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A majority of the studies on cognition in schizophrenia have been conducted in drug-treated patients. In healthy subjects, administration of antipsychotic medication has been found to have a negative impact on cognitive performance in domains such as speed of processing and attention. Antipsychotic drugs occupy the D2-dopamine receptor, a receptor subtype that has been related to cognitive function. Studies employing Positron Emission Tomography have shown that poor performance in several cognitive domains is associated to low D2-receptor binding. It is therefore crucial to examine cognition in drug-naïve patients with schizophrenia.
In FES patients: To examine the profile of cognitive impairments in the absence of antipsychotic medication and compare with the cognitive profile of patients who are on antipsychotic medication.
To study cognition in FES.
The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery was administered to 60 patients with early schizophrenia and 30 healthy controls, 50% of the patients were drug-naïve. This research is ongoing and a part of the Karolinska Schizophrenia Project (KaSP), a multidisciplinary research consortium that examines the pathophysiology of schizophrenia.
Preliminary findings show that patients perform worse than healthy controls in all cognitive domains, with no significant differences between drug-naïve and medicated patients. Attention and Visual memory were the domains with the greatest impairments. The results are compared with our previous meta-analytic findings in drug-naïve patients.
These preliminary findings confirm the existence of cognitive impairments at the early stage of schizophrenia in the absence of antipsychotic medication.
A diagnosis of schizophrenia has significant effects on the burden of the families. Elucidating its magnitude, type and determinants lead to strategies to ease it.
To study the objective (time and money spent) and subjective burden (care-related quality of life) of informal care.
To study determinants of the objective and subjective burden
107 patients (53% females; Mean age; 43± 11 years) from 7 centers and 118 of their informal care-givers (67% females, Mean age; 58 ± 15 years) entered the study. Factors previously found of importance for the magnitude of care burden was assessed. The subjective burden was assessed using the CarerQol, VAS scale (0-10). The objective burden was assessed prospectively during four weeks with daily recordings of money and time spent.
The Mean (SD) GAF was 52 (11). The mean (SD) time spent on caring was 22 (36) hours per week. Caregivers’ expenses corresponded to 14% of the mean gross income. Females experienced a higher subjective caregiver burden than men [6.5 (2.0) vs 7.3 (1.8)]. A significantly inverse relation between the patients levels of functioning and the subjective burden was found.
The burden of informal care is considerable and surpasses that of formal care. The patient's functional level significantly determined the subjective burden. The prospective daily diary design revealed a great underestimation of the time spent when recalling it. Since antipsychotic medication is insufficient to alleviate negative symptoms other function-increasing interventions such as social training and jobs should be an integrated part of psychiatric care.
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
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