Schizophrenia Bulletin Advance Access originally published online on May 20, 2008
Schizophrenia Bulletin 2009 35(5):1022-1029; doi:10.1093/schbul/sbn044
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Neuropsychological Function and Dysfunction in Schizophrenia and Psychotic Affective Disorders
2 Department of Psychiatry, Box 1230, Emory University School of Medicine, One Gustave L. Levy Place, New York, NY 10029
3 Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
4 Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY
5 School of Social Work, Bar Ilan University, Rama Gan, Israel
6 Department of Psychiatry, University of California, San Diego, CA
7 Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, NY
1 To whom correspondence should be addressed; e-mail: avi.reichenberg{at}mssm.edu.
Background: Mounting evidence suggests that compromised neurocognitive function is a central feature of schizophrenia. There are, however, schizophrenia patients with a normal neuropsychological (NP) performance, but estimates of the proportion of NP normal patients vary considerably between studies. Neurocognitive dysfunction is also a characteristic of other psychotic disorders, yet there are inconsistencies in the literature regarding the similarity to impairments in schizophrenia. NP normality in psychotic affective disorders has not been systematically studied.
Methods: Data came from the Suffolk County Mental Health Project, an epidemiological study of first-admission patients with psychotic disorders. Respondents with a diagnosis of schizophrenia (N = 94) or schizoaffective disorder (N = 15), bipolar disorder (N = 78), and major depressive disorder (N = 48) were administered a battery of NP tests assessing 8 cognitive domains 2 years after index admission. Patients’ performance profile was compared, and their NP status was classified based on 3 previously published criteria that vary in their stringency.
Results: The 4 diagnostic groups had comparable NP performance profile patterns. All groups demonstrated impairments in memory, executive functions, and attention and processing speed. However, schizophrenia patients were more impaired than the other groups on all cognitive domains. Results were not attenuated when IQ was controlled. Prevalence of NP normality ranged between 16% and 45% in schizophrenia, 20% and 33% in schizoaffective disorder, 42% and 64% in bipolar disorder, and 42% and 77% in depression, depending on the criterion employed.
Conclusions: Evidence suggests that differences in NP performance between schizophrenia and psychotic affective disorders are largely quantitative. NP impairment is also common in psychotic affective disorders. A significant minority of schizophrenia patients are NP normal.
Keywords: normality / mood disorders / psychosis / cognition / intelligence
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