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Community Outcome in Cognitively Normal Schizophrenia Patients

Published online by Cambridge University Press:  01 August 2014

Eva Muharib*
York University, Toronto, Ontario, Canada
R. Walter Heinrichs
York University, Toronto, Ontario, Canada
Ashley Miles
York University, Toronto, Ontario, Canada
Farena Pinnock
York University, Toronto, Ontario, Canada
Stephanie McDermid Vaz
Cleghorn Early Intervention in Psychosis Program, Hamilton, Ontario, Canada St. Joseph’s Healthcare, Hamilton, Ontario, Canada & McMaster University, Hamilton, Ontario, Canada
Narmeen Ammari
York University, Toronto, Ontario, Canada
Correspondence and reprint requests to: Eva Muharib, Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3. E-mail:


Recent reports suggest that cognition is relatively preserved in some schizophrenia patients. However, little is known about the functional advantage these patients may demonstrate. The purpose of this study was to identify cognitively normal patients with a recently developed test battery and to determine the functional benefit of this normality relative to cognitively impaired patients. Average-range cognitive ability was defined by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) composite score (T≥40) and applied to 100 patients with schizophrenia or schizoaffective disorder and to 81 non-psychiatric research participants. With group assignment adjusted for demographic variables, this procedure yielded 14 cognitively normal patients, 21 cognitively impaired patients, and 21 healthy adults with normal-range MCCB scores. Cognitively normal patients were indistinguishable from controls across all MCCB scales. Furthermore, their performance was superior to impaired patients on all scales except Social Cognition. Cognitively normal patients were also superior to impaired patients on a summary index of simulated life skills and functional competence. Nevertheless, both patient groups were equally disadvantaged relative to controls in independent community living. These findings suggest that normal-range cognition exists in schizophrenia, but fails to translate into enhanced community outcome. (JINS, 2014, 20, 1–7)

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Copyright © The International Neuropsychological Society 2014 

