RESUMEN

Background: Stiff Person Syndrome Spectrum Disorders (SPSD) are a group of rare neurological disorders that can present alongside other autoimmune conditions. However, not much is known about the breadth of non-neurological autoantibodies seen in SPSD nor the observed prevalence of co-existing autoimmune comorbidities and their impact on SPSD. Objective: This study aimed to investigate the prevalence of non-neurological autoantibodies and associated conditions in a large cohort of people with SPSD. Methods: A retrospective review of 205 patients with suspected/definitive SPSD seen at Johns Hopkins Hospital from 1997 to 2023 was performed as part of an ongoing, observational study. Relevant demographics, clinical data (e.g., SPSD phenotypes, comorbid conditions, and dates of diagnoses), and laboratory values were collected from electronic medical records. Lab values were excluded if completed within 6 months of receiving intravenous immunoglobin treatment. Summary statistics were performed and assessment for any associations between autoimmune comorbidities and disease burden (modified Rankin score [mRS] and ambulation status) was performed. Results: The majority of participants had classic SPS (66%), followed by SPS-plus (18%) and PERM (6%) with less than 5% each of the remaining phenotypes and suspected SPS. The average age at symptom onset in this cohort was 44.1 ± 14.5 years (mean ± standard deviation). The majority of the cohort was white (66%) and female patients (75%). The mean mRS was 2.5, and over 70% required assistive devices for ambulation. The most commonly identified non-neurological autoantibodies were anti-nuclear (ANA) (31%), thyroperoxidase (30%), thyroglobulin (20%), and anti-parietal cell (18%) autoantibodies. The most common comorbid autoimmune conditions were autoimmune thyroiditis (38%), insulin-dependent diabetes mellitus (26%), and pernicious anemia (10%). Having more autoimmune comorbidities was weakly associated with higher mRS and a greater need for ambulatory assistance. Conclusion: The results of this study will hopefully help promote awareness of which autoantibody and medical comorbidity clinicians should be aware of and monitor people with SPSD. Further research is needed to identify if poorly controlled non-neurological autoimmune disorders contribute to disease burden in SPSD and/or if the timing of being diagnosed with one of these conditions plays a role in future disability.

RESUMEN

PURPOSE: To provide a descriptive analysis on the presurgical evaluation and surgical management of a cohort of patients with stroke related epilepsy (SRE). METHODS: We retrospectively examined the clinical characteristics, results of non-invasive and invasive presurgical evaluation, surgical management and outcome of consecutive patients with drug-resistant SRE in our institution from January 1, 2013 to January 1, 2020. RESULTS: Twenty-one of 420 patients (5%) who underwent intracranial EEG (iEEG), resective epilepsy surgery and/or vagus nerve stimulation (VNS) placement, had SRE. Of 13 patients who had iEEG, the ictal onset (IO) was exclusively within the stroke lesion in only one patient. In five patients the IO was extra-lesional and in the remaining seven patients it included the stroke lesion as well as extra-lesional structures. The IO included the mesial temporal region in 11 of the 13 patients (85%). The posterior margin of the stroke lesion was always involved. Five patients underwent surgery without iEEG. In total, 10 patients underwent resective surgery, four VNS placement and two had both corpus callosotomy and VNS placement. Of the patients who had resective surgery, nine were Engel I or II at last follow up. CONCLUSION: We found that seizures in patients with drug resistant SRE were more frequently originated in the mesial temporal region than in the stroke lesion itself. Despite the complex epileptic network underlying drug-resistant SRE, a thorough presurgical assessment and adequate use of surgical options can lead to excellent surgical outcomes.

