Skip to main content Accessibility help
×
Home

Cognitive heterogeneity in first-episode schizophrenia

  • Eileen M. Joyce (a1), Sam B. Hutton (a2), Stanley H. Mutsatsa (a3) and Thomas R. E. Barnes (a3)

Abstract

Background

Studies of chronic schizophrenia suggest that there are subgroups with different profiles of cognitive impairment.

Aims

To determine whether such heterogeneity is present at illness onset and any relationship to clinical variables.

Method

Ninety-three community patients with first-episode schizophrenia and 50 healthy volunteers were assessed for premorbid (Revised National Adult Reading Test) and current IQ, memory and executive function.

Results

Half of those with schizophrenia had preserved IQ in the normal range but there was evidence of a specific impairment in spatial working memory even in those with high/average IQ; 37 out of 93 (40%) had generalised cognitive decline. Those with low premorbid IQ were significantly younger at illness onset. For the entire group, age at onset correlated positively with premorbid but not current IQ.

Conclusions

At illness onset, cognitive heterogeneity is present in people with schizophrenia, with a high proportion having undergone general cognitive decline. However, working memory impairment may be a common feature. Lower premorbid IQ is a risk factor for an earlier onset.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Cognitive heterogeneity in first-episode schizophrenia
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Cognitive heterogeneity in first-episode schizophrenia
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Cognitive heterogeneity in first-episode schizophrenia
      Available formats
      ×

Copyright

Corresponding author

Dr Eileen Joyce, Institute of Neurology, University College London, Box 19, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. E-mail: e.joyce@ion.ucl.ac.uk