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Albert, N., Bertelsen, M., Thorup, A., Petersen, L., Jeppesen, P., Le Quack, P., Nordentoft, M. (2011). Predictors of recovery from psychosis analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5 years. Schizophrenia Research, 125, 257266.CrossRefGoogle ScholarPubMed
Ammari, N., Heinrichs, R.W., & Miles, A.A. (2010). An investigation of 3 neurocognitive subtypes in schizophrenia. Schizophrenia Research, 121, 3238.CrossRefGoogle Scholar
August, S.M., Kiwanuka, J.N., McMahon, R.P., & Gold, J.M. (2012). The MATRICS Consensus Battery (MCCB): Clinical and cognitive correlates. Schizophrenia Research, 134, 7682.CrossRefGoogle ScholarPubMed
Bowie, C.R., & Harvey, P.D. (2006). Cognitive deficits and functional outcome in schizophrenia. Journal of Neuropsychiatric Disease and Treatment, 2, 531536.CrossRefGoogle Scholar
Bowie, C.R., McGurk, S.R., Mausbach, B., Patterson, T.L., & Harvey, P.D. (2012). Combined cognitive remediation and functional skills training for schizophrenia: Effects on cognition, functional competence, and real-world behavior. American Journal of Psychiatry, 169, 1018.CrossRefGoogle ScholarPubMed
Bowie, C.R., Reichenberg, A., Patterson, T.L., Heaton, R.K., & Harvey, P.D. (2006). Determinants of real-world functional performance in schizophrenia subjects: Correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry, 163, 418425.CrossRefGoogle Scholar
Bowie, C.R., Twamley, E.W., Anderson, H., Halpern, B., Patterson, T.L., & Harvey, P.D. (2007). Self-assessment of functional status in schizophrenia. Journal of Psychiatric Research, 41, 10121018.CrossRefGoogle Scholar
Bromley, E., Mikesell, L., Mates, A., Smith, M., & Brekke, J.S. (2012). A video ethnography approach to assessing the ecological validity of neurocognitive and functional measures in severe mental illness: Results from a feasibility study. Schizophrenia Bulletin, 38, 981991.CrossRefGoogle ScholarPubMed
Dickinson, D., Ramsey, M.E., & Gold, J.M. (2007). Overlooking the obvious: A meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry, 64(5), 532542.CrossRefGoogle Scholar
Dickinson, D., Tenhula, W., Morris, S., Brown, C., Peer, J., Spencer, K., Bellack, A.S. (2010). A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia. The American Journal of Psychiatry, 167, 170180.CrossRefGoogle Scholar
Eack, S.M., Greeno, C.G., Pogue-Geile, M.F., Newhill, C.E., Hogarty, G.E., & Keshavan, M.S. (2010). Assessing social-cognitive deficits in schizophrenia with the Mayer-Salovey-Caruso Emotional Intelligence Test. Schizophrenia Bulletin, 36(2), 370380.CrossRefGoogle ScholarPubMed
Fett, A.K., Viechtbauer, W., Dominguez, M.D., Penn, D.L., van Os, J., & Krabbendam, L. (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis. Neuroscience and Biobehavioral Reviews, 35(3), 573588.CrossRefGoogle ScholarPubMed
First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B. (1996). Structured clinical interview for DSM-IV axis I disorders: Non-patient edition (SCID-I/NP). New York: New York.Google Scholar
Green, M.F., Kern, R.S., Braff, D.L., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the “right stuff”? Schizophrenia Bulletin, 26(1), 119136.CrossRefGoogle Scholar
Harvey, P.D., Keefe, R.S., Patterson, T.L., Heaton, R.K., & Bowie, C.R. (2009). Abbreviated neuropsychological assessment in schizophrenia: Prediction of different aspects of outcome. Journal of Clinical and Experimental Neuropsychology, 31, 462471.CrossRefGoogle Scholar
Heinrichs, R.W. (2005). The primacy of cognition in schizophrenia. American Psychologist, 60(3), 229242.CrossRefGoogle ScholarPubMed
Heinrichs, R.W., Miles, A., Smith, D., Zargarian, T., McDermid Vaz, S., Goldberg, J.O., &Ammari, N. (2008). Cognitive, clinical, and functional characteristics of verbally superior schizophrenia patients. Neuropsychology, 22(3), 321328.CrossRefGoogle ScholarPubMed
Heinrichs, R.W., & Zakzanis, K.K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12, 426445.CrossRefGoogle Scholar
Jaeger, J., Berns, S.M., & Czobor, P. (2003). The multidimensional scale of independent functioning: A new instrument for measuring functional disability in psychiatric populations. Schizophrenia Bulletin, 29(1), 153167.CrossRefGoogle ScholarPubMed
Kern, R.S., Nuechterlein, K.H., Green, M.F., Baade, L.E., Fenton, W.S., Gold, J.M., Marder, S.R. (2008). The MATRICS Consensus Cognitive Battery, Part 2: Co-norming and standardization. The American Journal of Psychiatry, 165, 214220.CrossRefGoogle ScholarPubMed
Kern, R.S., Gold, J.M., Dickinson, D., Green, M.F., Nuechterlein, K.H., Baade, L.E., Marder, S.R. (2011). The MCCB impairment profile for schizophrenia outpatients: Results from the MATRICS psychometric and standardization study. Schizophrenia Research, 126, 124131.CrossRefGoogle ScholarPubMed
Kremen, W.S., Seidman, L.J., Faraone, S.V., Toomey, R., & Tsuang, M.T. (2000). The paradox of normal neuropsychological function in schizophrenia. Journal of Abnormal Psychology, 109(4), 743752.CrossRefGoogle Scholar
Kremen, W.S., Seidman, L.J., Faraone, S.V., & Tsuang, M.T. (2001). Intelligence quotient and neuropsychological profiles in patients with schizophrenia and normal volunteers. Society of Biological Psychiatry, 50, 453462.CrossRefGoogle ScholarPubMed
Leung, W.W., Bowie, C.R., & Harvey, P.D. (2008). Functional implications of neuropsychological normality and symptom remission in older outpatients diagnosed with schizophrenia: A cross-sectional study. Journal of International Neuropsychological Society, 14, 479488.CrossRefGoogle ScholarPubMed
MacCabe, J.H., Brebion, G., Reichenberg, A., Ganguly, T., McKenna, P.J., Murray, R.M., & David, A.S. (2012). Superior intellectual ability in schizophrenia: Neuropsychological characteristics. Neuropsychology, 26(2), 181190.CrossRefGoogle ScholarPubMed
McKibbin, C.L., Brekke, J.S., Sires, D., Jeste, D.V., & Thomas, L.P. (2004). Direct assessment of functional abilities: Relevance to persons with schizophrenia. Schizophrenia Research, 72, 5367.CrossRefGoogle ScholarPubMed
Nuechterlein, K.H., Green, M.F., Kern, R.S., Baade, L.E., Barch, D.M., Cohen, J.D., Marder, S.R. (2008). The MATRICS Consensus Cognitive Battery, part 1: Test selection, reliability, and validity. The American Journal of Psychiatry, 165(2), 203213.CrossRefGoogle ScholarPubMed
Opler, L.A., Kay, S.R., Lindenmayer, J.P., & Fiszbein, A. (1999). Structured clinical interview: The Positive and Negative Syndrome Scale (SCI-PANSS). North Tonawanda, NY: Multi-Health Systems Inc.Google Scholar
Palmer, B.W., Keaton, R.K., Paulsen, J.S., Kuck, J., Braff, D., Harris, M.J., Jeste, D.V. (1997). Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology, 11(3), 437446.CrossRefGoogle ScholarPubMed
Patterson, T.L., Goldman, S., McKibbin, C.L., Hughs, T., & Jeste, D.V. (2001). UCSD performance-based skills assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin, 27(2), 235245.CrossRefGoogle ScholarPubMed
Psychological Corporation. (1999). Wechsler Abbreviated Scale of Intelligence (WASI) manual. San Antonio, TX: Psychological Corporation.Google ScholarPubMed
Schmidt, S.J., Mueller, D.R., & Roder, V. (2011). Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: Empirical review and new results by structural equation modeling. Schizophrenia Bulletin, 37(S2), 4154.CrossRefGoogle ScholarPubMed
Shamsi, S., Lau, A., Lencz, T., Burdick, K.E., DeRosse, P., Brenner, R., Malhotra, A.K. (2011). Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophrenia Research, 126(1–3), 257264.CrossRefGoogle Scholar
Silverstein, S.M., All, S.D., & Jaeger, J. (2011). Cognition-UPSA score relationships: A further analysis of Silverstein et al. (2010) data and some caveats. Psychiatry Research, 187(3), 424431.CrossRefGoogle ScholarPubMed
Velligan, D.I., Mahurin, R.K., Diamond, P.L., Hazelton, B.C., Eckert, S.L., & Miller, A.L. (1997). The functional significance of symptomatology and cognitive function in schizophrenia. Schizophrenia Research, 25, 2131.CrossRefGoogle Scholar
Weickert, T.W., Goldberg, T.E., Gold, J.M., Bigelow, L.B., Egan, M.F., & Weinberger, D.R. (2000). Cognitive impairments in patients with schizophrenia displaying preserved and compromised intellect. Archives of General Psychiatry, 57, 907913.CrossRefGoogle Scholar
Wilkinson, G.S., & Robertson, G. (2006). WRAT-4: The Wide Range Achievement test administration manual (4th ed.). Wilmington, DE: Wide Range.Google Scholar
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