Asunto(s)

Epilepsia Refractaria , Epilepsia , Estimulación del Nervio Vago , Epilepsia Refractaria/cirugía , Electroencefalografía , Epilepsia/etiología , Epilepsia/cirugía , Humanos , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVES: There is an incomplete understanding of the host humoral immune response to severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2, which underlies COVID-19, during acute infection. Host factors such as age and sex as well as the kinetics and functionality of antibody responses are important factors to consider as vaccine development proceeds. The receptor-binding domain of the CoV spike (RBD-S) protein mediates host cell binding and infection and is a major target for vaccine design to elicit neutralising antibodies. METHODS: We assessed serum anti-SARS-CoV-2 RBD-S IgG, IgM and IgA antibodies by a two-step ELISA and neutralising antibodies in a cross-sectional study of hospitalised COVID-19 patients of varying disease severities. Anti-RBD-S IgG levels were also determined in asymptomatic seropositives. RESULTS: We found equivalent levels of anti-RBD-S antibodies in male and female patients and no age-related deficiencies even out to 93 years of age. The anti-RBD-S response was evident as little as 6 days after onset of symptoms and for at least 5 weeks after symptom onset. Anti-RBD-S IgG, IgM and IgA responses were simultaneously induced within 10 days after onset, with anti-RBD-S IgG sustained over a 5-week period. Anti-RBD-S antibodies strongly correlated with neutralising activity. Lastly, anti-RBD-S IgG responses were higher in symptomatic COVID-19 patients during acute infection compared with asymptomatic seropositive donors. CONCLUSION: Our results suggest that anti-RBD-S IgG reflect functional immune responses to SARS-CoV-2, but do not completely explain age- and sex-related disparities in COVID-19 fatalities.

RESUMEN

SARS-CoV-2 is the newly emerged virus responsible for the global COVID-19 pandemic. There is an incomplete understanding of the host humoral immune response to SARS-CoV-2 during acute infection. Host factors such as age and sex as well the kinetics and functionality of antibody responses are important factors to consider as vaccine development proceeds. The receptor-binding domain of the CoV spike (RBD-S) protein is important in host cell recognition and infection and antibodies targeting this domain are often neutralizing. In a cross-sectional study of anti-RBD-S antibodies in COVID-19 patients we found equivalent levels in male and female patients and no age-related deficiencies even out to 93 years of age. The anti-RBD-S response was evident as little as 6 days after onset of symptoms and for at least 5 weeks after symptom onset. Anti-RBD-S IgG, IgM, and IgA responses were simultaneously induced within 10 days after onset, but isotype-specific kinetics differed such that anti-RBD-S IgG was most sustained over a 5-week period. The kinetics and magnitude of neutralizing antibody formation strongly correlated with that seen for anti-RBD-S antibodies. Our results suggest age- and sex- related disparities in COVID-19 fatalities are not explained by anti-RBD-S responses. The multi-isotype anti-RBD-S response induced by live virus infection could serve as a potential marker by which to monitor vaccine-induced responses.

RESUMEN

The northern corn rootworm (NCR), Diabrotica barberi Smith & Lawrence, is an economic pest of maize in the U.S. Corn Belt. The objective of this study was to determine the baseline susceptibility of a laboratory NCR strain to Bt proteins eCry3.1Ab, mCry3A, Cry3Bb1, and Cry34/35Ab1 using seedling, single plant, and diet-toxicity assays. Plant assays were performed in greenhouse using corn hybrids expressing one of the Bt proteins and each respective near-isoline. Diet-toxicity assays, consisting of Bt proteins overlaid onto artificial diet were also conducted. In both plant assays, significantly more larvae survived Cry34/35Ab1-expressing corn compared with all other Bt-expressing corn, and larvae that survived eCry3.1Ab-expressing corn had significantly smaller head capsule widths compared with larvae that survived Cry34/35Ab1-expressing corn. In seedling assays, larvae surviving eCry3.1Ab-expressing corn also had significantly smaller head capsule widths compared with larvae that survived mCry3A-expressing corn. Additionally, larvae that survived mCry3A-expressing corn weighed significantly more than larvae surviving eCry3.1Ab- and Cry34/35Ab1-expressing corn. In single plant assays, no significant differences in larval dry weight was observed between any of the Bt-expressing corn. In diet assays, LC50s ranged from 0.14 (eCry3.1Ab) to 10.6 µg/cm2 (Cry34/35Ab1), EC50s ranged from 0.12 (Cry34/35Ab1) to 1.57 µg/cm2 (mCry3A), IC50s ranged from 0.08 (eCry3.1Ab) to 2.41 µg/cm2 (Cry34/35Ab1), and MIC50s ranged from 2.52 (eCry3.1Ab) to 14.2 µg/cm2 (mCry3A). These results establish the toxicity of four Bt proteins to a laboratory diapausing NCR strain established prior to the introduction of Bt traits and are important for monitoring resistance evolution in NCR field populations.

