Abstract
Background: Negative symptoms and cognitive dysfunction are of crucial functional and prognostic importance in schizophrenia. However, the nature of the relationship between them and the factors that may influence it have not been well established. Aims: To investigate whether the relationship between negative symptoms and executive function changes according to the duration of illness in schizophrenia. Methods: The Positive and Negative Syndrome Scale was used to assess psychopathology and the Wisconsin Card Sorting Test (WCST) to evaluate executive function in a sample of 200 schizophrenic patients who were classified in 3 groups according to their duration of illness: up to 5 years (short duration group), 6-20 years (intermediate duration group) and over 20 years of illness (long duration group). Results: Medium-sized correlations were found between negative symptoms and WCST performance as assessed by the number of completed categories in all 3 groups. However, differences were found according to the duration of schizophrenia. For patients in the short duration group, negative symptoms correlated with WCST nonperseverative errors, but for those in the long duration group the correlation was with perseverative errors. Conclusion: We found a differential relationship between negative and cognitive symptoms in different stages of schizophrenia. Illness duration should be considered when studying the relationship between negative symptoms and cognition.
References
1.
Bleuler M: Dementia Praecox or the Group of Schizophrenias, 1911. New York, International University Press, 1950.
2.
Pogue-Geile MF, Harrow M: Negative symptoms in schizophrenia: their longitudinal course and prognostic importance. Schizophr Bull 1985;11:427-439.
3.
McGlashan TH, Fenton WS: The positive-negative distinction in schizophrenia. Review of natural history validators. Arch Gen Psychiatry 1992;49:63-72.
4.
Arndt S, Andreasen NC, Flaum M, Miller D, Nopoulos P: A longitudinal study of symptom dimensions in schizophrenia. Prediction and patterns of change. Arch Gen Psychiatry 1995;52:352-360.
5.
Schultz SK, Miller DD, Oliver SE, Arndt S, Flaum M, Andreasen NC: The life course of schizophrenia: age and symptom dimensions. Schizophr Res 1997;23:15-23.
6.
Mancevski B, Keilp J, Kurzon M, Berman RM, Ortakov V, Harkavy-Friedman J, Rosoklija G, Dwork AJ: Lifelong course of positive and negative symptoms in chronically institutionalized patients with schizophrenia. Psychopathology 2007;40:83-92.
7.
Kelley ME, Haas GL, van Kammen DP: Longitudinal progression of negative symptoms in schizophrenia: a new look at an old problem. Schizophr Res 2008;105:188-196.
8.
Möller HJ, Bottlender R, Wegner U, Wittmann J, Strauss A: Long-term course of schizophrenic, affective and schizoaffective psychosis: focus on negative symptoms and their impact on global indicators of outcome. Acta Psychiatr Scand Suppl 2000;407:54-57.
9.
Milev P, Ho BC, Arndt S, Andreasen NC: Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 2005;162:495-506.
10.
Schennach-Wolff R, Jäger M, Seemüller F, Obermeier M, Messer T, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Huff W, Heuser I, Maier W, Lemke MR, Rüther E, Buchkremer G, Gastpar M, Möller HJ, Riedel M: Defining and predicting functional outcome in schizophrenia and schizophrenia spectrum disorders. Schizophr Res 2009;113:210-217.
11.
Ventura J, Hellemann GS, Thames AD, Koellner V, Nuechterlein KH: Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res 2009;113:189-199.
12.
Bottlender R, Strauss A, Möller HJ: Social disability in schizophrenic, schizoaffective and affective disorders 15 years after first admission. Schizophr Res 2010;116:9-15.
13.
Faerden A, Finset A, Friis S, Agartz I, Barrett EA, Nesvåg R, Andreassen OA, Marder SR, Melle I: Apathy in first episode psychosis patients: one year follow-up. Schizophr Res 2010;116:20-26.
14.
Kraepelin E: Dementia Praecox and Paraphrenia, 1919. New York, Krieger, 1971.
15.
