Neuropsychological Deficits of Acute Schizophrenic Patients Without Neuroleptic Medication
Abstract
Abstract: Patients with acute, moderate to severe schizophrenic psychosis without medication are rarely investigated systematically by neuropsychological tests and existing data from the literature show either generally lower test performance or deficits only in circumscribed neuropsychological domains. The aim of the study was to identify the neuropsychological profile of these patients (N = 28) in basic tests of the functional domains episodic memory and orientation, immediate memory, visuo-constructive performance and non-verbal logical thinking, psychomotor speed, letter fluency (FAS) and serial subtraction. If all patients with alcohol or drug abuse or comorbid neurological disorder are excluded, a deficit, compared to a well matched control group, is found only in verbal fluency and the first of two probes of episodic memory. There was a normal performance in digit span, nonverbal logical thinking and a drawing task. As explanation of the deficit pattern the hypothesis of a disorder of frontal functions is considered. The frontal type neuropsychological deficits may be caused by a disturbance of frontal cortico-subcortical loops for which a disturbance of neuronal net function is discussed.
Zusammenfassung: Patienten mit akuter mittelschwerer bis schwerer schizophrener Psychose sind selten ohne Medikation systematisch neuropsychologisch untersucht worden. Daten aus der Literatur zeigen entweder eine allgemein verminderte Testperformanz oder nur Defizite in umschriebenen neuropsychologischen Bereichen. Das Ziel der Studie war, das Profil neuropsychologischer Defizit derartiger Patienten zu identifizieren (N = 28), wobei Untersuchungsverfahren der Bereiche Episodisches Gedächtnis und Orientierung, Immediatgedächtnis, visuokonstruktive Performanz und nicht-verbales schlussfolgerndes Denken, psychomotorische Schnelligkeit, verbale Fluency und serielle Subtraktion verwendet wurden. Wenn alle Patienten mit Alkohol- und Drogenabusus und neurologischer Komorbidität ausgeschlossen werden, zeigt sich ein Defizit der schizophrenen Patienten in der verbalen Fluency und der ersten von zwei Merkfähigkeitsproben. Eine ungestörte Testperformanz zeigte sich in der Zahlenspanne, dem nicht-verbalen schlussfolgernden Denken und der visuokonstruktiven Aufgabe. Zur Erklärung wird die Hypothese einer Störung von Frontalhirnfunktionen diskutiert. Die Störung der Frontalhirnfunktionen kann unter anderem auf einer Störung der frontalen kortiko-subkortikalen Projektionsschleifen beruhen, für welche die Störung eines neuronalen Netzes diskutiert wird.
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