Asunto(s)

Bacillus thuringiensis , Escarabajos , Animales , Bacillus thuringiensis/genética , Proteínas Bacterianas , Escarabajos/genética , Dieta , Endotoxinas , Proteínas Hemolisinas , Laboratorios , Larva , Control Biológico de Vectores , Plantas Modificadas Genéticamente/genética , Plantones , Zea mays/genética

RESUMEN

Unlike anoxia-intolerant mammals, painted turtles can survive extended periods without oxygen. This is partly accomplished by an anoxia-mediated increase in gamma-aminobutyric acid (GABA) release, which activates GABA receptors and mediates spike arrest in turtle neurons via shunting inhibition. Extracellular taurine levels also increase during anoxia; why this occurs is unknown but it is speculated that glycine and/or GABAA/B receptors are involved. Given the general importance of inhibitory neurotransmission in the anoxia-tolerant painted turtle brain, we investigated the function of taurine as an inhibitory neuromodulator in turtle pyramidal neurons. Using whole-cell patch-clamp electrophysiological methods to record from neurons within a cortical brain sheet, we found that taurine depolarized membrane potential by ∼8 mV, increased whole-cell conductance ∼2-fold, and induced an inward current that possessed characteristics similar to GABA- and glycine-evoked currents. These effects were mitigated following glycine receptor antagonism with strychnine and GABAA receptor antagonism with gabazine, bicuculine or picrotoxin, but were unchanged following GABAB or glutamatergic receptor inhibition. These data indicate that a high concentration of taurine in vitro mediates its effects through both glycine and GABAA receptors, and suggests that taurine, in addition to GABA, inhibits neuronal activity during anoxia in the turtle cortex.

Asunto(s)

Células Piramidales/fisiología , Receptores de GABA-A/fisiología , Receptores de Glicina/fisiología , Taurina/farmacología , Tortugas/fisiología , Potenciales de Acción/fisiología , Anaerobiosis , Animales , Técnicas de Placa-Clamp/veterinaria , Células Piramidales/efectos de los fármacos , Proteínas de Reptiles/fisiología

RESUMEN

Neurons from the western painted turtle (Chrysemys picta bellii) are remarkably resilient to anoxia. This is partly due to a reduction in the permeability of excitatory glutamatergic ion channels, initiated by mitochondrial ATP-sensitive K(+) (mK(+)ATP) channel activation. The aim of this study was to determine if: 1) PKCε, a kinase associated with hypoxic stress tolerance, is more highly expressed in turtle brain than the anoxia-intolerant rat brain; 2) PKCε translocates to the mitochondrial membrane during anoxia; 3) PKCε modulates mK(+)ATP channels at the Thr-224 phosphorylation site on the Kir6.2 subunit; and 4) Thr-224 phosphorylation sensitises mK(+)ATP channels to anoxia. Soluble and mitochondrial-rich particulate fractions of turtle and rat cerebral cortex were isolated and PKCε expression was determined by Western blot, which revealed that turtle cortical PKCε expression was half that of the rat. Following the transition to anoxia, no changes in PKCε expression in either the soluble or particulate fraction of the turtle cortex were observed. Furthermore, incubation of tissue with tat-conjugated activator or inhibitor peptides had no effect on the amount of PKCε in either fraction. However, we observed a 2-fold increase in Thr-224 phosphorylation following 1h of anoxia. The increased Thr-224 phosphorylation was blocked by the general kinase inhibitor staurosporine but this did not affect the latency or magnitude of mK(+)ATP channel-mediated mitochondrial depolarization following anoxia, as indicated by rhodamine-123. We conclude that PKCε does not play a role in the onset of mitochondrial depolarization and therefore glutamatergic channel arrest in turtle cerebral cortex.

