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Neuropsychological impairment in first episode and chronic schizophrenic patients
223
The opposite effects of antipsychotic treatment on Negative Priming are consistent with the Kraepelinian distinction between schizophrenic and affective psychoses. The implications for attentional theories of schizophrenia are ambiguous because it is unclear whether the direction of the treatment effect on Negative Priming or its absolute level is the better measure of normalisation. The effect of anti-psychotic treatment on Negative Priming in schizophrenics parallels that in healthy sinistrals.
XIII.G. 1 CONTRASTS IN NEUROPSYCHOLOGICAL TEST PROFILE BETWEEN FIRST EPISODE PATIENTS WITH SCHIZOPHRENIA OR AFFECTIVE DISORDERS M. Albus, W. H u b m a n n , N. Sobizack, C. Wahlheirn and F. M o h r
XIII.F.9 HALOPERIDOL REDUCES STROOP INTERFERENCE AND INCREASES NEGATIVE PRIMING IN HEALTHY PEOPLE J.H. Williams 1, N.A. Wellman 1, D.P. Geaney 2, P.J. Cowen 2, J. Feldon 3 and J.N.P. Rawlins 1
Depts of Experimental Psychology 1 & Psychiatry 2, Oxford & Institute of Toxicology 3, Zurich, Switzerland Clinically, schizophrenics have impaired attention. If attentional impairments contribute to schizophrenic symptoms, then antipsychotic drugs may exert their therapeutic effects partly by effects on attention. We analysed the effects of small doses of haloperidol in healthy volunteers on two tests which measure aspects of attention: Stroop interference and Negative Priming. 159 healthy subjects received intravenous injections of saline or haloperidol (0.5 mg or 1.0mg) double-blind. They then completed a computerised serial Stroop colour-naming task in which some stimuli were negatively primed. Haloperidol reduced Stroop interference and increased Negative Priming, irrespective of dose:-
Stroop interference Negative Priming
XIII.G. Other
(ms+sem) (ms + sem)
Salinetreated
Haloperidoltreated
81.6+3.7 14.2 + 3.3
70.4+4.1 24.3 ___4.2
The Stroop results indicate that haloperidol strengthened inhibition of responses to distracting colour words. The Negative Priming results confirm the persistence of this drug-enhanced inhibition to the next trial (cf. Beech et al., 1990, PAID 11, 1141). Thus, antipsychotics can enhance the ability to inhibit responses to seemingly irrelevant stimuli: this may contribute to their therapeutic action. However, strikingly, the direction of the haloperidol effect on Negative Priming was reversed in sinistrals.
State Mental Hospital Haar, Vockestrafle 72, 85529 Haar, Germany Patients with first episode (FE) DSM-III-R schizophrenia (n = 27), unipolar depression (n = 10), bipolar disorder (n = 17) and age and gender-matched controls (n=27) balanced for education and for parental socioeconomic status were administered a battery of standardized neuropsychological (NP) tests (Wisconsin Card Sorting Test, WAIS-R, Wechsler Memory Scale, California Verbal Learning Test, Trail Making Test, Stroop Color Word Test, Reading Span Test, Continuous Performance Test, Span of Apprehension). FE schizophrenics performed significantly worse compared to affective patients in the area of visual motor processing and attention. Affective patients without psychotic features were not significantly different compared to controls. However, affective patients with psychotic features performed as poor as schizophrenics with the most pronounced impairment in the area of visual motor processing and attention. Thus, the presence of psychotic features has considerable impact on NP performance. Our data tentatively suggest the assumption of a 'continuum of cognitive impairment' ranging from (less impaired affective disorders without psychotic features to more impaired affective disorders with psychotic features and schizophrenia. *Supported by a grant of the German Research Foundation.
