Chan, P

Chan, RCK

Chen, E

Chen, RYL

Kwong, P

Journal of the International Neuropsychological Society

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TitleComparison of Short-Term Clinical and Neurocognitive OutcomeBetween Atypical and Typical Antipsychotics in First EpisodeSchizophreniaAuthor(s) Chen, E; Chan, RCK; Chan, P; Kwong, P; Chen, RYLCitationThe 30th Annual International Neuropsychological SocietyConference, Toronto, Canada, 13-16 February 2002. In Journal ofthe International Neuropsychological Society JINS, 2002, v. 8 n.2, p. 180-181Issued Date 2002URL http://hdl.handle.net/10722/46980Rights Journal of International Neuropsychological Society. Copyright© Cambridge University Press.J.S. BEDWELL, M. SHALANGO, G. STRAUSS, & L.S. MILLER.Accelerated Age-Related Decline of Visual Perception in Schizophrenia.Previous research has indicated that relatives of persons with schizophre-nia display reduced performance on tasks of visual processing. Additionalresearch has indicated that persons with schizophrenia evidence an accel-erated age-related decline on a specific task of visual perception, but to theauthors’ knowledge, no research has examined this effect in first-degreerelatives—which would rule out potential confounds present when exam-ining persons with schizophrenia directly. This study contributes to thegap in the literature and provides preliminary data from a larger ongoingstudy. Several computer tasks were administered to an initial sample of 23first-degree relatives of persons with schizophrenia0schizoaffective disor-der and 18 controls. The groups were well matched on age (controls: M 549.5, SD 5 12.92, range 30–75; relatives: M 5 51.0, SD 5 11.6, range30–72; t 5 .393, p 5 .70), but differed on socioeconomic status, IQ esti-mate, and visual acuity. However, there was no indication of differencebetween groups in the relation of age to visual acuity (controls: R2 5 .09;relatives: R2 5 .06). Based on performance from conditions on 2 computertests that required intense visual processing (Backward Masking and Spanof Apprehension) a single summary score was created to represent accu-racy. Although both groups displayed decreasing accuracy with increasingage, the data suggested that the relatives displayed an accelerated age-related decline (controls: R2 5 .20, relatives: R2 5 .63, z 5 1.73, p 5 .07),which may reflect the influence of genes unique to schizophrenia on brainfunctioning. This finding supports previous research reporting a similarage-related decline in persons with schizophrenia and extends the findingto include healthy first-degree relatives.Correspondence: Jeffrey S. Bedwell, Clinical Psychology Program, Uni-versity of Georgia, Athens, GA 30602. jbedwell@arches.uga.eduM. PÉREZ-GÓMEZ, I. BAEZA, S. CAÑIZARES, M. SALAMERO,M. BERNARDO, & C. JUNQUÉ. The Effect of Risperidone on Fron-tal Functions in First-Episode Schizophrenia.Objective: To study the impact of the atypical antipsychotic risperidone onfrontal functions in neuroleptic-naive first-episode schizophrenic patients.Method: Subjects: 26 neuroleptic-naive first episode schizophrenic pa-tients (14 male, 12 female) were recruited from the Acute PsychiatricWard of the Hospital Clinic i Provincial de Barcelona. They were com-pared with 16 healthy control subjects (matched for gender, age and edu-cation). Procedure: We assessed frontal functions with the followingneuropsychological tasks: Trail Making Test B (TMT B), Continuous Per-formance Test (CPT), The Stroop Test, Tower of Hanoi, and ControlledOral Word Association (COWA). Patients were tested before and one monthafter initiation of risperidone treatment. Healthy subjects were assessed atbaseline and one month later to control practice effects on cognitive tests.Statistical Analysis: Multivariate analysis of variance for repeated mea-sures for the frontal battery were performed to compare the results atbaseline and one month after assessment. Groups were also compared atbaseline by mean analyses (T-test, U-Mann-Whitney). Results: There weresignificative differences between patients and controls in the CPT, Strooptask, Trail Making B, and Tower of Hanoi at baseline. When comparisontest–retests were made there was a significant difference in the Tower ofHanoi and COWA. Conclusions: Patients differed from control subjects inattentional tasks and executive functions at baseline. Before and aftertreatment there were differences in frontal functions: planning and verbalfluency.Correspondence: Mercedes Perez-Gomez, Department of Psychiatry andClinical Psychobiology, University of Barcelona, Casanovas 143, Barce-lona 08036, Spain. mpgomez@psi.ub.esJ. POOLE, H. WILLIAMS, M. FISHER, & S. VINOGRADOV. TheRelation of Schizophrenic Patients’ Coping Strategies to Neuropsy-chological Functioning, Symptom Severity, and Illness Outcome.The Coping Response Inventory (CRI) is a measure of coping strategiesthat individuals employ to deal with stressful life events. It has beenextensively used to evaluate patients with general medical conditions,substance abuse, and mood disorders, but not those with psychotic disor-ders. We administered the CRI to 88 clinically stable schizophrenic out-patients, to investigate whether patients’ coping strategies are related tothe neurocognitive and symptomatic expressions of their illness, as well asto clinical outcome. Compared to normative values, we found that schizo-phrenic subjects used significantly fewer proactive coping strategies (i.e.,logical analysis, seeking help, positive-reframing, trying alternate solu-tions) and used significantly more avoidant strategies (emotional out-bursts, resignation, avoidant thinking). Use of proactive coping strategieswas associated with better performance on several cognitive measures(e.g., executive problem solving, facial affect recognition); use of avoid-ant strategies was associated with poor performance on other measures(e.g., visuospatial abilities). The strongest correlates of avoidant strat-egies, however, were patients’ symptoms (notably, dysphoric mood andpsychosis). In terms of outcome, greater use of proactive strategies andless use of avoidant strategies were associated with higher quality of life(socially and intrapsychically) and less frequent psychiatric hospitaliza-tion. This study suggests that the CRI can be a valuable adjunct to thecomprehensive neuropsychological evaluation. Our findings highlight therelation of schizophrenic patients’proactive coping strategies to their neuro-psychological resources, the relation of their avoidant strategies to un-resolved symptoms, and the relation of both types of strategies to patients’quality of life and illness outcome.Correspondence: Heather Williams, 1159 Regent Street, Alameda, CA94501. hawilliams21@hotmail.comR.E. HARLAND, R. KRIKORIAN, P.K. SHEAR, & S.M. STRA-KOWSKI. Cognitive Flexibility and Psychiatric Symptomatology inDifferent Domains of Psychosocial Functioning in Individuals withSchizophrenia.Individuals with schizophrenia often experience significant impairment inautonomous living, occupational functioning, and social functioning, andboth psychiatric symptoms and cognitive deficits predict these aspects offunctioning. However, the extent to which each of these factors contrib-utes to functional disability remains unclear. The purpose of this study wasto determine the extent to which cognitive inflexibility, an executive func-tion deficit observed in schizophrenia, contributed to specific domains ofpsychosocial functioning. Thirty-eight community-dwelling individuals(23 females, 15 males, M age 5 42.3, SD 5 7.7) with SCID-I0P diagnosesof schizophrenia were evaluated. Participants’ psychotic, disorganized,and negative symptoms were rated formally using the SAPS and the SANS.Autonomous living, occupational functioning, and social functioning wererated using the Role Functioning Scale. The number of perseverative er-rors derived from the Wisconsin Card Sorting Test (WCST) was used asan index of mental flexibility. Bivariate correlations revealed that both theWCST and symptomatology were significantly related to autonomous liv-ing, occupational function, and social function. Partial correlations re-vealed that the WCST accounted for unique variance in autonomous living,while symptomatology was not significant after WCST was controlled. Incontrast, symptomatology accounted for unique variance in both occupa-tional function and social function once the WCST was partialed out,while the WCST was not a significant independent predictor. These resultssuggest that the predictive utility of cognitive functioning and symptom-atology may differ as a function of the specific psychosocial skills exam-ined. In particular, autonomous functioning appears to require greatercognitive flexibility than other aspects of functioning.Correspondence: Renata Harland, Department of Psychology, VancouverGeneral Hospital, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Can-ada. renata.harland.1hsc.on.caE. CHEN, R. CHAN, P. CHAN, P. KWONG, & R. CHEN. Compari-son of Short-Term Clinical and Neurocognitive Outcome Between Atyp-ical and Typical Antipsychotics in First Episode Schizophrenia.Treatment with atypical antipsychotics for patients with schizophrenia hasbeen shown to have a beneficial effect on psychotic symptoms as well asa minimization of the medication side-effect profile. However, its effectsfor negative symptoms and neurocognitive impairments have not beenconsistently reported. The purpose of this study was to compare the short-180 JINS, Vol. 8, No. 2term clinical and neurocognitive outcome between the first episode schizo-phrenic patients treated with atypical antipsychotic risperidone and thosetreated with conventional antipsychotic haloperidol in a randomized open-label trial design. A total of 49 patients (29 patients in the risperidonegroup and 20 patients in the haloperidol group) were recruited. The Posi-tive and Negative Symptoms Scale and High Royds Evaluation of Nega-tivity Scale were used to assess psychotic symptoms. Neurocognitivefunction tests on attention, memory, and executive function were admin-istered to patients upon admission and discharge. Medication side-effectand drop-out rate were also assessed. Despite the significant improvementof psychotic symptoms in both groups across the trial periods, risperidonedid not demonstrate superiority in reduction of psychotic symptoms aswell as medication side-effect profile as compared to haloperidol. How-ever, patients in the risperidone group tended to show improvement in theModified Wisconsin Card Sorting Test. The results indicate that positivesymptomatic outcome is very good for first episode schizophrenia, whethertreated with haloperidol or risperidone. Negative symptoms improved sig-nificantly but not completely in either group. Even though risperidone wasused in a short-term treatment, it tends to improve general cognitive im-pairments in first episode schizophrenic patients as compared to haloperidol.Correspondence: Eric Chen, Department of Psychiatry, the University ofHong Kong, Pokfulam Road, Hong Kong, China. eyhchen@hkucc. hku.hkK.E. WILDER-WILLIS, P.K. SHEAR, R.M. STUTZ, & S.M. STRA-KOWSKI. Cognitive Correlates of Psychosocial Outcome in BipolarDisorder.A subgroup of individuals with bipolar disorder (BPD) experience diffi-culties in psychosocial functioning during periods of clinical stability.BPD is also associated with impairment in memory and executive func-tioning. The goal of the current study was to determine whether executivefunctioning and memory were associated with difficulties in primary role(e.g., ability to carry out responsibilities associated with work, school, orhousework) and relationship functioning (e.g., ability to form close rela-tionships) in euthymic patients with BPD. Twenty-four clinically stableindividuals with BPD (M age 5 30, SD 5 7) participated in the study andwere administered tests of executive functioning [Wisconsin Card SortingTest (WCST), Trail-Making test (TMT)], verbal memory [California Ver-bal Memory Test (CVLT)], and visual spatial memory and constructionalability [Benton Visual Retention Test (BVRT)]. Psychosocial functioningand clinical stability were assessed with the Longitudinal InterviewFollow-up Evaluation (LIFE) and the presence of depressive, manic, andpsychotic symptoms were assessed with the Hamilton Depression Scale(HAM–D), Young Mania Rating Scale (YMRS), and Scale for the Assess-ment of Positive Symptoms (SAPS), respectively. Recognition memory( p , .01! and visual-spatial constructional skills ( p , .01! made signifi-cant, independent contributions to primary role functioning after control-ling for the effects of demographic and clinical variables. Sequencingskills made a significant and independent contribution to relationship func-tioning after controlling for the effects of demographic and clinical vari-ables ( p , .04!. The findings suggest that executive functioning andmemory contribute to deficient psychosocial functioning in euthymic pa-tients with BPD.Correspondence: Kelly Wilder-Willis, 429 Dyer Hall, Department ofPsychology, University of Cincinnati, Cincinnati, OH 45221-0376.shearpk@email.uc.eduG.E. GETZ, M. STEED, K.E. WILDER-WILLIS, M.E. ZIMMER-MAN, K. BATES-COREY, A. J. JAK, P.K. SHEAR, & S.M. STRA-KOWSKI. Nonverbal Memory Impairment in Mania and Euthymia.Recent research has indicated that individuals with bipolar disorder (BPD)exhibit cognitive dysfunction, which appears to persist in approximatelyone-third of patients even during euthymia. We have reported that manicpatients exhibit nonverbal memory impairment, including perseverativeerrors, in the context of spared visuospatial perception and construction.The goal of the present study was to re-examine data for the manic sample,this time including a euthymic comparison group, to determine if nonver-bal memory deficits are specific to periods of abnormal mood. Thirtyhealthy participants, 36 manic patients with BPD, and 24 patients withBPD in remission were administered the Benton Visual Retention Test(BVRT) as part of a comprehensive neuropsychological battery. In therecall condition, after covarying for the copy condition, there were signif-icant group differences in errors ( p , .05! and correct designs ( p , .05!.The manic patients performed worse than the healthy volunteers ( p , .02for both scores). The euthymic patients performed comparably to the manic( p . .27 for both scores) as well as the control groups ( p . .17 for bothscores). Further, the manic patients made more perseverations ( p , .003!and rotations ( p , .05! than the control group. The euthymic patients alsomade significantly more perseverations ( p , .04! than the control group,but there were no significant differences between euthymic and manicpatients on any error type ( p . .13 for all cases). This study indicates thatpatients with BPD, even while in remission, demonstrate subtle nonverbalmemory impairment.Correspondence: Glen Getz, Departments of Psychiatry and Psychology,Bipolar and Psychotic Disorders Research Program, University of Cincin-nati, Cincinnati, OH 45267-0559. getzg@email.uc.eduD. MATTHEWS & L. FISHER. Pathological Apathy With EpisodicExplosiveness: A Case Study.Pathological apathy is sometimes referred to as “subcortical dementia,”“pseudodepression,” the “indifference reaction,” or the “lateral frontalconvexity syndrome.” It is a neuropsychiatric syndrome seen in cerebralvascular disorders or neoplastic lesions, characterized by lack of initiative,poor spontaneity, flat effect, decreased motivation, and lack of interest inusual activities. There may be unusual cheerfulness and anosognosia. Insome cases, there may be some associated depression, but the loss of driveand ambition and lack of concern over these dramatic changes is not due toa depressive disorder. Lesions of the right frontal convexity, right tempo-ral lobe, or posterior internal capsule can produce this type of pathologicalapathy. The present case study presents a 28-year-old male patient whosuffered polysubstance-induced lesions in frontal and temporal regionsdetected by neurophysiological abnormalities. Cortical functions includ-ing basic intellect, language, and perceptual motor skills were intact but hewas severely disabled by chronic apathy. He had been a college student,athlete, and musician, but subsequently was no longer capable of living orworking independently. Diagnostic test results and treatment plans will bereviewed for this classic case of pathological apathy.Correspondence: Larry Fisher, Ph.D., Comprehensive NeurobehavioralSystems, 2501 Cypress Creek Rd., Cedar Park, TX 78613. cnsgroup@swbell.netK.D. HIATT, A.R. LORENZ, & J.P. NEWMAN. LateralizedInformation-Processing Deficits in Psychopathic Offenders.Psychopaths demonstrate failures using emotional information and inhib-itory threat cues. These performance deficits may be related to poor coor-dination of left- and right-hemisphere processing resources (Hare, 1998;Hiatt, Lorenz, & Newman, 2001), and may be particularly evident underconditions that primarily activate the left hemisphere (Bernstein, New-man, Wallace, & Luh, 2000; Kosson, 1998). Experiment 1 assessed emo-tion facilitation in 31 psychopaths and 43 controls while they performed alexical decision task that differentially activated the left and right hemi-spheres by requiring either right- or left-handed responses. Experiment 2examined the performance of 9 psychopaths and 41 controls on a passiveavoidance task in which the go0no-go stimuli were presented unpredict-ably on either the left or the right side of the monitor and all responseswere made with the right hand. In Experiment 1, a significant Psychopa-thy 3 Response Hand interaction @F~1,72! 5 4.00, p , .05# indicated thatpsychopaths displayed normal emotion facilitation when responding withthe left hand, but nonsignificant facilitation when responding with theright hand. In Experiment 2, a significant Psychopathy 3 Side interaction@F~1,48! 5 5.01, p , .05# revealed that psychopaths’ ability to discrimi-nate between go- and no-go cues was significantly worse for stimuli on theleft as opposed to the right side of the monitor. As the right hemisphereprocesses both emotional and left visual field information, these studiessuggest that psychopaths’ performance abnormalities may be related toThirtieth Annual INS Meeting Abstracts 181

Comparison of Short-Term Clinical and Neurocognitive Outcome Between Atypical and Typical Antipsychotics in First Episode Schizophrenia

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Comparison of Short-Term Clinical and Neurocognitive Outcome Between Atypical and Typical Antipsychotics in First Episode Schizophrenia

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