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Schizophrenia patients with high intelligence: A clinically distinct sub-type of schizophrenia?

  • E. Černis (a1), E. Vassos (a1), G. Brébion (a2), P.J. McKenna (a3), R.M. Murray (a1), A.S. David (a1) and J.H. MacCabe (a1)...



Schizophrenia patients are typically found to have low IQ both pre- and post-onset, in comparison to the general population. However, a subgroup of patients displays above average IQ pre-onset. The nature of these patients’ illness and its relationship to typical schizophrenia is not well understood. The current study sought to investigate the symptom profile of high-IQ schizophrenia patients.


We identified 29 schizophrenia patients of exceptionally high pre-morbid intelligence (mean estimated pre-morbid intelligence quotient (IQ) of 120), of whom around half also showed minimal decline (less than 10 IQ points) from their estimated pre-morbid IQ. We compared their symptom scores (SAPS, SANS, OPCRIT, MADRS, GAF, SAI-E) with a comparison group of schizophrenia patients of typical IQ using multinomial logistic regression.


The patients with very high pre-morbid IQ had significantly lower scores on negative and disorganised symptoms than typical patients (RRR = 0.019; 95% CI = 0.001, 0.675, P = 0.030), and showed better global functioning and insight (RRR = 1.082; 95% CI = 1.020, 1.148; P = 0.009). Those with a minimal post-onset IQ decline also showed higher levels of manic symptoms (RRR = 8.213; 95% CI = 1.042, 64.750, P = 0.046).


These findings provide evidence for the existence of a high-IQ variant of schizophrenia that is associated with markedly fewer negative symptoms than typical schizophrenia, and lends support to the idea of a psychosis spectrum or continuum over boundaried diagnostic categories.


Corresponding author

Corresponding author at: University of Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX. Tel.: +44 779 205 1130. E-mail (E. Černis).


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[1]Aleman, A., Agrawal, N., Morgan, K.D., David, A.S.. Insight in psychosis and neuropsychological function: meta-analysis. Brit J Psychiatry 2006;189:204212.
[2]Ammari, N., Heinrichs, R.W., Miles, A.A.. An investigation of 3 neurocognitive subtypes in schizophrenia. Schizophr Res 2010;121(1–3):3238.
[3]Anderson, D., Ardekani, B.A., Burdick, K.E., Robinson, D.G., John, M., Malhotra, A.K., et al.Overlapping and distinct grey and white matter abnormalities in schizophrenia and bipolar I disorder. Bipolar Disord 2013;15(6):680693.
[4]Andreasen, N.Scale for the assessment of negative symptoms (SANS). University of Iowa; 1984.
[5]Andreasen, N.Scale for the assessment of positive symptoms (SAPS). University of Iowa; 1984.
[6]Carlsson, R., Nyman, H., Ganse, G., Cullberg, J.. Neuropsychological functions predict 1- and 3-year outcome in first-episode psychosis. Acta Psychiatr Scand 2006;113(2):102111.
[7]Cvetić, T., Vuković, O.. Cognitive deficit in schizophrenia: comparative analysis of positive and negative subtype and predictors of positive subtype. Psychiatr Danub 2006;18(1–2):411.
[8]de Gracia Dominguez, M., Viechtbauer, W., Simons, C.J.P., van Os, J., Krabbendam, L.. Are psychotic psychopathology and neurocognition orthogonal? A systematic review of their associations. Psychol Bull 2009;135(1):157171.
[9]Demjaha, A., MacCabe, J.H., Murray, R.M.. How genes and environmental factors determine the different neurodevelopmental trajectories of schizophrenia and bipolar disorder. Schizophr Bull 2012;38(2):209214.
[10]Endicott, J., Spitzer, R.L., Fleiss, J.L., Cohen, J.. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976;33(6):766771.
[11]Heinrichs, W., Ammari, N., McDermid Vaz, S., Miles, A., Muharib, E.Above average intellectual ability and functional status in schizophrenia. Schizophr Bull 2011;267 [Conference: 13th International Congress on Schizophrenia Research, ICOSR Colorado Springs, CO United States. Conference Start: 20110402 Conference End: 20110406. Conference Publication: 37].
[12]Higier, R.G., Jimenez, A.M., Hultman, C.M., Borg, J., Roman, C., Kizling, I., et al.Enhanced neurocognitive functioning and positive temperament in twins discordant for bipolar disorder. Am J Psychiatry 2014;171(11):11911198.
[13]Kemp, R., David, A.Insight and compliance. In: Blackwell, , editor. Compliance and the treatment alliance in serious mental illness. Amsterdam: Hardwood Academic Publishers; 1997. p. 6186.
[14]Koenen, K.C., Moffitt, T.E., Roberts, A.L., Martin, L.T., Kubzansky, L., Harrington, H., et al.Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. Am J Psychiatry 2009;166(1):5057.
[15]Kremen, W.S., Seidman, L.J., Faraone, S.V., Toomey, R., Tsuang, M.T.. The paradox of normal neuropsychological function in schizophrenia. J Abnorm Psychol 2000;109(4):743752.
[16]Leeson, V.C., Barnes, T.R.E., Hutton, S.B., Ron, M.A., Joyce, E.M.. IQ as a predictor of functional outcome in schizophrenia: a longitudinal, four-year study of first-episode psychosis. Schizophr Res 2009;107(1):5560.
[17]Leeson, V.C., Sharma, P., Harrison, M., Ron, M.A., Barnes, T.R., Joyce, E.M.. IQ trajectory, cognitive reserve, and clinical outcome following a first episode of psychosis: a 3-year longitudinal study. Schizophr Bull 2011;37(4):768777.
[18]MacCabe, J.H.. Population-based cohort studies on premorbid cognitive function in schizophrenia. Epidemiol Rev 2008;30:7783.
[19]MacCabe, J.H., Aldouri, E., Fahy, T.A., Sham, P.C., Murray, R.M.. Do schizophrenic patients who managed to get to university have a non-developmental form of illness?. Psychol Med 2002;32:535544.
[20]MacCabe, J.H., Lambe, M.P., Cnattingius, S., Sham, P.C., David, A.S., Reichenberg, A., et al.Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. Br J Psychiatry 2010;196:109115.
[21]MacCabe, J.H., Brébion, G., Reichenberg, A., Ganguly, T., McKenna, P.J., Murray, R.M., et al.Superior intellectual ability in schizophrenia: neuropsychological characteristics. Neuropsychology 2012;26(2):181190.
[22]McGuffin, P., Farmer, A., Harvey, I.. A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Arch Gen Psychiatry 1991;48(8):764770.
[23]Montgomery, S.A., Asberg, M.. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134(4):382389.
[24]Nelson, H.E., Willison, J.R.The revised national adult reading test–test manual. Windsor, UK: NFER-Nelson; 1991.
[25]Nurnberger, J.I., Blehar, M.C., Kaufmann, C.A., York-Cooler, C., Simpson, S.G., Harkavy-Friedman, J., et al.Diagnostic interview for genetic studies: rationale, unique features, and training. Arch Gen Psychiatry 1994;51(11):849859.
[26]Perez-Iglesias, R., Tordesillas-Gutierrez, D., McGuire, P.K., Barker, G.J., Roiz-Santianez, R., Mata, I., et al.White matter integrity and cognitive impairment in first-episode psychosis. Am J Psychiatry 2010;167(4):451458.
[27]Russo, M., Kravariti, E., Demjaha, A., Dazzan, P., Morgan, C., Murray, R.M., et al.The relationship between neuropsychological functioning and symptom dimensions in first-episode psychosis. Schizophr Res 2010 [Conference: 2nd Schizophrenia International Research Society Conference, SIRS 2010 Florence Italy. Conference Start: 20100410 Conference End: 20100414. Conference Publication:117(2–3):175–6].
[28]Stirling, J., White, C., Lewis, S., Hopkins, R., Tantam, D., Huddy, A., et al.Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort. Schizophr Res 2003;65(2–3):7586.
[29]Vassos, E.Narrowing the schizophrenia phenotype: a twin study of symptom dimensions. In: Conference: 18th World Congress on Psychiatric Genetics; 2010.
[30]Wechsler, D.Wechsler adult intelligence scale, 3rd ed., San Antonio: TX: The Psychological Corporation; 1997.
[31]Wexler, B.E., Zhu, H., Bell, M.D., Nicholls, S.S., Fulbright, R.K., Gore, J.C., et al.Neuropsychological near normality and brain structure abnormality in schizophrenia. Am J Psychiatry 2009;166(2):189195.
[32]Woodberry, K.A., Giuliano, A.J., Seidman, L.J.Premorbid IQ in schizophrenia: a meta-analytic review. Am J Psychiatry 2008;165(5):579587.


Schizophrenia patients with high intelligence: A clinically distinct sub-type of schizophrenia?

  • E. Černis (a1), E. Vassos (a1), G. Brébion (a2), P.J. McKenna (a3), R.M. Murray (a1), A.S. David (a1) and J.H. MacCabe (a1)...


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Schizophrenia patients with high intelligence: A clinically distinct sub-type of schizophrenia?

  • E. Černis (a1), E. Vassos (a1), G. Brébion (a2), P.J. McKenna (a3), R.M. Murray (a1), A.S. David (a1) and J.H. MacCabe (a1)...
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