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Atypical antipsychotic medications and memory enhancement in schizophrenia
158 ATYPICAL ANTIPSYCHOTIC MEDICATIONS AND MEMORY ENHANCEMENT IN SCHIZOPHRENIA A. A. Sepehry,* W. G. Honer, A. E. T h o r n t o n
Department of Psychology, Simon Fraser University, Burnaby, BC, Canada We conducted a meta-analytic review of thirteen studies that provided data addressing the differential long-term memory (LTM) outcomes of patients (a) treated with atypical versus typical antipsychotic medications, and (b) receiving risperidone, olanzapine, quetiapine and clozapine treatments. Analyses revealed that treatment with atypical compounds resulted in significantly superior LTM outcomes compared to treatment with typical antipsychotic medications (d. = .308, 95% CI = . 131 - .485) on both verbal and non-verbal memory tasks. This effect is equivalent to approximately 4.5 points on a standardized memory test. In terms of the differences between atypical compounds, the LTM benefits were most evident for risperidone and olanzapine outcomes. Quetiapine had fewer studies, which may limit the results for this compound. In contrast, clozapine was not associated with a significantly more favorable LTM outcome than the typical control medication (i.e., haloperidol). Further investigations are necessary to determine whether the differential LTM outcomes directly reflect the pharmacology of these medications, confounding adjunctive treatments or participant selection bias. This research was supported by a grant from the Research Advisory Committee at Riverview Hospital, Port Coquitlam, BC.
VERBAL MEMORY LEARNING POTENTIAL IN SCHIZOPHRENIA T. E. Smith,* J. M. Fiszdon, J. E M c C l o u g h , J. R. Jaramillo, M. D. Bell
Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA Measures of attention, memory, and executive functioning have been identified as predictors of functional capacity and psychiatric rehabilitation outcomes in schizophrenia. Our group is studying plasticity of neurocognitive functioning by examining verbal memory learning capacity as a predictor of social and self-care skills. We report preliminary data from a study involving 22 individuals with schizophrenia or schizoaffective disorder. All subjects were administered 3 versions of modified California Verbal Learning Test-II (CVLT-II) word lists at 15-minute intervals. Subjects were randomized into intervention versus no intervention groups. The intervention consisted of training subjects in the use of semantic strategies immediately prior to and during administration of the second CVLT-II word list. Training included instruction, practice examples, and prompting for the use of semantic strategies. The group as a whole showed a non-significant trend towards improvement in memory performance from the 1st to the 3rd word list presentation. Subjects receiving the intervention showed significant performance improvement (higher CVLT-II Sum of Trials 1-5 score from list 1 to list 2; t=-2.76, p=.02). This improvement was sustained for list 3, although no further training was provided. A factorial repeated measures MANOVA showed an interaction effect (F=3.22, p=.05), with the intervention group showing a greater degree of improvement across the 3 word lists, compared to the no intervention group. The intervention group also showed significant increases in the use of semantic strategies from list 1 to list 2, whereas the no intervention group's use of semantic clustering techniques did not change. Inspection of the data indicated wide variability in subjects' ability to benefit from training. These
11. Psychology, Neurodata suggest that at least some individuals with chronic psychotic disorders demonstrate a capacity to learn verbal memory strategies in a controlled setting. Further analyses are underway to determine whether this learning capacity index is more predictive of functional skill and rehabilitation outcome than baseline neurocognitive performance.