XIII.G.2 NEUROPSYCHOLOGICAL IMPAIRMENT FIRST EPISODE AND CHRONIC SCHIZOPHRENIC PATIENTS
IN
M. Albus, W. Hubmann, C. Ehrenberg, U. Forcht, F. Mohr, N. Sobizack and C. Wahlheim
State Mental Hospital Haar, Vockestrafle 72, 85529 Haar, Germany Patients with first episode (FE, n = 37), with chronic schizophrenia (n = 41 ) and age and gender-matched controls (n = 40) balanced for education and for parental socioeconomic status were administered a battery of standardized neuropsychological (NP) tests (Wisconsin Card Sorting Test, WAIS-R, Wechsler Memory Scale, California Verbal Learning Test, Trail Making
224
Test, Stroop Color Word Test, Reading Span Test, Continuous Performance Test, Span of Apprehension). Both patient groups showed generalized impairment relative to controls. While FE schizophrenics showed most pronounced deficits in verbal learning and visual-motor-processing and attention (VSM), chronic schizophrenics showed the most pronounced deficits in VSM and abstraction-flexibility. The deficit pattern is consistent with general involvement of the prefrontal and temporalhippocampal system in FE schizophrenics and more pronounced impairment of frontal functions in chronic schizophrenics. Our findings support the hypothesis that NP deficits are fundamental manifestations of the illness and tentatively suggest that more pronounced frontally based dysfunctions are more prominent in chronic, Kraepelinian patients. *Supported by a grant of the German Research Foundation.
XIII.G.3 COGNITIVE A N D SOCIAL FUNCTIONING IN SCHIZOPHRENIA OUTPATIENTS WHO ABUSE SUBSTANCES J. A d d i n g t o n a n d D. A d d i n g t o n
Department of Psychiatry, University of Calgary, Foothills Hospital, 1403 29th Street, NW, Calgary, Alberta, Canada T2N 2T9 Individuals with schizophrenia have an increased vulnerability to abuse drugs or alcohol. The literature suggests that substance abuse interferes with the course and treatment of the disorder. This study is a cross-sectional design, comparing social and cognitive functioning and symptoms of 33 schizophrenia subjects who abuse substances (SA) with 33 nonabusing schizophrenia subjects (NSA). Subjects were matched on sex, age and education and were all outpatients. Social functioning, quality of life and interpersonal problem solving were assessed. Cognitive functioning included assessment of verbal ability, attention, executive functioning, and verbal and visual memory. NSA subjects had higher scores on measures of social functioning, in particular on Quality of Life (p < 0.001 ). SA subjects had higher levels of positive symptoms (p<0.05), more admissions and more recent admissions (p<0.01). There were no differences between the two groups on any measure of cognitive functioning. Although substance abuse does not appear to affect already compromised cognitive functioning, it does impact symptomatic status, need for hospitalization and quality of life.
XIII.G.4 THERAPY MONITORING WITH PREPULSE INHIBITION IN AN ACTIVE AUDITORY DISCRIMINATION IN PATIENTS WITH SCHIZOPHRENIA S. Bender, J. Wolstein, M. Butorac, I. Grzella, K. O r t m a n n , D. Zerbin, U. Schall a n d R.D. Oades
The University of Essen, Clinicfor General Psychiatry & Clinic .['or ChiM and Adolescent Psychiatry, Virchowstrafle 174, 45147 Essen, Germany Sensory gating deficits in schizophrenics as measured by prepulse inhibition (PPI) of the startle reflex or by the conditioning/testing procedure of the event-related potential (ERP) are indicators of impaired automatic information processing. If the prepulse precedes a target in an auditory discrimination, the selective aspect of perception, namely attention interferes with PPI as indicated by increased errors of commission and omission in schizophrenic patients (1). PPI in an active auditory discrimination is measured here in the course of neuroleptic treatment of young schizophrenic inpatients in order to monitor the therapeutic response. Symptoms (BPRS and PANSS), cognitive functions (Tower of London and Covert Orienting of Attention) and monoamine metabolites were assessed immediately before and then two and six months after therapy onset. The psychobiological measures were compared with non-medicated healthy volunteers. Preliminary results for 10 schizophrenic patients after 2 months indicate a significant improvement of positive and negative symptoms but no improvement on cognitive test performance. PPI measures on ERPs confirm a sensory gating deficit in schizophrenia and a prepulse interval (0/100/500 ms) by stimulus type (target/non-target) interaction of P3b amplitude measures indicating an interference of PPI with active discrimination. However, no change of ERP measures was found following two months of neuroleptic treatment. Supported by the Deutsche Forschungsgemeinschaft. References 1. Schall, U. et al. (1996) Intern. J. Neuroscience, in press.
XIII.G.5 OLFACTORY AND NEUROPSYCHOLOGICAL DEFICITS IN FIRST EPISODE PSYCHOSIS W.J. Brewer, D.J. Smith, D. Velakoulis, V. A n d e r s o n , P. M c G o r r y , D. Copolov, B. Singh a n d C. Pantelis
Schizophrenia Research Unit & Cognitive Neuropsychiatry Unit, Mental Health Research Institute & The Royal Melbourne Hospital Private Bag 11, Parkville, 3052, Vic., Australia
The opposite effects of antipsychotic treatment on Negative Priming are consistent with the Kraepelinian distinction between schizophrenic and affective psychoses. The implications for attentional theories of schizophrenia are ambiguous because it is unclear whether the direction of the treatment effect on Negative Priming or its absolute level is the better measure of normalisation. The effect of anti-psychotic treatment on Negative Priming in schizophrenics parallels that in healthy sinistrals.