Footnotes

Hide All

Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes

References

Hide All
Addington, J. & Addington, D. (2000) Neurocognitive and social functioning in schizophrenia: a 2. 5 year follow-up study. Schizophrenia Research, 44, 4756.
Ambelas, A. (1992) Preschizophrenics: adding to the evidence, sharpening the focus. British Journal of Psychiatry, 160, 401404.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Andreasen, N. (1981) Scale for the Assessment of Negative Symptoms (SANS). Iowa City, IA: University of Iowa.
Andreasen, N. (1983) Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA: University of Iowa.
Barnes, T. R. E., Hutton, S. B., Chapman, M. J., et al (2000) West London first-episode study of schizophrenia: Clinical correlates of duration of untreated psychosis. British Journal of Psychiatry, 177, 207211.
Bedwell, J., Keller, B., Smith, A., et al (1999) Why does post-psychotic IQ decline in childhood-onset schizophrenia. American Journal of Psychiatry, 156, 19961997.
Blyler, C. R., Gold, J. M., Iannone, V. N., et al (2000) Short form of the WAIS-III for use with patients with schizophrenia. Schizophrenia Research, 46, 209215.
Crawford, J., Parker, D., Stewart, L., et al (1989) Prediction of WAIS IQ with the National Adult Reading Test; cross validation and extension. British Journal of Clinical Psychology, 28, 267273.
Crawford, J. R., Allan, K. M., Cochrane, R. H. B., et al (1990) Assessing the validity of using NART-estimated pre-morbid IQs in the individual case. British Journal of Clinical Psychology, 29, 435436.
Crawford, J. R., Besson, J. A., Bremner, M., et al (1992) Estimation of premorbid intelligence in schizophrenia. British Journal of Psychiatry, 161, 6974.
Crawford, J. R., Deary, I. J., Starr, J., et al (2001) The NARTas an index of prior intellectual functioning: a retrospective validity study covering a 66 year interval. Psychological Medicine, 31, 451458.
David, A., Malmberg, A., Brandt, L., et al (1997) IQ and risk for schizophrenia. A population based cohort study. Psychological Medicine, 27, 131132.
Davidson, M., Reichenberg, A., Rabinowitz, J., et al (1999) Behavioural and intellectual markers for schizophrenia in apparently healthy male adolescents. American Journal of Psychiatry, 156, 13281335.
Eberhard, J., Riley, F. & Levander, S. (2003) Premorbid IQ and schizophrenia. Increasing cognitive reduction by episodes. European Archives of Psychiatry and Clinical Neuroscience, 253, 8488.
Erlenmeyer-Kimling, L. & Cornblatt, B. (1987) The New York high-risk project. A follow-up report. Schizophrenia Bulletin, 13, 451461.
Erlenmeyer-Kimling, L., Rock, D., Squires-Wheeler, E., et al (1991) Early life precursors of psychiatric outcomes in adulthood in subjects at risk for schizophrenia or affective disorders. Psychiatry Research, 39, 239256.
Fuller, R., Nopoulos, P., Arndt, S., et al (2002) Longitudinal assessment of pre-morbid cognitive functioning in patients with schizophrenia through examination of standardised scholastic test performance. American Journal of Psychiatry, 158, 183189.
Glahn, D., Therman, S., Manninen, M., et al (2003) Spatial working memory as an endophenotype for schizophrenia. Biological Psychiatry, 53, 624626.
Gold, J. M., Goldberg, R. W., McNary, S. W., et al (2002) Cognitive correlates of job tenure among patients with severe mental illness. American Journal of Psychiatry, 159, 13951402.
Goldberg, T., Hyde, T., Kleinman, J., et al (1993) Course of schizophrenia: neuropsychological evidence for a static encephalopathy. Schizophrenia Bulletin, 19, 797804.
Goldstein, G. & Shermansky, W. (1995) Influences on cognitive heterogeneity in schizophrenia. Schizophrenia Research, 18, 5960.
Grimes, K. & Walker, E. (1994) Childhood emotional expression, educational attainment and age of onset of illness in schizophrenia. Journal of Abnormal Psychology, 103, 784790.
Gunnell, D., Harrison, G., Rasmussen, E., et al (2002) Associations between premorbid intellectual performance, early-life exposures and early-onset schizophrenia. Cohort study. British Journal of Psychiatry, 181, 298305.
Heinrichs, R. & Awad, A. (1993) Neurocognitive subtypes of chronic schizophrenia. Schizophrenia Research, 9, 4958.
Hill, S., Ragland, J., Gur, R. (2002) Neuropsychological profiles delineate distinct profiles of schizophrenia, an interaction between memory, executive function and uneven distribution of clinical subtypes. Journal of Clinical and Experimental Neuropsychology, 24, 765780.
Hutton, S. H., Puri, B. K., Duncan, L.-J., et al (1998) Executive function in first episode schizophrenia. Psychological Medicine, 28, 463473.
Hutton, S. B., Huddy, V., Barnes, T. R. E., et al (2004) The relationship between antisaccades, smooth pursuit and executive dysfunction in first episode schizophrenia. Biological Psychiatry, 56, 553559.
Jones, P., Murray, R., Rodgers, B., et al (1994) Child developmental risk factors for adult schizophreniain the British 1946 birth cohort. Lancet, 344, 13981402.
Kaufman, A. (1990) Assessing Adolescent and Adult Intelligence. Boston, MA: Allyn and Bacon.
Keshavan, M. (1999) Development, disease and degeneration in schizophrenia: a unitary patho-physiological model. Journal of Psychiatric Research, 33, 513521.
Kremen, W. S., Buka, S., Seidman, L. J., et al (1998) IQ decline during childhood and adult psychotic symptoms in a community sample: a 19-year longitudinal study. American Journal of Psychiatry, 155, 672677.
Kremen, W. S., Seidman, L. J., Faraone, S. V., et al (2001) Intelligence quotient and neuropsychological profiles in patients with schizophrenia and in normal volunteers. Biological Psychiatry, 50, 453462.
Liddle, P. F. & Barnes, T. R. (1990) Syndromes of chronic schizophrenia. British Journal of Psychiatry, 157, 558561.
Lieberman, J., Jody, D., Geisler, S., et al (1993) Time course and biological correlates of treatment response to first episode schizophrenia. Archives of General Psychiatry, 50, 369376.
Missar, C., Gold, J., Goldberg, T. (1994) WAIS–R short forms in chronic schizophrenia. Schizophrenia Research, 12, 247250.
Morrison, G., Sharkey, V., Allardyce, J., et al (2000) Nithsdale Schizophrenia Surveys: a longitudinal study of National Adult Reading Test stability. Psychological Medicine, 30, 717720.
Nelson, H. & O'Connell, A. (1978) Dementia: the estimation of pre-morbid intelligence levels using the new adult reading test. Cortex, 14, 234244.
Nelson, H. & Willison, J. (1991) The Revised National Adult Reading Test (NART) – Test Manual (2nd edn). Windsor: NFER-Nelson.
Nelson, H., Pantelis, C., Carruthers, K., et al (1990) Cognitive functioning and symptomology in chronic schizophrenia. Psychological Medicine, 20, 357365.
O'Carroll, R. (1987) The inter-rater reliability of the National Adult Reading Test (NART). A pilot study. British Journal of Clinical Psychology, 26, 229230.
O'Carroll, R. (1995) The assessment of pre-morbid ability. A critical review. Neurocase, 1, 8389.
O'Carroll, R., Walker, M., Dunan, J., et al (1992) Selecting controls for schizophrenia research studies: the use of the National Adult Reading Test (NART) as a measure of pre-morbid ability. Schizophrenia Research, 8, 137141.
Owen, A., Downes, J., Sahakian, B., et al (1990) Planning and spatial working memory following frontal lobe lesions in man. Neuropsychologia, 28, 10211034.
Owen, A. M., Roberts, A. C., Polkey, C. E., et al (1991) Extra-dimensional versus intra-dimensional set shifting performance following frontal lobe excisions, temporal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia, 29, 9931006.
Palmer, B., Heaton, R., Paulsen, J., et al (1997) Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology, 11, 437446.
Rabinowitz, J., Reichenberg, A., Weiser, M., et al (2000) Cognitive and behavioural functioning in men with schizophrenia both before and shortly after first admission to hospital. Cross-sectional analysis. British Journal of Psychiatry, 177, 2632.
Russell, A., Munro, J., Jones, P., et al (1997) Schizophrenia and the myth of intellectual decline. American Journal of Psychiatry, 154, 635639.
Russell, A. J., Munro, J., Jones, P. B., et al (2002) The National Adult Reading Test as a measure of premorbid IQ in schizophrenia. British Journal of Clinical Psychology, 39, 297305.
Sahakian, B. & Owen, A. (1992) Computerised assessment in neuropsychiatry using CANTAB. Journal of the Royal Society of Medicine, 85, 399402.
Sahakian, B., Morris, R., Evenden, J., et al (1988) A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain, 111, 695718.
Shallice, T. (1982) Specific impairments of planning. Philosophical Transactions of the Royal Society of London – Series B: Biological Sciences, 298, 199209.
Smith, D., Roberts, S., Brewer, W., et al (1998) Test–retest reliability of the National Adult Reading Test as an estimate of pre-morbid IQ in patients with schizophrenia. Cognitive Neuropsychiatry, 3, 7180.
SPSS (1999) SPSS for Windows, Release 10. Chicago, IL: SPSS.
Weickert, T., Goldberg, T., Gold, J., et al (2000) Cognitive impairment in patients with schizophrenia displaying preserved and compromised intellect. Archives of General Psychiatry, 57, 907913.

Cognitive heterogeneity in first-episode schizophrenia

  • Eileen M. Joyce (a1), Sam B. Hutton (a2), Stanley H. Mutsatsa (a3) and Thomas R. E. Barnes (a3)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Cognitive heterogeneity in first-episode schizophrenia

  • Eileen M. Joyce (a1), Sam B. Hutton (a2), Stanley H. Mutsatsa (a3) and Thomas R. E. Barnes (a3)
Submit a response

eLetters

We encountered an error trying to retrieve eLetters for this article. Please try again or contact Customer Services

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *