Abstract
Earlier studies suggested more severe overall cognitive impairments in deficit versus non-deficit schizophrenia; however, the specific contribution of different cognitive domains to this overall cognitive impairment remains unclear. The purpose of this study was to compare the two subtypes in general cognitive functioning as well as in individual cognitive domains using the composite score approach. One hundred and forty-three patients fulfilling the criteria for the deficit syndrome were compared with 123 patients diagnosed with non-deficit schizophrenia. Neurocognitive functioning was assessed by a neuropsychological test battery measuring the domains of sustained vigilance/attention, working memory, short-term memory, verbal memory, cognitive flexibility, and ideation fluency. Using the raw neuropsychological measures, we calculated a global index of cognitive impairment and domain-specific composite z-scores. Association between these composite scores and the deficit syndrome was examined by logistic regression analysis. After adjusting for relevant covariates including sex, age, education, smoking, and antipsychotic dose, results indicated a significant increase in the likelihood of deficit syndrome as a function of global (OR = 5.40; 95% CI 3.02–9.65) as well as domain-specific impairments (OR > 2 for all individual domains except for short-term memory). Cognitive flexibility was an independent predictor (OR = 2.92; 95% CI 1.47–5.80), whereas other cognitive domains demonstrated no unique contribution to the general cognitive impairment. Patients with deficit schizophrenia suffer from a more severe degree of neurocognitive impairment, which is qualitatively similar to the dysfunction seen in non-deficit schizophrenia. However, our results indicate that cognitive flexibility is specifically impaired in deficit versus non-deficit patients and may therefore represent a core feature of this subtype.
Similar content being viewed by others
References
Carpenter WT Jr, Heinrichs DW, Wagman AM (1988) Deficit and nondeficit forms of schizophrenia: the concept. Am J Psychiatry 145:578–583
Kirkpatrick B, Buchanan RW, Ross DE, Carpenter WT Jr (2001) A separate disease within the syndrome of schizophrenia. Arch Gen Psychiatry 58:165–171
Galderisi S, Maj M (2009) Deficit schizophrenia: an overview of clinical, biological and treatment aspects. Eur Psychiatry 24:493–500
Green MF (2007) Stimulating the development of drug treatments to improve cognition in schizophrenia. Annu Rev Clin Psychol 3:159–180
Buchanan RW, Strauss ME, Kirkpatrick B, Holstein C, Breier A, Carpenter WT Jr (1994) Neuropsychological impairments in deficit vs nondeficit forms of schizophrenia. Arch Gen Psychiatry 51:804–811
Bryson G, Whelahan HA, Bell M (2001) Memory and executive function impairments in deficit syndrome schizophrenia. Psychiatry Res 102:29–37
Brazo P, Marie RM, Halbecq I, Benali K, Segard L, Delamillieure P, Langlois-Thery S, Van Der Elst A, Thibaut F, Petit M, Dollfus S (2002) Cognitive patterns in subtypes of schizophrenia. Eur Psychiatry 17:155–162
Galderisi S, Maj M, Mucci A, Cassano GB, Invernizzi G, Rossi A, Vita A, Dell’Osso L, Daneluzzo E, Pini S (2002) Historical, psychopathological, neurological, and neuropsychological aspects of deficit schizophrenia: a multicenter study. Am J Psychiatry 159:983–990
Cohen AS, Saperstein AM, Gold JM, Kirkpatrick B, Carpenter WT Jr, Buchanan RW (2007) Neuropsychology of the deficit syndrome: new data and meta-analysis of findings to date. Schizophr Bull 33:1201–1212
Jaeger J, Czobor P, Berns SM (2003) Basic neuropsychological dimensions in schizophrenia. Schizophr Res 65:105–116
Bilder RM, Goldman RS, Volavka J, Czobor P, Hoptman M, Sheitman B, Lindenmayer JP, Citrome L, McEvoy J, Kunz M, Chakos M, Cooper TB, Horowitz TL, Lieberman JA (2002) Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol in patients with chronic schizophrenia or schizoaffective disorder. Am J Psychiatry 159:1018–1028
Psychiatric American Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Association Press, Washington, DC
Rethelyi JM, Bakker SC, Polgar P, Czobor P, Strengman E, Pasztor PI, Kahn RS, Bitter I (2010) Association study of NRG1, DTNBP1, RGS4, G72/G30, and PIP5K2A with schizophrenia and symptom severity in a Hungarian sample. Am J Med Genet B Neuropsychiatr Genet 153B:792–801
Balázs J, Bitter I, Hideg K, Vitrai J (1998) The Hungarian version of the M.I.N.I. and the M.I.N.I. Plus (in Hungarian). Psychiatria Hungarica 13:160–168
Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276
Kirkpatrick B, Buchanan RW, McKenney PD, Alphs LD, Carpenter WT Jr (1989) The schedule for the deficit syndrome: an instrument for research in schizophrenia. Psychiatry Res 30:119–123
Baldessarini RJ, Tarazi FI (2001) Drugs and the treatment of psychiatric disorders: antipsychotic and antimaniac agents. In: Hardman JG, Limbird LE, Gilman AG (eds) Goodman and Gilman’s the pharmacological basis of therapeutics. McGraw-Hill, New York, pp 485–520
Woods SW (2003) Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 64:663–667
Strauss E, Sherman EMS, Spreen O (2006) A compendium of neuropsychological tests. Administration, norms, and commentary. Oxford University Press, Oxford
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Hillsdale, NJ
Owens SF, Rijsdijk F, Picchioni MM, Stahl D, Nenadic I, Murray RM, Toulopoulou T (2011) Genetic overlap between schizophrenia and selective components of executive function. Schizophr Res 127:181–187
Cascella NG, Testa SM, Meyer SM, Rao VA, Diaz-Asper CM, Pearlson GD, Schretlen DJ (2008) Neuropsychological impairment in deficit vs. non-deficit schizophrenia. J Psychiatr Res 42:930–937
Wang X, Yao S, Kirkpatrick B, Shi C, Yi J (2008) Psychopathology and neuropsychological impairments in deficit and nondeficit schizophrenia of Chinese origin. Psychiatry Res 158:195–205
Polgar P, Farkas M, Nagy O, Kelemen O, Rethelyi J, Bitter I, Myers CE, Gluck MA, Keri S (2008) How to find the way out from four rooms? The learning of “chaining” associations may shed light on the neuropsychology of the deficit syndrome of schizophrenia. Schizophr Res 99:200–207
Szendi I, Racsmany M, Cimmer C, Csifcsak G, Kovacs ZA, Szekeres G, Galsi G, Toth F, Nagy A, Garab EA, Boda K, Gulyas G, Kiss JG, Dombi J, Pleh C, Janka Z (2010) Two subgroups of schizophrenia identified by systematic cognitive neuropsychiatric mapping. Eur Arch Psychiatry Clin Neurosci 260:257–266
Dickinson D, Ragland JD, Gold JM, Gur RC (2008) General and specific cognitive deficits in schizophrenia: Goliath defeats David? Biol Psychiatry 64:823–827
Tuulio-Henriksson A, Perala J, Saarni SI, Isometsa E, Koskinen S, Lonnqvist J, Suvisaari J (2011) Cognitive functioning in severe psychiatric disorders: a general population study. Eur Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-010-0186-y
Cascella NG, Fieldstone SC, Rao VA, Pearlson GD, Sawa A, Schretlen DJ (2010) Gray-matter abnormalities in deficit schizophrenia. Schizophr Res 120:63–70
Sacco KA, Termine A, Seyal A, Dudas MM, Vessicchio JC, Krishnan-Sarin S, Jatlow PI, Wexler BE, George TP (2005) Effects of cigarette smoking on spatial working memory and attentional deficits in schizophrenia: involvement of nicotinic receptor mechanisms. Arch Gen Psychiatry 62:649–659