XIII.G. 1 CONTRASTS IN NEUROPSYCHOLOGICAL TEST PROFILE BETWEEN FIRST EPISODE PATIENTS WITH SCHIZOPHRENIA OR AFFECTIVE DISORDERS M. Albus, W. H u b m a n n , N. Sobizack, C. Wahlheirn and F. M o h r
XIII.F.9 HALOPERIDOL REDUCES STROOP INTERFERENCE AND INCREASES NEGATIVE PRIMING IN HEALTHY PEOPLE J.H. Williams 1, N.A. Wellman 1, D.P. Geaney 2, P.J. Cowen 2, J. Feldon 3 and J.N.P. Rawlins 1
Depts of Experimental Psychology 1 & Psychiatry 2, Oxford & Institute of Toxicology 3, Zurich, Switzerland Clinically, schizophrenics have impaired attention. If attentional impairments contribute to schizophrenic symptoms, then antipsychotic drugs may exert their therapeutic effects partly by effects on attention. We analysed the effects of small doses of haloperidol in healthy volunteers on two tests which measure aspects of attention: Stroop interference and Negative Priming. 159 healthy subjects received intravenous injections of saline or haloperidol (0.5 mg or 1.0mg) double-blind. They then completed a computerised serial Stroop colour-naming task in which some stimuli were negatively primed. Haloperidol reduced Stroop interference and increased Negative Priming, irrespective of dose:-
Stroop interference Negative Priming
XIII.G. Other
(ms+sem) (ms + sem)
Salinetreated
Haloperidoltreated
81.6+3.7 14.2 + 3.3
70.4+4.1 24.3 ___4.2
The Stroop results indicate that haloperidol strengthened inhibition of responses to distracting colour words. The Negative Priming results confirm the persistence of this drug-enhanced inhibition to the next trial (cf. Beech et al., 1990, PAID 11, 1141). Thus, antipsychotics can enhance the ability to inhibit responses to seemingly irrelevant stimuli: this may contribute to their therapeutic action. However, strikingly, the direction of the haloperidol effect on Negative Priming was reversed in sinistrals.
State Mental Hospital Haar, Vockestrafle 72, 85529 Haar, Germany Patients with first episode (FE) DSM-III-R schizophrenia (n = 27), unipolar depression (n = 10), bipolar disorder (n = 17) and age and gender-matched controls (n=27) balanced for education and for parental socioeconomic status were administered a battery of standardized neuropsychological (NP) tests (Wisconsin Card Sorting Test, WAIS-R, Wechsler Memory Scale, California Verbal Learning Test, Trail Making Test, Stroop Color Word Test, Reading Span Test, Continuous Performance Test, Span of Apprehension). FE schizophrenics performed significantly worse compared to affective patients in the area of visual motor processing and attention. Affective patients without psychotic features were not significantly different compared to controls. However, affective patients with psychotic features performed as poor as schizophrenics with the most pronounced impairment in the area of visual motor processing and attention. Thus, the presence of psychotic features has considerable impact on NP performance. Our data tentatively suggest the assumption of a 'continuum of cognitive impairment' ranging from (less impaired affective disorders without psychotic features to more impaired affective disorders with psychotic features and schizophrenia. *Supported by a grant of the German Research Foundation.
XIII.G.2 NEUROPSYCHOLOGICAL IMPAIRMENT FIRST EPISODE AND CHRONIC SCHIZOPHRENIC PATIENTS
IN
M. Albus, W. Hubmann, C. Ehrenberg, U. Forcht, F. Mohr, N. Sobizack and C. Wahlheim
State Mental Hospital Haar, Vockestrafle 72, 85529 Haar, Germany Patients with first episode (FE, n = 37), with chronic schizophrenia (n = 41 ) and age and gender-matched controls (n = 40) balanced for education and for parental socioeconomic status were administered a battery of standardized neuropsychological (NP) tests (Wisconsin Card Sorting Test, WAIS-R, Wechsler Memory Scale, California Verbal Learning Test, Trail Making
224
Test, Stroop Color Word Test, Reading Span Test, Continuous Performance Test, Span of Apprehension). Both patient groups showed generalized impairment relative to controls. While FE schizophrenics showed most pronounced deficits in verbal learning and visual-motor-processing and attention (VSM), chronic schizophrenics showed the most pronounced deficits in VSM and abstraction-flexibility. The deficit pattern is consistent with general involvement of the prefrontal and temporalhippocampal system in FE schizophrenics and more pronounced impairment of frontal functions in chronic schizophrenics. Our findings support the hypothesis that NP deficits are fundamental manifestations of the illness and tentatively suggest that more pronounced frontally based dysfunctions are more prominent in chronic, Kraepelinian patients. *Supported by a grant of the German Research Foundation.