Asunto(s)

Encéfalo/citología , Mitocondrias/metabolismo , Canales de Potasio de Rectificación Interna/metabolismo , Proteína Quinasa C-epsilon/metabolismo , Tortugas , Animales , Encéfalo/metabolismo , Regulación Enzimológica de la Expresión Génica , Hipoxia/metabolismo , Mitocondrias/efectos de los fármacos , Fosforilación/efectos de los fármacos , Canales de Potasio de Rectificación Interna/química , Proteína Quinasa C-epsilon/antagonistas & inhibidores , Inhibidores de Proteínas Quinasas/farmacología , Ratas , Solubilidad , Treonina/metabolismo

RESUMEN

BACKGROUND: Clinical video telehealth provides a means for increasing access to psychotherapy. Insomnia is prevalent, is associated with a number of negative sequelae, and can be effectively managed with cognitive behavioral treatment of insomnia (CBT-I). Telehealth technologies can provide a means for increasing access to CBT-I. MATERIALS AND METHODS: The Tele-Insomnia program is a Veterans Health Administration (VHA) initiative in which CBT-I is delivered in a group format by telehealth. Veterans received six weekly sessions of group CBT-I, completing the Insomnia Severity Index (ISI) and daily sleep diaries throughout treatment. Paired-samples t-tests were used to examine differences in each measure from the first to the last session of treatment. RESULTS: There were statistically and clinically significant improvements in the ISI and all sleep diary variables with the exception of total sleep time. Video quality was excellent, and there were few connectivity problems. CONCLUSIONS: Clinical video telehealth technology can be used to deliver group CBT-I in a manner that produces clinically significant improvement. This model is scalable and has been used to develop a national clinical telehealth program.

Asunto(s)

Terapia Cognitivo-Conductual/métodos , Psicoterapia de Grupo/métodos , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Telemedicina/métodos , Adulto , Anciano , Estudios de Factibilidad , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Proyectos Piloto , Estados Unidos , United States Department of Veterans Affairs

RESUMEN

Recent reports suggest that cognition is relatively preserved in some schizophrenia patients. However, little is known about the functional advantage these patients may demonstrate. The purpose of this study was to identify cognitively normal patients with a recently developed test battery and to determine the functional benefit of this normality relative to cognitively impaired patients. Average-range cognitive ability was defined by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) composite score (T≥40) and applied to 100 patients with schizophrenia or schizoaffective disorder and to 81 non-psychiatric research participants. With group assignment adjusted for demographic variables, this procedure yielded 14 cognitively normal patients, 21 cognitively impaired patients, and 21 healthy adults with normal-range MCCB scores. Cognitively normal patients were indistinguishable from controls across all MCCB scales. Furthermore, their performance was superior to impaired patients on all scales except Social Cognition. Cognitively normal patients were also superior to impaired patients on a summary index of simulated life skills and functional competence. Nevertheless, both patient groups were equally disadvantaged relative to controls in independent community living. These findings suggest that normal-range cognition exists in schizophrenia, but fails to translate into enhanced community outcome.

Asunto(s)

Trastornos del Conocimiento/etiología , Características de la Residencia , Esquizofrenia/fisiopatología , Psicología del Esquizofrénico , Adolescente , Adulto , Anciano , Análisis de Varianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Valores de Referencia , Adulto Joven

RESUMEN

OBJECTIVE: The main purpose of this investigation was to identify patterns of intellectual performance in schizophrenia patients suggesting preserved, deteriorated, and premorbidly impaired ability, and to determine clinical, cognitive, and functional correlates of these patterns. METHOD: We assessed 101 patients with schizophrenia or schizoaffective disorder and 80 non-psychiatric control participants. The "preserved" performance pattern was defined by average-range estimated premorbid and current IQ with no evidence of decline (premorbid-current IQ difference <10 points). The "deteriorated" pattern was defined by a difference between estimated premorbid and current IQ estimates of 10 points or more. The premorbidly "impaired" pattern was defined by below average estimated premorbid and current IQ and no evidence of decline greater than 10 points. Preserved and deteriorated patterns in healthy controls were also identified and studied in comparison to patient findings. The groups were compared on demographic, neurocognitive, clinical and functionality variables. RESULTS: Patients with the preserved pattern outperformed those meeting criteria for deteriorated and compromised intellectual ability on a composite measure of neurocognitive ability as well as in terms of functional competence. Patients demonstrating the deteriorated and compromised patterns were equivalent across all measures. However, "preserved" patients failed to show any advantage in terms of community functioning and demonstrated cognitive impairments relative to control participants. CONCLUSIONS: Our results suggest that proposed patterns of intellectual decline and stability exist in both the schizophrenia and general populations, but may not hold true across other cognitive abilities and do not translate into differential functional outcome.

