- Email: [email protected]
Memory and negative symptoms predict role play performance in schizophrenic outpatients
115
Table I (see McGlashan
et
al.)
Cognitive function
N
Low SANS Mean
N
High SANS Mean
P
18 mo. MMSE 30 mo. MMSE
59 19 40 42 42
27.5 28.3 33.7 44.1 117.8
31 16 29 30 30
25.6 26.4 27.4 63.8 184.9
0.003 0.126 0.039 0.012 0.001
Fluency Trails A Trails B
1.(1COGNITIVE FUNCTIONING AND PERSISTENTLY HIGH NEGATIVE SYMPTOMS IN CHRONIC SCHIZOPHRENIA Thomas H. McGlashan, Donald Quinlan, William Glazer, David Schuldberg Yale Psychiatric Institute , P.O. Box 208038, New Ha ven,
cr 06520, USA Cognitive functioning was compared in chronic schizophrenic outpatients as part of a long term study of vulnerability to tardive dyskinesia (TD) . RDC schizophrenic outpatients at the Connecticut Mental Health center with no signs of TD were followed along every 6 months for 4 years (Morgenstern and Glazer, 1993). At baseline and 24 months they received SANS and SAPS evaluation. Patients were divided into a persistently high SANS group (above the median SANS score at both assessments) and a persistently low SANS groups (below the median twice). Cognitive functioning was assessed twice at 18 and 30 months with the Mini Mental Status Exam, and once at 24 months with Trail-Making A & B, and Verbal Fluency. Results are shown in the table printed above. The persistently high SANS group was more cognitively impaired on all tests. The largest differences were seen with 18 mo. MMSEffraiis B. Cognitive impairments appear greatest in schizophrenic patients with persistent negative symptoms, i.e., a deficit state.
~'1 RELATIONSHIP BETWEEN PLASMA CORTISOL AND COGNITIVE FUNCTION IN SCHIZOPHRENIA S.R . McGurk, M. Lee, H.Y . Meltzer Department ofPsychiatry. Vanderbilt University School of Medicine, Nashville, TN 37215, USA
Cortisol has a modulatory effect on neuronal function. At low concentrations, it has a trophic effect; high concentrations for prolonged periods may have a neurotoxic effect. Schizophrenia is characterized by high concentrations of cortisol during periods of marked increase in positive symptoms and normal to slightly elevated levelsduring quiescent periods.
We postulated that high serum cortisol levels might be associated with better cognitive function during basal periods and during treatment with c1ozapine. Plasma cortisol was determined at 30 min intervals over a two hour period from 9 AM to 11 AM in samples obtained via an indwelling catheter in 19 neuroleptic-resistant schizophrenic patients who were neuroleptic free for at least 7 days, and in 30 patients during the course of clozapine treatment . Significant correlations were found between plasma cortisol area under the curve (AVC) and the WISC-R Maze (rho = 0.48, p=O.04) and Percent Perseveration on the Wisconsin Card Sort (rho = -0.45, p= 0.05) . There were no correlations with 7 other measures of cognitive function. The Controlled Word Association score after 6 months of treatment with clozapine was also correlated with plasma cortisol AVC (rho=0.47 , p=O.OI) . There were strong trends for similar relationships with the Wisconsin Card Sort and the Digit Symbol Substitution tests. These results are more consistent with a trophic than a toxic effect of plasma cortisol on cognitive function.
~14
MEMORY AND NEGATIVE SYMPTOMS PREDICT ROLE PLAY PERFORMANCE IN SCHIZOPHRENIC OUTPATIENTS Michael B. McKee, Thomas E. Smith, James W. Hull, Catherine A. Walsh, Lisa Guttroff, Robert A. Ellis New York Hospital-Cornell Medical Center, Westchester Division 21 Bloomingdale Road, White Plains, NY 10605, USA
Neuropsychological deficits as well as deficits in social skill have been shown to be prevalent in schizophrenic patients, and several reports have suggested significant relationships between them. A sample of 30 outpatients with DSM-IV diagnosis of schizophrenia were administered a battery of neuropsychological tests, along with the Role Play Test of the Social Problem Solving Assessment Battery. Predictors of Role Play included average positive symptoms, average negative symptoms, sum of attention scores (DS-CPT and SPAN), sum of scores of the California Verbal Learning Test, sum of executive functioning (Wisconsin Card Sort and Stroop), estimate of IQ and the chlorpromazine equivalent of neuroleptics were included as covariates. The overall model predicted 33% of the variance in the sum of Role Play scores, which was significant [F(2,27)=9.55.p<0.005]. Predictors making significantunique contributions to the prediction of Role Play performance were memory scores as formulated above, and average negative
116
symptoms [B=0.38, p<0.05, and B= -0.35, p<0.05). Variables not entering the best-fitting model were attention, executive function, positive symptoms, IQ estimate and chlorpromazine equivalent. Our finding supports previous reports, and further explicates the complex relationships between neurocognitive factors and social interactions.