XIII.G.3 COGNITIVE A N D SOCIAL FUNCTIONING IN SCHIZOPHRENIA OUTPATIENTS WHO ABUSE SUBSTANCES J. A d d i n g t o n a n d D. A d d i n g t o n
Department of Psychiatry, University of Calgary, Foothills Hospital, 1403 29th Street, NW, Calgary, Alberta, Canada T2N 2T9 Individuals with schizophrenia have an increased vulnerability to abuse drugs or alcohol. The literature suggests that substance abuse interferes with the course and treatment of the disorder. This study is a cross-sectional design, comparing social and cognitive functioning and symptoms of 33 schizophrenia subjects who abuse substances (SA) with 33 nonabusing schizophrenia subjects (NSA). Subjects were matched on sex, age and education and were all outpatients. Social functioning, quality of life and interpersonal problem solving were assessed. Cognitive functioning included assessment of verbal ability, attention, executive functioning, and verbal and visual memory. NSA subjects had higher scores on measures of social functioning, in particular on Quality of Life (p < 0.001 ). SA subjects had higher levels of positive symptoms (p<0.05), more admissions and more recent admissions (p<0.01). There were no differences between the two groups on any measure of cognitive functioning. Although substance abuse does not appear to affect already compromised cognitive functioning, it does impact symptomatic status, need for hospitalization and quality of life.
XIII.G.4 THERAPY MONITORING WITH PREPULSE INHIBITION IN AN ACTIVE AUDITORY DISCRIMINATION IN PATIENTS WITH SCHIZOPHRENIA S. Bender, J. Wolstein, M. Butorac, I. Grzella, K. O r t m a n n , D. Zerbin, U. Schall a n d R.D. Oades
The University of Essen, Clinicfor General Psychiatry & Clinic .['or ChiM and Adolescent Psychiatry, Virchowstrafle 174, 45147 Essen, Germany Sensory gating deficits in schizophrenics as measured by prepulse inhibition (PPI) of the startle reflex or by the conditioning/testing procedure of the event-related potential (ERP) are indicators of impaired automatic information processing. If the prepulse precedes a target in an auditory discrimination, the selective aspect of perception, namely attention interferes with PPI as indicated by increased errors of commission and omission in schizophrenic patients (1). PPI in an active auditory discrimination is measured here in the course of neuroleptic treatment of young schizophrenic inpatients in order to monitor the therapeutic response. Symptoms (BPRS and PANSS), cognitive functions (Tower of London and Covert Orienting of Attention) and monoamine metabolites were assessed immediately before and then two and six months after therapy onset. The psychobiological measures were compared with non-medicated healthy volunteers. Preliminary results for 10 schizophrenic patients after 2 months indicate a significant improvement of positive and negative symptoms but no improvement on cognitive test performance. PPI measures on ERPs confirm a sensory gating deficit in schizophrenia and a prepulse interval (0/100/500 ms) by stimulus type (target/non-target) interaction of P3b amplitude measures indicating an interference of PPI with active discrimination. However, no change of ERP measures was found following two months of neuroleptic treatment. Supported by the Deutsche Forschungsgemeinschaft. References 1. Schall, U. et al. (1996) Intern. J. Neuroscience, in press.
XIII.G.5 OLFACTORY AND NEUROPSYCHOLOGICAL DEFICITS IN FIRST EPISODE PSYCHOSIS W.J. Brewer, D.J. Smith, D. Velakoulis, V. A n d e r s o n , P. M c G o r r y , D. Copolov, B. Singh a n d C. Pantelis
Schizophrenia Research Unit & Cognitive Neuropsychiatry Unit, Mental Health Research Institute & The Royal Melbourne Hospital Private Bag 11, Parkville, 3052, Vic., Australia