Asunto(s)

Trastornos del Conocimiento/etiología , Discapacidad Intelectual/etiología , Trastornos Psicóticos/complicaciones , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Adulto , Trastornos del Conocimiento/diagnóstico , Femenino , Humanos , Vida Independiente/psicología , Pruebas de Inteligencia , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Conducta Social , Adulto Joven

RESUMEN

It has been well established that neurocognitive deficits are a core feature in schizophrenia and predict difficulties in functional independence. However, few studies have assessed the longitudinal stability of cognition and key aspects of functional outcome concurrently. Even less attention has been directed at the contingency of cognitive change on real world outcome changes. Accordingly, this study will assess the extent to which significant changes in cognition and community status are independent or related. As a point of comparison, the stability of clinical symptom status and the relationship between symptom and outcome change are evaluated. Symptoms, cognitive abilities, and community outcome was assessed in 128 patients with schizophrenia at baseline and again one year later. Intraclass correlation coefficients were used to index stability and reliable change index analyses quantified the prevalence of significant improvement or deterioration in each of the three illness features. Results from these analyses revealed that symptom status, cognitive functioning, and community outcome are similarly stable in treated schizophrenia outpatients. A small proportion of the sample demonstrated significant improvement or deterioration in these domains, with only weak evidence that such change was predicted by changes in symptoms or cognition. Further, there was no strong evidence of a preferential relationship for cognition relative to symptoms in relation to functional outcome. These results shed light on the strength and nature of the cognition-real world outcome relationship in schizophrenia and have implications for pharmacological and behavioral interventions aimed at improving real world outcome.

Asunto(s)

Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/etiología , Vida Independiente , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Características de la Residencia

RESUMEN

The Wechsler Adult Intelligence Scale (WAIS) has been used extensively to study impairment across a range of cognitive domains in schizophrenia. However, cognitive performance among those with the illness has yet to be examined using the newest edition of this measure. Hence, the current study aims first, to provide WAIS-IV normative data for Canadian individuals with schizophrenia of low average intelligence; second, to examine schizophrenia performance on all WAIS-IV subtest, index and general intelligence scores relative to healthy comparison subjects; and third, to revalidate the pattern of impairment identified in this clinical group using the WAIS-III, where processing speed (PS) was most affected, followed by working memory (WM), perceptual reasoning (PR) and verbal comprehension (VC). The WAIS-IV was administered to outpatients with schizophrenia and their performance compared with age, gender, and education matched controls. WAIS-IV schizophrenia performance data are provided. Analyses revealed significant impairment on several tasks, including the new Cancellation subtest and the VC supplemental subtest, Comprehension. At the index score level, group differences in PS were significantly larger than those observed in all other cognitive domains. Impairments were also observed in WM amid relatively preserved performance in VC, thereby confirming the pattern of impairment identified using the WAIS-III.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Escalas de Wechsler/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Manejo de Caso , Trastornos del Conocimiento/rehabilitación , Centros Comunitarios de Salud Mental , Comprensión , Femenino , Humanos , Masculino , Memoria a Corto Plazo , Persona de Mediana Edad , Ontario , Psicometría/estadística & datos numéricos , Trastornos Psicóticos/rehabilitación , Tiempo de Reacción , Valores de Referencia , Reproducibilidad de los Resultados , Esquizofrenia/rehabilitación , Adulto Joven

RESUMEN

This study examined the reliability and validity of a new performance-based measure of functional competence for individuals with serious mental illness, the Canadian Objective Assessment of Life Skills (COALS). The COALS assesses both routinized procedural knowledge routines (PKR) and executive operations (EXO) in order to capture functional outcome variance. The COALS was administered to 101 outpatients with schizophrenia and schizoaffective disorder and 80 non-psychiatric controls. One month later, 95 patients and 63 controls completed a follow-up assessment. Measures of psychopathology, neurocognition, functionality and community adjustment were also administered. Results indicated that the COALS summary scores had good test-retest reliability for patient data. Further, the COALS correlated with other measures of functionality and with negative symptoms, but was independent of positive symptoms, demonstrating concurrent and discriminant validity. The overall COALS summary score added incremental validity to the prediction of community independence over and above the contribution of symptoms, intellectual ability and neurocognitive performance. Inclusion of EXO scores provided incremental validity not available with PKR scores alone. The COALS increases the number of functional competence instruments and offers the advantage of specific validity while incorporating important distinctions in cognitive performance.