11S NEUROPSYCHOLOGICAL DEFICITS PREDICT SCHIZOPHRENIC INPATIENTS' ATTENDANCE AND PARTICIPATION IN SOCIAL SKILLS TRAINING GROUPS Michael B. McKee, James W. Hull, Thomas E. Smith New York Hospital-Cornell Medical Center. Westchester Division 21 Bloomingdale Road. White Plains. NY 10605. USA Recent research has begun to document the complex links between neuropsychological processes and the production of social behavior in schizophrenia. Social skill and neuropsychological deficits have been shown to be prevalent and consistent over time in a majority of schizophrenic patients. There are several recent reports suggesting significant relationships between neuropsychological deficits and social functioning in schizophrenia. Based upon the literature, we hypothesized that attention, memory and executive function would be better predictors of participation in skills training than symptoms in a group of acutely ill patients. We found a mechanism by which neuropsychological deficits lead to poorer social functioning in patients undergoing treatment-they mediate participation in the psychosocial program. In a study of 19 hospitalized chronic schizophrenic patients participating in a manualized skills training program, neuropsychological functioning was found to be an important mediating variable. Executive functioning capacity was positively associated with level of participation in the training groups, and deficits in sustained attention together with negative symptoms correlated negatively with overall program attendance. Neuropsychological functioning should be considered as an important assessment domain when identify~g. patients with minimal requirements to begin skills trammg.
~((.
EEG CHANGES AND PERFORMANCE IN SPAN OF APPREHENSION IN PATIENTS WITH EARLY PSYCHOSIS
SAT values were divided by resting EEG, duration of illness, dosage of medication, and level of education. Interestingly, number of correct answers on three letters' level showed no significant differences between patients with or without EEG abnormalities, but did so on twelve letters' level. The same result, was found for incorrect answers. Level of education significantly differentiated reaction time for correct and incorrect answers. Dosages of antipsychotic medication under ISO chlorpromazine equivalents had to slightly higher reaction times of incorrect answers. These results show that EEG abnormalities are related to di1licu1ties in attention and that dosages of antipsychotic medication influences reaction time.
'111 EFFECTS OF ORAL ZIPRASIDONE AND RISPERIDONE ON COGNITIVE FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA OR SCHIZOAFFECTIVE DISORDER: PRELIMINARY DATA Damon Mitchell, Corinne Hagger, Alexandra L. Wise, S. Charles Schulz DepartmentofPsychiatry, Case Western Reserve University. 11100EuclidAve., Cleveland, on 44106, USA The present study was designed to evaluate the effects of two atypical antipsychotic agents (ziprasidone, risperidone) on cognitive functioning in outpatients with schizophrenia or schizoaffective disorder over 52 weeks. The study utilized an openlabel, randomized treatment design. Following a 3-14 day stabilization period (baseline), patients were treated with either ziprasidone (40-80 mg, BID) or risperidone (3-5 mg, BID). Neuropsychological tests were administered at baseline (NII), after six weeks of drug treatment (N = 8), and after one year or at premature termination (N=5). Tests included measures of general cognitive functioning (NAART-R, WAIS-R), verbal fluency ('F. A, S'), attention (PASAT; TrailMaking Test, Part A), memory (BVRT, CVLT), and executive functioning (TrailMaking Test, Part B; WeST). Preliminary analysis of the data did not show significant cognitive improvement following ziprasidone treatment. There were no significant differences between ziprasidone and risperidone in alleviating cognitive deficits. However, trends toward improvement were observed on some measures. Furthermore, some data suggest a possible differential effectiveness between the two agents.
Marco c.o. Merlo, Helene Hofer, Hans D. Brenner
31g UNILATERAL OLFACTORY FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA
Psychiatric InstitutionsBerne East, University ofBerne. 3000 Berne60. Switzerland
Paul J. Moberg, Bruce I. Turetsky, Richard Doty, Donald McKeown, Ruben e. Gur, Raquel E. Gur
. Twen~y-four . patients
d~agnosls of schizophrenic, schizoaffective, or schizophreniform
DepartmentofPsychiatry, University ofPennsylvania, Philadelphia PA /9104. USA
disorder) were tested with a computerized version of Span of Apprehension Test (SAT) during postacute phase. Two levels of complexity were presented by three and twelve letters. The
Deficits in olfactory processing have been well-
with early psychosis (DSM-IV
Table I (see McGlashan
et
al.)