Heinrichs RW, Zakzanis KK: Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 1998;12:426-445.
16.
Bilder RM, Goldman RS, Robinson D, Reiter G, Bell L, Bates JA, Pappadopulos E, Willson DF, Alvir JM, Woerner MG, Geisler S, Kane JM, Lieberman JA: Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. Am J Psychiatry 2000;157:549-559.
17.
Fuller R, Nopoulos P, Arndt S, O'Leary D, Ho BC, Andreasen NC: Longitudinal assessment of premorbid cognitive functioning in patients with schizophrenia through examination of standardized scholastic test performance. Am J Psychiatry 2002;159:1183-1189.
18.
Torrey EF: Studies of individuals with schizophrenia never treated with antipsychotic medications: a review. Schizophr Res 2002;58:101-115.
19.
Addington J, Brooks BL, Addington D: Cognitive functioning in first episode psychosis: initial presentation. Schizophr Res 2003;62:59-64.
20.
Woodberry KA, Giuliano AJ, Seidman LJ: Premorbid IQ in schizophrenia: a meta-analytic review. Am J Psychiatry 2008;165:579-587.
21.
Galderisi S, Davidson M, Kahn RS, Mucci A, Boter H, Gheorghe MD, Rybakowski JK, Libiger J, Dollfus S, López-Ibor JJ, Peuskens J, Hranov LG, Fleischhacker WW, EUFEST Group: Correlates of cognitive impairment in first episode schizophrenia: the EUFEST study. Schizophr Res 2009;115:104-114.
22.
Mesholam-Gately RI, Giuliano AJ, Goff KP, Faraone SV, Seidman LJ: Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 2009;23:315-336.
23.
Elvevåg B, Goldberg TE: Cognitive impairment in schizophrenia is the core of the disorder. Crit Rev Neurobiol 2000;14:1-21.
24.
Lewandowski KE, Cohen BM, Ongur D: Evolution of neuropsychological dysfunction during the course of schizophrenia and bipolar disorder. Psychol Med 2011;41:225-241.
25.
Green MF, Nuechterlein KH: Should schizophrenia be treated as a neurocognitive disorder? Schizophr Bull 1999;25:309-319.
26.
Green MF, Kern RS, Braff DL, Mintz J: Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff'? Schizophr Bull 2000;26:119-136.
27.
Green MF, Kern RS, Heaton RK: Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res 2004;72:41-51.
28.
Bowie CR, Harvey PD: Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatr Dis Treat 2006;2:531-536.
29.
Jabben N, Arts B, van Os J, Krabbendam L: Neurocognitive functioning as intermediary phenotype and predictor of psychosocial functioning across the psychosis continuum: studies in schizophrenia and bipolar disorder. J Clin Psychiatry 2010;71:764-774.
30.
Heinrichs RW: The primacy of cognition in schizophrenia. Am Psychol 2005;60:229-242.
31.
Bozikas VP, Kosmidis MH, Kiosseoglou G, Karavatos A: Neuropsychological profile of cognitively impaired patients with schizophrenia. Compr Psychiatry 2006;47:136-143.
32.
Hutton SB, Puri BK, Duncan LJ, Robbins TW, Barnes TR, Joyce EM: Executive function in first-episode schizophrenia. Psychol Med 1998;28:463-473.
33.
Riley EM, McGovern D, Mockler D, Doku VC, OCeallaigh S, Fannon DG, Tennakoon L, Santamaria M, Soni W, Morris RG, Sharma T: Neuropsychological functioning in first-episode psychosis - evidence of specific deficits. Schizophr Res 2000;43:47-55.
34.
Joyce E, Hutton S, Mutsatsa S, Gibbins H, Webb E, Paul S, Robbins T, Barnes T: Executive dysfunction in first-episode schizophrenia and relationship to duration of untreated psychosis: the West London Study. Br J Psychiatry Suppl 2002;43:s38-s44.
35.
Chan RC, Chen EY, Law CW: Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia. Schizophr Res 2006;82:51-64.
