Skip to main content Accessibility help
×
Home
Hostname: page-component-79b67bcb76-4whtl Total loading time: 0.25 Render date: 2021-05-15T21:28:25.959Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills?

Published online by Cambridge University Press:  09 May 2017

S. Moritz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
J. P. Klein
Affiliation:
Department of Psychiatry and Psychotherapy, Lübeck University, Ratzeburger Allee 160, 23538 Lübeck, Germany
T. Desler
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
H. Lill
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
J. Gallinat
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
B. C. Schneider
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
Corresponding
E-mail address:

Abstract

Background

Most original studies and all meta-analyses conducted to date converge on the conclusion that patients with schizophrenia display rather generalized neurocognitive deficits. For the present study, we reopen this seemingly closed chapter and examine whether important influences, such as lack of motivation and negative attitudes towards cognitive assessment, result in poorer secondary neuropsychological performance.

Method

A sample of 50 patients with an established diagnosis of schizophrenia were tested for routine neurocognitive assessment and compared to 60 nonclinical volunteers. Before and after the assessment, subjective momentary influences were examined (e.g. motivation, concerns about assessment, fear about poor outcome) for their impact on performance using a new questionnaire called the Momentary Influences, Attitudes and Motivation Impact (MIAMI) on Cognitive Performance Scale.

Results

As expected, patients performed significantly worse than controls on all neurocognitive domains tested (large effect size, on average). However, patients also displayed more subjective momentary impairment, as well as more fears about the outcome and less motivation than controls. Mediation analyses indicated that these influences contributed to (secondary) poorer neurocognitive performance. Differences in neurocognitive scores shrank to a medium effect size, on average, when MIAMI scores were accounted for.

Conclusions

The data argue that performance on measures of neurocognition in schizophrenia are to a considerable extent due to secondary factors. Poor motivation, fears and momentary impairments distinguished patients from controls and these variables heavily impacted performance. Before concluding that neurocognitive deficits in psychiatric patients are present, clinicians should take these confounding influences into account. Although patients with schizophrenia achieved, on average, worse test scores than controls, a large subgroup displayed spared performance.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below.

Footnotes

SM and JPK have equally contributed to the manuscript and share first authorship.