COGNITIVE IMPAIRMENTS IN ADULT FIRSTDEGREE RELATIVES OF SCHIZOPHRENIA PATIENTS: A META-ANALYTIC REVIEW B. E. Snitz,* A. W. MacDonald, C. S. Carter Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Cognitive deficits have frequently been reported in the unaffected first-degree relatives of schizophrenia patients. However, a quantitative review of studies focusing on the strength of effect sizes across cognitive domains has not yet, to our knowledge, been published. In the present meta-analysis, we reviewed studies of adult relatives only, with the aim of advancing the search for candidate cognitive endophenotypes for schizophrenia. Studies were selected for inclusion if 1) they used standardized criteria to diagnose schizophrenia probands; 2) the mean age of relatives was over 18 years, with no relative under 16; 3) no relatives diagnosed with schizophrenia were included; and 4) the control group was matched on age. Wilcox unbiased effect size was calculated for the difference in mean scores between relatives and controls, correcting for unequal variance and unequal sample sizes. Cognitive/neuropsychological tasks were included if they had been reported in at least three independent samples. Preliminary results indicate significantly worse performance in relatives compared to controls on 20 out of 22 cognitive measures included. Small effects (.20-.49) were observed for general verbal and spatial abilities, perceptual and motor measures, and tests of executive processes. Small-to-moderate (.50-.79) effects were found for immediate and delayed memory measures. Moderate-to-large (>.80) effects were observed for difficult versions of the Continuous Performance Test. These results suggest that at least mild cognitive impairment across all domains is present in relatives of schizophrenia patients. Furthermore, tests of memory and attention appear more sensitive to deficits in relatives. However, the extent to which these measures are assessing generalized cognitive deficit versus specific cognitive impairments is unclear from the literature. The role of moderator variables, such as task difficulty and variance, will be highlighted. More broadly, the challenge of the generalized deficit problem will be discussed, as well as its role in detecting cognitive impairments associated with liability to schizophrenia.
NEUROLOGICAL SOFT SIGNS (NSSS) IN FIRST EPISODE PSYCHOSIS PREDICT TEN YEAR OUTCOME J. S t M i n g , * C. White, S. Lewis, R. Hopkins, A. Huddy, L. M o n t a g u e
Psychology and Speech Pathology, Manchester Metropolitan University, Manchesteg England, United Kingdom An epidemiological first admission psychosis (mainly schizophrenia) cohort (n=109) was recruited from three hospitals in Manchester, UK, between 1986 and 1988. Participants were assessed on a range of clinical, behavioural and neurological measures. The latter included tests to assess soft perceptual and motor signs such as agraphaes-
International Congress on Schizophrenia Research 2003
Department of Psychology, Simon Fraser University, Burnaby, BC, Canada We conducted a meta-analytic review of thirteen studies that provided data addressing the differential long-term memory (LTM) outcomes of patients (a) treated with atypical versus typical antipsychotic medications, and (b) receiving risperidone, olanzapine, quetiapine and clozapine treatments. Analyses revealed that treatment with atypical compounds resulted in significantly superior LTM outcomes compared to treatment with typical antipsychotic medications (d. = .308, 95% CI = . 131 - .485) on both verbal and non-verbal memory tasks. This effect is equivalent to approximately 4.5 points on a standardized memory test. In terms of the differences between atypical compounds, the LTM benefits were most evident for risperidone and olanzapine outcomes. Quetiapine had fewer studies, which may limit the results for this compound. In contrast, clozapine was not associated with a significantly more favorable LTM outcome than the typical control medication (i.e., haloperidol). Further investigations are necessary to determine whether the differential LTM outcomes directly reflect the pharmacology of these medications, confounding adjunctive treatments or participant selection bias. This research was supported by a grant from the Research Advisory Committee at Riverview Hospital, Port Coquitlam, BC.