Cognitive function
N
Low SANS Mean
N
High SANS Mean
P
18 mo. MMSE 30 mo. MMSE
59 19 40 42 42
27.5 28.3 33.7 44.1 117.8
31 16 29 30 30
25.6 26.4 27.4 63.8 184.9
0.003 0.126 0.039 0.012 0.001
Fluency Trails A Trails B
1.(1COGNITIVE FUNCTIONING AND PERSISTENTLY HIGH NEGATIVE SYMPTOMS IN CHRONIC SCHIZOPHRENIA Thomas H. McGlashan, Donald Quinlan, William Glazer, David Schuldberg Yale Psychiatric Institute , P.O. Box 208038, New Ha ven,
cr 06520, USA Cognitive functioning was compared in chronic schizophrenic outpatients as part of a long term study of vulnerability to tardive dyskinesia (TD) . RDC schizophrenic outpatients at the Connecticut Mental Health center with no signs of TD were followed along every 6 months for 4 years (Morgenstern and Glazer, 1993). At baseline and 24 months they received SANS and SAPS evaluation. Patients were divided into a persistently high SANS group (above the median SANS score at both assessments) and a persistently low SANS groups (below the median twice). Cognitive functioning was assessed twice at 18 and 30 months with the Mini Mental Status Exam, and once at 24 months with Trail-Making A & B, and Verbal Fluency. Results are shown in the table printed above. The persistently high SANS group was more cognitively impaired on all tests. The largest differences were seen with 18 mo. MMSEffraiis B. Cognitive impairments appear greatest in schizophrenic patients with persistent negative symptoms, i.e., a deficit state.
~'1 RELATIONSHIP BETWEEN PLASMA CORTISOL AND COGNITIVE FUNCTION IN SCHIZOPHRENIA S.R . McGurk, M. Lee, H.Y . Meltzer Department ofPsychiatry. Vanderbilt University School of Medicine, Nashville, TN 37215, USA
Cortisol has a modulatory effect on neuronal function. At low concentrations, it has a trophic effect; high concentrations for prolonged periods may have a neurotoxic effect. Schizophrenia is characterized by high concentrations of cortisol during periods of marked increase in positive symptoms and normal to slightly elevated levelsduring quiescent periods.
We postulated that high serum cortisol levels might be associated with better cognitive function during basal periods and during treatment with c1ozapine. Plasma cortisol was determined at 30 min intervals over a two hour period from 9 AM to 11 AM in samples obtained via an indwelling catheter in 19 neuroleptic-resistant schizophrenic patients who were neuroleptic free for at least 7 days, and in 30 patients during the course of clozapine treatment . Significant correlations were found between plasma cortisol area under the curve (AVC) and the WISC-R Maze (rho = 0.48, p=O.04) and Percent Perseveration on the Wisconsin Card Sort (rho = -0.45, p= 0.05) . There were no correlations with 7 other measures of cognitive function. The Controlled Word Association score after 6 months of treatment with clozapine was also correlated with plasma cortisol AVC (rho=0.47 , p=O.OI) . There were strong trends for similar relationships with the Wisconsin Card Sort and the Digit Symbol Substitution tests. These results are more consistent with a trophic than a toxic effect of plasma cortisol on cognitive function.
~14
MEMORY AND NEGATIVE SYMPTOMS PREDICT ROLE PLAY PERFORMANCE IN SCHIZOPHRENIC OUTPATIENTS Michael B. McKee, Thomas E. Smith, James W. Hull, Catherine A. Walsh, Lisa Guttroff, Robert A. Ellis New York Hospital-Cornell Medical Center, Westchester Division 21 Bloomingdale Road, White Plains, NY 10605, USA
Neuropsychological deficits as well as deficits in social skill have been shown to be prevalent in schizophrenic patients, and several reports have suggested significant relationships between them. A sample of 30 outpatients with DSM-IV diagnosis of schizophrenia were administered a battery of neuropsychological tests, along with the Role Play Test of the Social Problem Solving Assessment Battery. Predictors of Role Play included average positive symptoms, average negative symptoms, sum of attention scores (DS-CPT and SPAN), sum of scores of the California Verbal Learning Test, sum of executive functioning (Wisconsin Card Sort and Stroop), estimate of IQ and the chlorpromazine equivalent of neuroleptics were included as covariates. The overall model predicted 33% of the variance in the sum of Role Play scores, which was significant [F(2,27)=9.55.p<0.005]. Predictors making significantunique contributions to the prediction of Role Play performance were memory scores as formulated above, and average negative
116
symptoms [B=0.38, p<0.05, and B= -0.35, p<0.05). Variables not entering the best-fitting model were attention, executive function, positive symptoms, IQ estimate and chlorpromazine equivalent. Our finding supports previous reports, and further explicates the complex relationships between neurocognitive factors and social interactions.