36.
Egan MF, Goldberg TE, Gscheidle T, Weirich M, Rawlings R, Hyde TM, Bigelow L, Weinberger DR: Relative risk for cognitive impairments in siblings of patients with schizophrenia. Biol Psychiatry 2001;50:98-107.
37.
Zalla T, Joyce C, Szöke A, Schürhoff F, Pillon B, Komano O, Perez-Diaz F, Bellivier F, Alter C, Dubois B, Rouillon F, Houde O, Leboyer M: Executive dysfunctions as potential markers of familial vulnerability to bipolar disorder and schizophrenia. Psychiatry Res 2004;121:207-217.
38.
Birkett P, Sigmundsson T, Sharma T, Toulopoulou T, Griffiths TD, Reveley A, Murray R: Executive function and genetic predisposition to schizophrenia - the Maudsley family study. Am J Med Genet B Neuropsychiatr Genet 2008;147:285-293.
39.
Martínez-Arán A, Penadés R, Vieta E, Colom F, Reinares M, Benabarre A, Salamero M, Gastó C: Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome. Psychother Psychosom 2002;71:39-46.
40.
Reed RA, Harrow M, Herbener ES, Martin EM: Executive function in schizophrenia: is it linked to psychosis and poor life functioning? J Nerv Ment Dis 2002;190:725-732.
41.
Rocca P, Montemagni C, Castagna F, Giugiario M, Scalese M, Bogetto F: Relative contribution of antipsychotics, negative symptoms and executive functions to social functioning in stable schizophrenia. Prog Neuropsychopharmacolo Biol Psychiatry 2009;33:373-379.
42.
Penadés R, Catalán R, Puig O, Masana G, Pujol N, Navarro V, Guarch J, Gastó C: Executive function needs to be targeted to improve social functioning with cognitive remediation therapy (CRT) in schizophrenia. Psychiatry Res 2010;177:41-45.
43.
Keefe RS: Should cognitive impairment be included in the diagnostic criteria for schizophrenia? World Psychiatry 2008;7:22-28.
44.
Peña J, Ojeda N, Segarra R, Eguiluz JI, García J, Gutiérrez M: Executive functioning correctly classified diagnoses in patients with first-episode psychosis: evidence from a 2-year longitudinal study. Schizophr Res 2011;126:77-80.
45.
Heaton RK, Gladsjo JA, Palmer BW, Kuck J, Marcotte TD, Jeste DV: Stability and course of neuropsychological deficits in schizophrenia. Arch Gen Psychiatry 2001;58:24-32.
46.
Hill SK, Schuepbach D, Herbener ES, Keshavan MS, Sweeney JA: Pretreatment and longitudinal studies of neuropsychological deficits in antipsychotic-naïve patients with schizophrenia. Schizophr Res 2004;68:49-63.
47.
Klingberg S, Wittorf A, Sickinger S, Buchkremer G, Wiedemann G: Course of cognitive functioning during the stabilization phase of schizophrenia. J Psychiatr Res 2008;42:259-267.
48.
Rodríguez-Sánchez JM, Pérez-Iglesias R, González-Blanch C, Pelayo-Terán JM, Mata I, Martínez O, Sánchez-Cubillo I, Vázquez-Barquero JL, Crespo-Facorro B: 1-year follow-up study of cognitive function in first-episode non-affective psychosis. Schizophr Res 2008;104:165-174.
49.
Tsai J, Lysaker PH, Vohs JL: Negative symptoms and concomitant attention deficits in schizophrenia: associations with prospective assessments of anxiety, social dysfunction, and avoidant coping. J Ment Health 2010;19:184-192.
50.
Shamsi S, Lau A, Lencz T, Burdick KE, Derosse P, Brenner R, Lindenmayer JP, Malhotra AK: Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophr Res 2011;126:257-264.
51.
Marder SR, Fenton W: Measurement and treatment research to improve cognition in schizophrenia: NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia. Schizophr Res 2004;72:5-9.
52.