VERBAL MEMORY LEARNING POTENTIAL IN SCHIZOPHRENIA T. E. Smith,* J. M. Fiszdon, J. E M c C l o u g h , J. R. Jaramillo, M. D. Bell
Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA Measures of attention, memory, and executive functioning have been identified as predictors of functional capacity and psychiatric rehabilitation outcomes in schizophrenia. Our group is studying plasticity of neurocognitive functioning by examining verbal memory learning capacity as a predictor of social and self-care skills. We report preliminary data from a study involving 22 individuals with schizophrenia or schizoaffective disorder. All subjects were administered 3 versions of modified California Verbal Learning Test-II (CVLT-II) word lists at 15-minute intervals. Subjects were randomized into intervention versus no intervention groups. The intervention consisted of training subjects in the use of semantic strategies immediately prior to and during administration of the second CVLT-II word list. Training included instruction, practice examples, and prompting for the use of semantic strategies. The group as a whole showed a non-significant trend towards improvement in memory performance from the 1st to the 3rd word list presentation. Subjects receiving the intervention showed significant performance improvement (higher CVLT-II Sum of Trials 1-5 score from list 1 to list 2; t=-2.76, p=.02). This improvement was sustained for list 3, although no further training was provided. A factorial repeated measures MANOVA showed an interaction effect (F=3.22, p=.05), with the intervention group showing a greater degree of improvement across the 3 word lists, compared to the no intervention group. The intervention group also showed significant increases in the use of semantic strategies from list 1 to list 2, whereas the no intervention group's use of semantic clustering techniques did not change. Inspection of the data indicated wide variability in subjects' ability to benefit from training. These
11. Psychology, Neurodata suggest that at least some individuals with chronic psychotic disorders demonstrate a capacity to learn verbal memory strategies in a controlled setting. Further analyses are underway to determine whether this learning capacity index is more predictive of functional skill and rehabilitation outcome than baseline neurocognitive performance.
COGNITIVE IMPAIRMENTS IN ADULT FIRSTDEGREE RELATIVES OF SCHIZOPHRENIA PATIENTS: A META-ANALYTIC REVIEW B. E. Snitz,* A. W. MacDonald, C. S. Carter Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Cognitive deficits have frequently been reported in the unaffected first-degree relatives of schizophrenia patients. However, a quantitative review of studies focusing on the strength of effect sizes across cognitive domains has not yet, to our knowledge, been published. In the present meta-analysis, we reviewed studies of adult relatives only, with the aim of advancing the search for candidate cognitive endophenotypes for schizophrenia. Studies were selected for inclusion if 1) they used standardized criteria to diagnose schizophrenia probands; 2) the mean age of relatives was over 18 years, with no relative under 16; 3) no relatives diagnosed with schizophrenia were included; and 4) the control group was matched on age. Wilcox unbiased effect size was calculated for the difference in mean scores between relatives and controls, correcting for unequal variance and unequal sample sizes. Cognitive/neuropsychological tasks were included if they had been reported in at least three independent samples. Preliminary results indicate significantly worse performance in relatives compared to controls on 20 out of 22 cognitive measures included. Small effects (.20-.49) were observed for general verbal and spatial abilities, perceptual and motor measures, and tests of executive processes. Small-to-moderate (.50-.79) effects were found for immediate and delayed memory measures. Moderate-to-large (>.80) effects were observed for difficult versions of the Continuous Performance Test. These results suggest that at least mild cognitive impairment across all domains is present in relatives of schizophrenia patients. Furthermore, tests of memory and attention appear more sensitive to deficits in relatives. However, the extent to which these measures are assessing generalized cognitive deficit versus specific cognitive impairments is unclear from the literature. The role of moderator variables, such as task difficulty and variance, will be highlighted. More broadly, the challenge of the generalized deficit problem will be discussed, as well as its role in detecting cognitive impairments associated with liability to schizophrenia.
NEUROLOGICAL SOFT SIGNS (NSSS) IN FIRST EPISODE PSYCHOSIS PREDICT TEN YEAR OUTCOME J. S t M i n g , * C. White, S. Lewis, R. Hopkins, A. Huddy, L. M o n t a g u e
Psychology and Speech Pathology, Manchester Metropolitan University, Manchesteg England, United Kingdom An epidemiological first admission psychosis (mainly schizophrenia) cohort (n=109) was recruited from three hospitals in Manchester, UK, between 1986 and 1988. Participants were assessed on a range of clinical, behavioural and neurological measures. The latter included tests to assess soft perceptual and motor signs such as agraphaes-
International Congress on Schizophrenia Research 2003