11S NEUROPSYCHOLOGICAL DEFICITS PREDICT SCHIZOPHRENIC INPATIENTS' ATTENDANCE AND PARTICIPATION IN SOCIAL SKILLS TRAINING GROUPS Michael B. McKee, James W. Hull, Thomas E. Smith New York Hospital-Cornell Medical Center. Westchester Division 21 Bloomingdale Road. White Plains. NY 10605. USA Recent research has begun to document the complex links between neuropsychological processes and the production of social behavior in schizophrenia. Social skill and neuropsychological deficits have been shown to be prevalent and consistent over time in a majority of schizophrenic patients. There are several recent reports suggesting significant relationships between neuropsychological deficits and social functioning in schizophrenia. Based upon the literature, we hypothesized that attention, memory and executive function would be better predictors of participation in skills training than symptoms in a group of acutely ill patients. We found a mechanism by which neuropsychological deficits lead to poorer social functioning in patients undergoing treatment-they mediate participation in the psychosocial program. In a study of 19 hospitalized chronic schizophrenic patients participating in a manualized skills training program, neuropsychological functioning was found to be an important mediating variable. Executive functioning capacity was positively associated with level of participation in the training groups, and deficits in sustained attention together with negative symptoms correlated negatively with overall program attendance. Neuropsychological functioning should be considered as an important assessment domain when identify~g. patients with minimal requirements to begin skills trammg.
~((.
EEG CHANGES AND PERFORMANCE IN SPAN OF APPREHENSION IN PATIENTS WITH EARLY PSYCHOSIS
SAT values were divided by resting EEG, duration of illness, dosage of medication, and level of education. Interestingly, number of correct answers on three letters' level showed no significant differences between patients with or without EEG abnormalities, but did so on twelve letters' level. The same result, was found for incorrect answers. Level of education significantly differentiated reaction time for correct and incorrect answers. Dosages of antipsychotic medication under ISO chlorpromazine equivalents had to slightly higher reaction times of incorrect answers. These results show that EEG abnormalities are related to di1licu1ties in attention and that dosages of antipsychotic medication influences reaction time.
'111 EFFECTS OF ORAL ZIPRASIDONE AND RISPERIDONE ON COGNITIVE FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA OR SCHIZOAFFECTIVE DISORDER: PRELIMINARY DATA Damon Mitchell, Corinne Hagger, Alexandra L. Wise, S. Charles Schulz DepartmentofPsychiatry, Case Western Reserve University. 11100EuclidAve., Cleveland, on 44106, USA The present study was designed to evaluate the effects of two atypical antipsychotic agents (ziprasidone, risperidone) on cognitive functioning in outpatients with schizophrenia or schizoaffective disorder over 52 weeks. The study utilized an openlabel, randomized treatment design. Following a 3-14 day stabilization period (baseline), patients were treated with either ziprasidone (40-80 mg, BID) or risperidone (3-5 mg, BID). Neuropsychological tests were administered at baseline (NII), after six weeks of drug treatment (N = 8), and after one year or at premature termination (N=5). Tests included measures of general cognitive functioning (NAART-R, WAIS-R), verbal fluency ('F. A, S'), attention (PASAT; TrailMaking Test, Part A), memory (BVRT, CVLT), and executive functioning (TrailMaking Test, Part B; WeST). Preliminary analysis of the data did not show significant cognitive improvement following ziprasidone treatment. There were no significant differences between ziprasidone and risperidone in alleviating cognitive deficits. However, trends toward improvement were observed on some measures. Furthermore, some data suggest a possible differential effectiveness between the two agents.
Marco c.o. Merlo, Helene Hofer, Hans D. Brenner
31g UNILATERAL OLFACTORY FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA
Psychiatric InstitutionsBerne East, University ofBerne. 3000 Berne60. Switzerland
Paul J. Moberg, Bruce I. Turetsky, Richard Doty, Donald McKeown, Ruben e. Gur, Raquel E. Gur
. Twen~y-four . patients
d~agnosls of schizophrenic, schizoaffective, or schizophreniform
DepartmentofPsychiatry, University ofPennsylvania, Philadelphia PA /9104. USA
disorder) were tested with a computerized version of Span of Apprehension Test (SAT) during postacute phase. Two levels of complexity were presented by three and twelve letters. The
Deficits in olfactory processing have been well-
with early psychosis (DSM-IV