IQ Trajectory, Cognitive Reserve, and Clinical Outcome Following a First Episode of Psychosis: A 3-Year Longitudinal Study

Comparison of current and estimated premorbid IQ in schizophrenia suggests that there are subgroups with low IQ, deteriorated IQ (DIQ), or preserved IQ and that this is established by psychosis onset. There are no controlled studies examining the trajectory of these IQ subgroups longitudinally or their relationship with clinical and social outcomes. Of 129 individuals with first-episode schizophrenia or schizoaffective disorder, 25% showed stable low IQ, 31% showed stable IQ in the average/high range, and 44% demonstrated intellectual deterioration by 10 points or more. Patients in the low and deteriorated groups were equally impaired on tests of memory and executive function compared with the preserved average/high-IQ group and controls and showed more negative and disorganization symptoms than the preserved average/high-IQ group. Sixty patients and 27 controls were assessed again 1 and 3 years later. There was no evidence that those with IQ deterioration at baseline continued on a declining cognitive trajectory or that those with preserved average/high IQ experienced subsequent IQ decline. The low IQ group showed no change in IQ, whereas both the DIQ and the preserved IQ groups improved. However, the rate of improvement of these 2 subgroups was no greater than that of the healthy controls, suggesting that this reflected practice effects. Both the low and the deteriorated groups had longer index admissions, more core negative symptoms, and worse occupational outcomes at 3 years. These data suggest that following psychosis onset, IQ is stable and that it is IQ at psychosis onset rather than premorbid IQ predicts a more severe illness

Cingulate Abnormalities Associated with PANSS Negative Scores in First Episode Schizophrenia

There is evidence for the involvement of the cingulate gyrus in schizophrenia. We present details of a Statistical Parametric Mapping (SPM) analysis of SPECT data from the largest study (N = 39) of drug naive schizophrenic patients. The main findings are that there is decreased perfusion in the anterior cingulate during verbal fluency when patients are compared to controls (matched individually by age, gender and father’s social class as determined by occupation) and also that PANSS negative scores correlate negatively with regional cerebral blood flow in the cingulate gyrus (Pearson’s Correlation coefficient of r = − 0.49 and significance p < 0.005). This suggests that measurement of change of perfusion in this region could be a useful biological marker in assessing the effect of neuroleptics on negative symptoms

Hypofrontality in Schizophrenia. A meta-analysis of functional imaging studies

The definitive version is available at www.blackwell-synergy.com '--Copyright Blackwell PublishingObjective: Hypofrontality is not a well-replicated finding in schizophrenia either at rest or under conditions of task activation. Method: Studies comparing whole brain and frontal blood flow/ metabolism in schizophrenic patients and normal controls were pooled.Voxel-based studies were also combined to examine the pattern of prefrontal activation in schizophrenia. Results: Whole brain flow/metabolism was reduced in schizophrenia to only a small extent.Restin g and activation frontal flow/metabolism were both reduced with a medium effect size.Duration of illness significantly moderated resting hypofrontality, but the moderating effects of neuroleptic treatment were consistent with an influence on global flow/metabolism only.Pooling of voxel-based studies did not suggest an abnormal pattern of activation in schizophrenia. Conclusion: Meta-analysis supports resting hypofrontality in schizophrenia.Task-activated hypofrontality is also supported, but there is little from voxel-based studies to suggest that this is associated with an altered pattern of regional functional architecture.Peer reviewe