Kirkpatrick B, Fenton WS, Carpenter WT Jr, Marder SR: The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 2006;32:214-219.
53.
Buckley PF, Stahl SM: Pharmacological treatment of negative symptoms of schizophrenia: therapeutic opportunity or cul-de-sac? Acta Psychiatr Scand 2007;115:93-100.
54.
Weinberger DR, Aloia MS, Goldberg TE, Berman KF: The frontal lobes and schizophrenia. J Neuropsychiatry Clin Neurosci 1994;6:419-427.
55.
Goldman-Rakic PS, Selemon LD: Functional and anatomical aspects of prefrontal pathology in schizophrenia. Schizophr Bull 1997;23:437-458.
56.
Martino DJ, Bucay D, Butman JT, Allegri RF: Neuropsychological frontal impairments and negative symptoms in schizophrenia. Psychiatry Res 2007;152:121-128.
57.
Crow TJ: Molecular pathology of schizophrenia: more than one disease process? Br Med J 1980;280:66-68.
58.
Nieuwenstein MR, Aleman A, de Haan EH: Relationship between symptom dimensions and neurocognitive functioning in schizophrenia: a meta-analysis of WCST and CPT studies. Wisconsin Card Sorting Test. Continuous Performance Test. J Psychiatr Res 2001;35:119-125.
59.
Harvey PD, Koren D, Reichenberg A, Bowie CR: Negative symptoms and cognitive deficits: what is the nature of their relationship? Schizophr Bull 2006;32:250-258.
60.
Dibben CR, Rice C, Laws K, McKenna PJ: Is executive impairment associated with schizophrenic syndromes? A meta-analysis. Psychol Med 2009;39:381-392.
61.
Donohoe G, Corvin A, Robertson IH: Evidence that specific executive functions predict symptom variance among schizophrenia patients with a predominantly negative symptom profile. Cogn Neuropsychiatry 2006;1:13-32.
62.
Faerden A, Vaskinn A, Finset A, Agartz I, Ann Barrett E, Friis S, Simonsen C, Andreassen OA, Melle I: Apathy is associated with executive functioning in first episode psychosis. BMC Psychiatry 2009;9:1.
63.
Rodriguez-Jimenez R, Aragües M, Jimenez-Arriero MA, Ponce G, Martinez I, Hoenicka J, Rubio G, Palomo T, Psychosis and Addictions Research Group (PARG): Psychopathology and Wisconsin Card Sorting Test performance in male schizophrenic patients: influence of dual diagnosis. Psychopathology 2008;41:58-64.
64.
Rodriguez-Jimenez R, Bagney A, Martinez-Gras I, Ponce G, Sanchez-Morla EM, Aragües M, Rubio G, Jimenez-Arriero MA, Santos JL, Palomo T, PARG: Executive function in schizophrenia: influence of substance use disorder history. Schizophr Res 2010;118:34-40.
65.
McGorry PD: Issues for DSM-V: clinical staging: a heuristic pathway to valid nosology and safer, more effective treatment in psychiatry. Am J Psychiatry 2007;164:859-860.
66.
McGorry PD: Staging in neuropsychiatry: a heuristic model for understanding, prevention and treatment. Neurotox Res 2010;18:244-255.
67.
McGorry PD, Hickie IB, Yung AR, Pantelis C, Jackson HJ: Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust NZ J Psychiatry 2006;40:66-622.
68.
Fava GA, Kellner R: Staging: a neglected dimension in psychiatric classification. Acta Psychiatr Scand 1993;87:225-230.
69.
Archer T, Kostrzewa RM, Palomo T, Beninger RJ: Clinical staging in the pathophysiology of psychotic and affective disorders: facilitation of prognosis and treatment. Neurotox Res 2010;18:211-228.
70.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text rev. Washington, American Psychiatric Association, 2000.
71.
First MB, Spitzer RL, Gibbon M, Williams JB: Structured Clinical Interview for DSM-IV-TR Axis I Disorders - Patient Edition (SCID-I/P). New York, Biometrics Research, New York State Psychiatric Institute, 2002.