Segarra R, Zabala A, Eguiluz JI, Ojeda N, Elizagarate E, Sanchez P, Ballesteros J, Gutierrez M (2010) Cognitive performance and smoking in first-episode psychosis: the self-medication hypothesis. Eur Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-010-0146-6
Hori H, Noguchi H, Hashimoto R, Nakabayashi T, Omori M, Takahashi S, Tsukue R, Anami K, Hirabayashi N, Harada S, Saitoh O, Iwase M, Kajimoto O, Takeda M, Okabe S, Kunugi H (2006) Antipsychotic medication and cognitive function in schizophrenia. Schizophr Res 86:138–146
Elie D, Poirier M, Chianetta J, Durand M, Gregoire C, Grignon S (2010) Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder. J Psychopharmacol 24:1037–1044
Malaspina D, Coleman E (2003) Olfaction and social drive in schizophrenia. Arch Gen Psychiatry 60:578–584
Horan WP, Blanchard JJ (2003) Neurocognitive, social, and emotional dysfunction in deficit syndrome schizophrenia. Schizophr Res 65:125–137
Milev P, Ho BC, Arndt S, Andreasen NC (2005) 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 162:495–506
Ojeda N, Pena J, Sanchez P, Elizagarate E, Ezcurra J (2008) Processing speed mediates the relationship between verbal memory, verbal fluency, and functional outcome in chronic schizophrenia. Schizophr Res 101:225–233
Sanchez P, Ojeda N, Pena J, Elizagarate E, Yoller AB, Gutierrez M, Ezcurra J (2009) Predictors of longitudinal changes in schizophrenia: the role of processing speed. J Clin Psychiatry 70:888–896
Bell M, Tsang HW, Greig TC, Bryson GJ (2009) Neurocognition, social cognition, perceived social discomfort, and vocational outcomes in schizophrenia. Schizophr Bull 35:738–747
McDowd J, Tang TC, Tsai PC, Wang SY, Su CY (2011) The association between verbal memory, processing speed, negative symptoms and functional capacity in schizophrenia. Psychiatry Res 187:329–334
Moller HJ, Jager M, Riedel M, Obermeier M, Strauss A, Bottlender R (2010) The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: comparison of psychopathological and psychosocial course and outcome and prediction of chronicity. Eur Arch Psychiatry Clin Neurosci 260:367–384
Strauss GP, Harrow M, Grossman LS, Rosen C (2010) Periods of recovery in deficit syndrome schizophrenia: a 20-year multi-follow-up longitudinal study. Schizophr Bull 36:788–799
Hogarty GE, Flesher S, Ulrich R, Carter M, Greenwald D, Pogue-Geile M, Kechavan M, Cooley S, DiBarry AL, Garrett A, Parepally H, Zoretich R (2004) Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Arch Gen Psychiatry 61:866–876
Eack SM, Hogarty GE, Cho RY, Prasad KM, Greenwald DP, Hogarty SS, Keshavan MS (2010) Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: results from a 2-year randomized controlled trial. Arch Gen Psychiatry 67:674–682
Fisher M, Holland C, Merzenich MM, Vinogradov S (2009) Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry 166:805–811
Acknowledgments
We wish to thank the help of Drs. Csilla Bolyós, Márta Farkas, Zita Murai, Éva Rózsavölgyi, Tamás Kurimay, and Péter Pásztor in recruiting patients to the study and the assistance of Sarolta Komlósi and Krisztina Járvás in data collection. The study was supported financially by the Moravcsik Foundation and the OTKA-83876 Postdoctoral Grant.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Réthelyi, J.M., Czobor, P., Polgár, P. et al. General and domain-specific neurocognitive impairments in deficit and non-deficit schizophrenia. Eur Arch Psychiatry Clin Neurosci 262, 107–115 (2012). https://doi.org/10.1007/s00406-011-0224-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-011-0224-4