References

Abramovitch, A, Abramowitz, JS, Mittelman, A (2013). The neuropsychology of adult obsessive-compulsive disorder: a meta-analysis. Clinical Psychology Review 33, 11631171.CrossRefGoogle ScholarPubMed
Abramovitch, A, Schweiger, A (2015). Misuse of cognitive neuropsychology in psychiatry research: the intoxicating appeal of neo-reductionism. Behavior Therapist 38, 187191.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 5th edn. American Psychiatric Association: Arlington, VA, USA.Google ScholarPubMed
Bentall, RP, Kinderman, P, Kaney, S (1994). The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research and Therapy 32, 331341.CrossRefGoogle ScholarPubMed
Bora, E, Murray, RM (2014). Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophrenia Bulletin 40, 744755.CrossRefGoogle ScholarPubMed
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study. British Journal of Psychiatry 195, 475482.CrossRefGoogle ScholarPubMed
Brewer, WJ, Wood, SJ, Phillips, LJ, Francey, SM, Pantelis, C, Yung, AR, Cornblatt, B, McGorry, PD (2006). Generalized and specific cognitive performance in clinical high-risk cohorts: a review highlighting potential vulnerability markers for psychosis. Schizophrenia Bulletin 32, 538555.CrossRefGoogle Scholar
Brickenkamp, R (1962). Aufmerksamkeits-Belastungs-Test Handanweisung d-2 [Attention-Pressure-Test Manual d2]. Hogrefe: Göttingen.Google Scholar
Carlsson, R, Nyman, H, Ganse, G, Cullberg, J (2006). Neuropsychological functions predict 1- and 3-year outcome in first-episode psychosis. Acta Psychiatrica Scandinavica 113, 102111.CrossRefGoogle ScholarPubMed
Cella, M, Reeder, C, Wykes, T (2015). Cognitive remediation in schizophrenia-now it is really getting personal. Current Opinion in Behavioral Sciences 4, 147151.CrossRefGoogle Scholar
Fatouros-Bergman, H, Cervenka, S, Flyckt, L, Edman, G, Farde, L (2014). Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. Schizophrenia Research 158, 156162.CrossRefGoogle ScholarPubMed
Fervaha, G, Agid, O, Takeuchi, H, Lee, J, Foussias, G, Zakzanis, KK, Graff-Guerrero, A, Remington, G (2015). Extrapyramidal symptoms and cognitive test performance in patients with schizophrenia. Schizophrenia Research 161, 351356.CrossRefGoogle Scholar
Fervaha, G, Zakzanis, KK, Foussias, G, Graff-Guerrero, A, Agid, O, & Remington, G (2014). Motivational deficits and cognitive test performance in schizophrenia. JAMA Psychiatry 71, 10581065.CrossRefGoogle Scholar
Fett, AKJ, Viechtbauer, W, Dominguez, MDG, Penn, DL, 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, 573588.CrossRefGoogle ScholarPubMed
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321330.Google Scholar
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119136.CrossRefGoogle Scholar
Green, MF, Kern, RS, Heaton, RK (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research 72, 4151.CrossRefGoogle ScholarPubMed
Härting, C, Markowitsch, HJ, Neufeld, H, Calabrese, P, Deisinger, K, Kessler, J (2000). Wechsler Gedächtnistest - Revidierte Fassung (WMS-R) [Wechsler Memory Scale - revised version (WMS-R)] . Hans Huber: Bern.Google Scholar
Harvey, PD, Loewenstein, DA, Czaja, SJ (2013). Hospitalization and psychosis: Influences on the course of cognition and everyday functioning in people with schizophrenia. Neurobiology of Disease 53, 1825.CrossRefGoogle Scholar
Heaton, RK (1981). Wisconsin Card Sorting Test. Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426445.CrossRefGoogle Scholar
Helmstaedter, C, Lendt, M, Lux, S (2001). VLMT Verbaler Lern- und Merkfähigkeitstest [VLMT Verbal Learning and Memory Test]. Belz Test: Göttingen.Google Scholar
Hovington, CL, Lepage, M (2012). Neurocognition and neuroimaging of persistent negative symptoms of schizophrenia. Expert Review of Neurotherapeutics 12, 5369.CrossRefGoogle ScholarPubMed
Jacobs, C, Petermann, F (2007). Wechsler Intelligenztest für Erwachsene (WIE) [Wechsler Intelligence Scale for Adults]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 55, 205208.CrossRefGoogle Scholar
Keefe, RS, Silva, SG, Perkins, DO, Lieberman, JA (1999). The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia: a review and meta-analysis. Schizophrenia Bulletin 25, 201222.CrossRefGoogle ScholarPubMed
Kinderman, P, Bentall, RP (1996). A new measure of causal locus: the internal, personal and situational attributions questionnaire. Personality and Individual Differences 20, 261264.CrossRefGoogle Scholar
Kit, KA, Tuokko, HA, Mateer, CA (2008). A review of the stereotype threat literature and its application in a neurological population. Neuropsychology Review 18, 132148.CrossRefGoogle Scholar
Kraepelin, E (1899). Psychiatrie. Ein Lehrbuch für Studierende und Aerzte [Psychiatry. A textbook for students and physicians]. J. A. Barth: Leipzig.Google Scholar
Kurtz, MM (2011). Neurocognition as a predictor of response to evidence-based psychosocial interventions in schizophrenia: what is the state of the evidence? Clinical Psychology Review 31, 663672.CrossRefGoogle ScholarPubMed
Leucht, S, Kane, JM, Kissling, W, Hamann, J, Etschel, E, Engel, R (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry 187, 366371.CrossRefGoogle ScholarPubMed