72.
Kane JM, Leucht S, Carpenter D, Docherty JP, Expert Consensus Panel for Optimizing Pharmacologic Treatment of Psychotic Disorders: The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. J Clin Psychiatry 2003;64(suppl 12):25.
73.
Birchwood M, Todd P, Jackson C: Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 1998;172:53-59.
74.
Birchwood M: Early intervention and sustaining the management of vulnerability. Aust NZ J Psychiatry Suppl 2000;34:s181-184.
75.
McGorry PD: The recognition and optimal management of early psychosis: an evidence-based reform. World Psychiatry 2002;1:76-83.
76.
Pantelis C, Yücel M, Wood SJ, McGorry PD, Velakoulis D: Early and late neurodevelopmental disturbances in schizophrenia and their functional consequences. Aust NZ J Psychiatry 2003;37:399-406.
77.
Pantelis C, Yücel M, Wood SJ, Velakoulis D, Sun D, Berger G, Stuart GW, Yung A, Phillips L, McGorry PD: Structural brain imaging evidence for multiple pathological processes at different stages of brain development in schizophrenia. Schizophr Bull 2005;31:672-696.
78.
Bertolote J, McGorry P: Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry Suppl 2005;48:s116-119.
79.
Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-276.
80.
Heaton RK: The Wisconsin Card Sorting Test Manual. Odessa, Psychological Assessment Resources Inc, 1981.
81.
Heaton RK, Chelune GJ, Kay KK, Curtiss G: Wisconsin Card Sorting Test Manual. Revised and Expanded. Los Angeles, Western Psychological Services, 1993.
82.
Grant DA, Berg EA: A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. J Exp Psychol 1948;38:404-411.
83.
Li CS: Do schizophrenia patients make more perseverative than non-perseverative errors on the Wisconsin Card Sorting Test? A meta-analytic study. Psychiatry Res 2004;129:179-190.
84.
Prentice KJ, Gold JM, Buchanan RW: The Wisconsin Card Sorting impairment in schizophrenia is evident in the first four trials. Schizophr Res 2008;106:81-87.
85.
Pantelis C, Velakoulis D, McGorry PD, Wood SJ, Suckling J, Phillips LJ, Yung AR, Bullmore ET, Brewer W, Soulsby B, Desmond P, McGuire PK: Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet 2003;361:281-288.
86.
Keshavan MS, Berger G, Zipursky RB, Wood SJ, Pantelis C: Neurobiology of early psychosis. Br J Psychiatry Suppl 2005;48:s8-s18.
87.
Velakoulis D, Wood SJ, Wong MT, McGorry PD, Yung A, Phillips L, Smith D, Brewer W, Proffitt T, Desmond P, Pantelis C: Hippocampal and amygdala volumes according to psychosis stage and diagnosis: a magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals. Arch Gen Psychiatry 2006;63:139-149.
88.
Meisenzahl EM, Koutsouleris N, Bottlender R, Scheuerecker J, Jäger M, Teipel SJ, Holzinger S, Frodl T, Preuss U, Schmitt G, Burgermeister B, Reiser M, Born C, Möller HJ: Structural brain alterations at different stages of schizophrenia: a voxel-based morphometric study. Schizophr Res 2008;104:44-60.
89.
Barceló F: Electrophysiological evidence of two different types of error in the Wisconsin Card Sorting Test. Neuroreport 1999;10:1299-1303.
90.
Nyhus E, Barceló F: The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: a critical update. Brain Cogn 2009;71:437-451.
91.
Lehoux C, Gobeil MH, Lefèbvre AA, Maziade M, Roy MA: The five-factor structure of the PANSS: a critical review of its consistency across studies. Clin Schizophr Relat Psychoses 2009;3:103-110.
92.
Wallwork RS, Fortgang R, Hashimoto R, Weinberger DR, Dickinson D: Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophr Res 2012;137:246-250.
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