprehensive clinical and neuropsychological studies of late-life schizophrenia. Methods and Materials: We have been studying a cohort of over 60 middle-aged and elderly patients who meet DSM-III-R criteria for schizophrenia, as well as a normal comparison group of 39 subjects from the same age range. The schizophrenic patients include both groups: those with early-onset schizophrenia (EOS), and those with late-onset schizophrenia (LOS). Our subjects undergo a detailed neuropsychiatric evaluation including past and family history, SCID, BPRS, SAPS, SANS, Hamilton’s Depression Rating Scale, AIMS, MMSE, along with a neurological workup to rule out structural brain lesions and other organic mental syndromes. The subjects also receive an expanded version of the Halstead-Reitan neuropsychological test battery. Results: Our results to date suggest that the LOS and EOS groups are
VISUOSPATIAL WORKING IN SCHIZOPHRENIA
MEMORY DEFICITS
R.S.E. Keefe*, S.E. Lees, D. Merhige, C. Blum, P.D. Harvey, K.L. Davis, R.C. Mohs Department of Psychiatry, Mount Sinai School of Medicine, 116A, 130 West Kingsbridge Road, Bronx, NY 10468, USA The dorsolateral prefrontal cortex (DLPFC) is an area of possible dysfunction in schizophrenia, yet no current tests measure the functioning of this specific cortical region. In monkeys, the DLPFC is organized such that working memory for the specific location of
WISCONSIN CARD SORTING PERFORMANCE PREDICTS VOCATIONAL OUTCOME FOLLOWING PSYCHIATRIC REHABILITATION Judith Jaeger*, Stefanie Bems, Estelle Douglas Hillside Hospital, P.O. Box 38, Glen Oaks, NY 11004, USA Performance on the Wisconsin Card Sorting Test (WCST), a putative measure of executive functioning mediated by the frontal lobes, is frequently impaired in schizophrenia and in disabled patients with other psychiatric diagnoses. While the remediability of this deficit has been debated, the functional outcome significance of WCST performance has not been demonstrated. We
present preliminary analyses from a longitudinal followup study of consecutive discharges (N=24, 54% schizophrenics) from a clinic-affiliated psychiatric rehabilitation program examining the association between WCST performance upon discharge and outcome functioning 3 months iater. Vocational functioning at three months was significantly associated with baseline WCST indices (p’s ranging from .Ol to <.GOl) using both nonparametric outcome classifications (ANOVA) and SAS instrumental role ratings (Pearson r). Patients with poor outcomes made almost three times as many perseverative errors as those with good outcomes. Findings were unchanged when the sample was restricted to schizophrenia only and when covarying for WAIS-R Information and Vocabulary, BPRS at baseline or 3 months, age of onset or number of previous hospitalizations. Our results suggest that poor performance on the WCST may reflect an aspect of cognitive dysfunction which is essential for successful vocational outcome, independent of othq measures of illness severity, and a valid target for treatment.
LATE-LIFE SCHIZOPHRENIA: LATE-ONSET
EARLY- VERSUS
similar
on most clinical
and neuropsychological
measures,
and
both groups are cognitively more impaired than normal controls. There are, however, some interesting differences between LOS and EOS groups-e.g.,
greater impairment
on Wisconsin
Card Sorting
Test - in the EOS than LOS patients. Comment: We will discuss our findings from the view-point of factors that may be associated with a delayed onset of schizophrenia.
THE NEUROLOGICAL EVALUATION SCALE (NES): FACTOR ANALYSIS AND CLINICAL CORRELATES L.P. Kqer*, Beam-Goulet,
M.D. Bell, P.H. Lysaker, L. Bretmer, J.H. Krystal
J.P. Seibyl, J.L.
Schizophrenia Biological Res Cntr, West Haven VAMC, CT 06216, . Tn. “J‘4 Buchanan and Heinrichs introduced the NES, an examination for neurological soft signs. NES items were clustered into three subscales and “other items” on an a priori basis. These clusters appeared to be clinically relevant. The purpose of this study is to present fmdings of NBS factors and clinical correlates. Methods: The NES was administered to 82 stable patients meeting DSMIII-R criteria for schizophrenia or schizoaffective disorder who participated in vocational rehabilitation. A factor analysis was performed and Pearson correlation coefficients were calculated for relevant clinical variables. Results: Preliminary analysis suggests the existence of four factors. Factor 1, “Memory,” correlated significantly with positive and cognitive symptoms, WAIS Digit Symbol, IQ, and Wisconsin Card Sort perseverative errors (WCSPE). Factor 2, “Sensory-Motor Disinhibition,” correlated with deficit syndrome, concreteness, negative symptoms, and abnormal movements. Factor 3. “Comnlex Motor Tasks.” correlated with WCS-PE. Factor 4 comprising glabelar reflex, mirror movements, and right-left confusion correlated with age. Implications: These findings generally parallel the factor structure introduced by
Dilip V. Jeste*, M. Jackuelyn Harris, Julia Kuck, Lou Arm McAdamS, Robert K. Heaton
Buchanan-and He&&hs. The neurologic deficits of some scbizophrenic patients may arise from alterations in brain function that may have important clinical significance. The preliminary data
Veterans Affairs Med. Ctr., VI16A, 3350 LA Jolla Village Dr., San Diego, CA 92161, USA
suggests that WCS-PE may be due to two partly distinct domains of pathology, one most associated with memory (temporal lobe) and the other related to complex (frontal lobe) motor tasks.
Introduction: There have been few prospective, comprehensive clinical and neuropsychological studies of late-life schizophrenia. Methods and Materials: We have been studying a cohort of over 60 middle-aged and elderly patients who meet DSM-III-R criteria for schizophrenia, as well as a normal comparison group of 39 subjects from the same age range. The schizophrenic patients include both groups: those with early-onset schizophrenia (EOS), and those with late-onset schizophrenia (LOS). Our subjects undergo a detailed neuropsychiatric evaluation including past and family history, SCID, BPRS, SAPS, SANS, Hamilton’s Depression Rating Scale, AIMS, MMSE, along with a neurological workup to rule out structural brain lesions and other organic mental syndromes. The subjects also receive an expanded version of the Halstead-Reitan neuropsychological test battery. Results: Our results to date suggest that the LOS and EOS groups are
VISUOSPATIAL WORKING IN SCHIZOPHRENIA
MEMORY DEFICITS
R.S.E. Keefe*, S.E. Lees, D. Merhige, C. Blum, P.D. Harvey, K.L. Davis, R.C. Mohs Department of Psychiatry, Mount Sinai School of Medicine, 116A, 130 West Kingsbridge Road, Bronx, NY 10468, USA The dorsolateral prefrontal cortex (DLPFC) is an area of possible dysfunction in schizophrenia, yet no current tests measure the functioning of this specific cortical region. In monkeys, the DLPFC is organized such that working memory for the specific location of