Lezak, MD (1995). Neuropsychological Assessment. Neuropsychological Assessment, 3rd ed. Oxford University Press: New York.Google ScholarPubMed
Loong, JWK (1990). The Wisconsin Card Sorting Test (IBM version) . Wang Neuropsychological Laboratory: San Luis Obispo, CA.Google Scholar
López-Muñoz, F, Álamo, C (2011). Neurobiological background for the development of new drugs in schizophrenia. Clinical Neuropharmacology 34, 111126.CrossRefGoogle Scholar
Mathews, SB, Arnold, SE, Epperson, CN (2014). Hospitalization and cognitive decline: can the nature of the relationship be deciphered? American Journal of Geriatric Psychiatry 22, 465480.CrossRefGoogle ScholarPubMed
Mesholam-Gately, RI, Giuliano, AJ, Goff, KP, Faraone, SV, Seidman, LJ (2009). Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 23, 315336.CrossRefGoogle ScholarPubMed
Moritz, S, Birkner, C, Kloss, M, Jahn, H, Hand, I, Haasen, C, Krausz, M (2002). Executive functioning in obsessive-compulsive disorder, unipolar depression, and schizophrenia. Archives of Clinical Neuropsychology 17, 477483.Google Scholar
Moritz, S, Heeren, D, Andresen, B, Krausz, M (2001). An analysis of the specificity and the syndromal correlates of verbal memory impairments in schizophrenia. Psychiatry Research 101, 2331.CrossRefGoogle Scholar
Moritz, S, Hottenrott, B, Jelinek, L, Brooks, AM, Scheurich, A (2012). Effects of obsessive-compulsive symptoms on neuropsychological test performance: complicating an already complicated story. The Clinical Neuropsychologist 26, 3144.CrossRefGoogle ScholarPubMed
Overall, JE, Gorham, DR (1962). The brief psychiatric rating scale. Psychological Reports 10, 799812.CrossRefGoogle Scholar
Palmer, BW, Dawes, SE, Heaton, RK (2009). What do we know about neuropsychological aspects of schizophrenia? Neuropsychology Review 19, 365384.CrossRefGoogle ScholarPubMed
Pennington, CR, Heim, D, Levy, AR, Larkin, DT (2016). Twenty years of stereotype threat research: a review of psychological mediators. PLoS ONE 11, e0146487.CrossRefGoogle ScholarPubMed
Reichenberg, A (2010). The assessment of neuropsychological functioning in schizophrenia. Dialogues in Clinical Neuroscience 12, 383392.Google Scholar
Reitan, RM (1992). Trail Making Test. Manual of Administration and Scoring. Reitan Neuropsychology Laboratory: Tucson, AZ, USA.Google Scholar
Schaefer, J, Giangrande, E, Weinberger, DR, Dickinson, D (2013). The global cognitive impairment in schizophrenia: consistent over decades and around the world. Schizophrenia Research 150, 4250.CrossRefGoogle ScholarPubMed
Scheurich, A, Fellgiebel, A, Schermuly, I, Bauer, S, Wölfges, R, Müller, MJ (2008). Experimental evidence for a motivational origin of cognitive impairment in major depression. Psychological Medicine 38, 237246.CrossRefGoogle ScholarPubMed
Schmidt-Atzert, L (2004). Test d2: Aufmerksamkeits-Belastungs-Test [Test d2: attention-strain-test]. Diagnostik von Konzentration und Aufmerksamkeit 6th edn. Hogrefe: Göttingen.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 2233.Google ScholarPubMed
Shin, NY, Lee, TY, Kim, E, Kwon, JS (2014). Cognitive functioning in obsessive-compulsive disorder: a meta-analysis. Psychological Medicine 44, 11211130.CrossRefGoogle ScholarPubMed
Spencer, SJ, Steele, CM, Quinn, DM (1999). Stereotype threat and women's math performance. Journal of Experimental Social Psychology 35, 428.CrossRefGoogle Scholar
Strauss, GP, Morra, LF, Sullivan, SK, Gold, JM (2015). The role of low cognitive effort and negative symptoms in neuropsychological impairment in schizophrenia. Neuropsychology 29, 282291.CrossRefGoogle Scholar
Tombaugh, TN (2004). Trail making Test A and B: normative data stratified by age and education. Archives of Clinical Neuropsychology 19, 203214.CrossRefGoogle Scholar
Vinogradov, S, Fisher, M, Warm, H, Holland, C, Kirshner, MA, Pollock, BG (2009). The cognitive cost of anticholinergic burden: decreased response to cognitive training in schizophrenia. American Journal of Psychiatry 166, 10551062.CrossRefGoogle Scholar
Wechsler, D (2008). Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) . Pearson: San Antonio, TX.Google Scholar
Wilson, B, Alderman, N, Burgess, P, Emslie, H, Evans, J (2003). Behavioural assessment of the dysexecutive syndrome (BADS). Journal of Occupational Psychology, Employment and Disability 5, 3337.Google Scholar
Wilson, RS, Hebert, LE, Scherr, PA, Dong, X, Leurgens, SE, Evans, DA (2012). Cognitive decline after hospitalization in a community population of older persons. Neurology 78, 950956.CrossRefGoogle Scholar
Woodard, JL, Axelrod, BN (1987). Wechsler memory scale - revised. Psychological Assessment 7, 445449. ST–Parsimonious prediction of Wechsler.CrossRefGoogle Scholar
Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472485.CrossRefGoogle ScholarPubMed
Zimmermann, P, Fimm, B (1995). Test for Attentional Performance (TAP) . PsyTest: Herzogenrath.Google Scholar

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.

Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills?
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.

Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills?
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.

Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills?
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *