Neuropsychology of First-Episode Schizophrenia: Initial Characterization and Clinical Correlates

• Published in: The American journal of psychiatry 2000-04, Vol.157 (4), p.549-559
• Main Authors: Bilder, Robert M., Goldman, Robert S., Robinson, Delbert, Reiter, Gail, Bell, Lisa, Bates, John A., Pappadopulos, Elizabeth, Willson, Deborah F., Alvir, Jose Maria J., Woerner, Margaret G., Geisler, Stephen, Kane, John M., Lieberman, Jeffrey A.
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Clinical variables; Cognition Disorders - diagnosis; Cognition Disorders - psychology; Female; First time; Functional Laterality; Humans; Male; Medical sciences; Neurology; Neuropsychological Tests - statistics & numerical data; Neuropsychology; Psychiatric Status Rating Scales - statistics & numerical data; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychomotor Performance; Psychopathology. Psychiatry; Psychoses; Psychotic Disorders - diagnosis; Psychotic Disorders - drug therapy; Psychotic Disorders - psychology; Schizophrenia; Schizophrenia - diagnosis; Schizophrenia - drug therapy; Schizophrenic Psychology; Severity of Illness Index; Sex Factors; Treatment Outcome; Wechsler Scales
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.157.4.549

OBJECTIVE: Neuropsychological impairments are well documented in schizophrenia and are important targets of treatment. Information about the severity and pattern of deficits after treatment for the first psychotic episode and about relationships between these deficits and syndromal characteristics remains limited. METHOD: Comprehensive neuropsychological assessments including 41 individual tests were given to 94 patients with first-episode schizophrenia after initial stabilization of psychosis and to a comparison group of 36 healthy volunteers. Profiles of neuropsychological deficits and the relationship of deficits to sex and handedness were examined. Correlations of neuropsychological deficit with a broad range of historical and clinical characteristics, including outcome, were explored. RESULTS: Patients had a large generalized neuropsychological deficit (1.5 standard deviations compared to healthy volunteers). Patients also had, superimposed on the generalized deficit, subtle relative deficits (less than 0.5 standard deviation compared to their own average profile) in memory and executive functions. Learning memory dysfunction best distinguished patients from healthy individuals; after accounting for this difference, only motor deficits further distinguished the groups. Patients with higher neuropsychological ability had only memory deficits, and patients with lower ability had both memory and executive deficits. No sex differences were observed beyond the normal advantage for men in motor speed. Dextral patients had less severe generalized deficit. Severity of residual symptoms was associated with greater generalized deficit. Executive and attentional deficits were most linked to global functional impairment and poor outcome. CONCLUSIONS: The results document a large generalized deficit, and more subtle differential deficits, in clinically stabilized first-episode patients. Learning memory deficits were observed even in patients with less severe generalized deficit, but the pattern was unlike the amnestic syndrome and probably reflects different mechanisms. Executive and attentional deficits marked the more severely disabled patients, and may portend relatively poor outcome. Failure to develop typical patterns of cerebral dominance may increase the risk for greater generalized deficit.