Asunto(s)

Actividades Cotidianas , Función Ejecutiva , Esquizofrenia/diagnóstico , Ajuste Social , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Psicometría/instrumentación , Trastornos Psicóticos/diagnóstico , Reproducibilidad de los Resultados

RESUMEN

As treatment efforts to enhance cognitive abilities in schizophrenia increase, so too does the need for a critical appraisal of instruments that measure functionality and adjustment to community living. The Multidimensional Scale of Independent Functioning (MSIF; Jaeger et al., 2003) is a promising instrument that assesses functionality in relation to different life settings, performance levels, responsibilities and environmental supports. However, its applicability to the schizophrenia population has been questioned because relevant data are scarce. This study provides descriptive and validity-related information by reporting MSIF scores in healthy community-dwelling adults (n=71) and in schizophrenia outpatients (n=156). Results show that healthy adults performed within defined "normal" ranges in most MSIF domains in comparison to schizophrenia patients who showed moderate to severe impairments. Moreover, the MSIF distinguished between the two groups with accuracy rates as high as 98% and effect sizes (standardized mean group difference) above 2.0 in almost all domains. Accordingly, the MSIF is a potentially valuable measure of community independence that can inform treatment initiatives and may be adaptable to the evaluation of functionality changes over time. The unique structure and content of information obtained by the MSIF makes it a candidate for inclusion in studies aimed at developing a new generation of instruments for the assessment of real world functioning in schizophrenia.

Asunto(s)

Actividades Cotidianas , Ambiente , Psicometría/métodos , Esquizofrenia/fisiopatología , Psicología del Esquizofrénico , Actividades Cotidianas/clasificación , Actividades Cotidianas/psicología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Características de la Residencia , Autoinforme , Ajuste Social , Adulto Joven

RESUMEN

The purpose of this investigation was to identify patients with cognitively impaired, cognitively normal and verbal memory-impaired subtypes of schizophrenia and to examine their clinical and functional validity as distinct forms of the disorder. These subtypes occurred in 73 of 154 patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder. A control group comprised of 18 healthy participants was also analyzed. Patient subtype and healthy groups were compared on adjunct cognitive as well as clinical and functional measures. The data support the cognitive validity and differentiation of these subtypes, with evidence that the generalized cognitive normality/impairment distinction associates with important aspects of symptom severity and functional outcome. Support for the clinical and functional validity of the verbal memory subtype was more equivocal. Overall, cognitively-based subtyping merits additional attention in efforts to organize the heterogeneity of the schizophrenia syndrome.

Asunto(s)

Trastornos del Conocimiento/clasificación , Trastornos del Conocimiento/etiología , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Adulto , Análisis de Varianza , Femenino , Humanos , Discapacidades para el Aprendizaje/diagnóstico , Discapacidades para el Aprendizaje/etiología , Masculino , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/etiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Aprendizaje Verbal/fisiología

RESUMEN

Measures of functional competence have been introduced to supplement standard cognitive and neuropsychological evaluations in schizophrenia research and practice. Functional competence comprises skills and abilities that are more relevant to daily life and community adjustment. However, it is unclear whether relevance translates into significantly enhanced prediction of real-world outcomes. The aim of this study was to assess the specific contribution of functional competence in predicting a key aspect of real-world outcome in schizophrenia: community independence. Demographic, clinical, cognitive, and functional competence data were obtained from 127 patients with schizophrenia or schizoaffective disorder and used to predict community independence concurrently and longitudinally after 10 months. Hierarchical regression analyses indicated that demographic, clinical, and cognitive predictors accounted jointly for 35%-38% of the variance in community independence across assessment points. Functional competence data failed to add significantly to this validity. Considered separately from demographic and clinical predictors, cognitive and functional competence data accounted for significant amounts of outcome variance. However, the addition of functional competence to standard cognitive test data yielded a significant increase in validity only for concurrent and not for longitudinal prediction of community independence. The specific real-world validity of functional competence is modest, yielding information that is largely redundant with standard cognitive performance.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Vida Independiente/psicología , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Ajuste Social , Adulto , Anciano , Trastornos del Conocimiento/rehabilitación , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pronóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría , Trastornos Psicóticos/rehabilitación , Esquizofrenia/rehabilitación , Adulto Joven

RESUMEN

Cognitive performance rather than symptoms, especially positive symptoms, is regarded as the primary predictor of functional outcome in schizophrenia. However, contradictory evidence exists and many studies fail to sample from the extremes of outcome measures. This study tested whether the differential importance assigned to symptoms and cognitive impairment is supportable in patients with high and low levels of community independence. Schizophrenia patients with highly unfavorable (n=24) and highly favorable (n=28) functional outcomes as defined by community support requirements were studied. Standard cognitive and psychopathology measures were analyzed using independent groups comparisons and outcome prediction with logistic regression methods. Symptom severity and cognitive data separately accounted for significant amounts of variance in community independence. Positive as well as negative symptoms, non-psychotic psychopathology and cognition generated large effect sizes between highly unfavorable and favorable outcome groups. The conditional validity of both overall psychopathology and positive symptoms was significant over and above the contribution of cognition to outcome prediction. Results suggest researchers may have underestimated the role of psychopathology in general and positive symptoms in particular as potential determinants of functional status in schizophrenia.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adaptación Psicológica , Adulto , Trastornos del Conocimiento/psicología , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Ajuste Social , Apoyo Social

RESUMEN

The existence of small numbers of schizophrenia patients with superior ability in specific cognitive domains is implied by meta-analytic evidence as well as by occasional empirical reports. The authors identified 25 patients with superior (i.e., > or =90th percentile) ability on the Vocabulary subtest of the Wechsler Adult Intelligence Scale 3rd edition (Wechsler, 1997). These cognitively advantaged patients were compared with 22 healthy participants performing at the superior level and with 126 schizophrenia patients and 50 healthy participants scoring below the superior range. Verbally superior schizophrenia patients and verbally superior healthy participants had similar cognitive profiles and life skills performance, but diverged markedly in terms of independent "real-world" functioning. Verbally superior patients significantly outperformed more typical patients in other aspects of cognitive performance, life skills, and support requirements. However, severity of positive and negative symptoms was equivalent in the patient groups. Detailed biobehavioral study of cognitively exceptional patients may offer new insights into mechanisms mediating psychotic disorders.

Asunto(s)

Trastornos del Conocimiento/etiología , Esquizofrenia/fisiopatología , Psicología del Esquizofrénico , Conducta Verbal/fisiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Wechsler

RESUMEN

Competence in self-administration of a drug regimen is related to both treatment adherence and functional outcome. Previous research with middle-aged and older schizophrenia patients suggests a central role for cognitive performance in predicting this competence. We examined the relative and joint contributions of demographic, clinical and cognitive predictors of medication management ability in an age-representative group of patients. The study participants comprised 147 patients with schizophrenia or schizoaffective disorder ranging from 21 to 65 years of age. Measures included demographic variables, current symptoms, subjective treatment response and a battery of cognitive tests. Competence in medication management was indexed with the Medication Management Ability Assessment (MMAA). Multiple regression analyses revealed that cognitive variables accounted for a significant proportion of the variance in MMAA scores over and above the contribution of all other variables. Measures of word recognition and pronunciation, auditory working memory and verbal learning yielded unique contributions to prediction. Positive and negative symptoms and subject treatment evaluations did not independently predict medication competency. This study documents a considerable range in MMAA scores across a demographically broad schizophrenia sample and supports the unique contribution of specific cognitive factors in predicting medication competence.

Asunto(s)

Trastornos del Conocimiento/epidemiología , Quimioterapia , Esquizofrenia/epidemiología , Autocuidado , Adolescente , Adulto , Anciano , Aptitud , Trastornos del Conocimiento/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estudios Prospectivos , Trastornos Psicóticos/epidemiología , Reconocimiento en Psicología , Vocabulario

RESUMEN

This study sought to objectify the distinction between schizophrenia and schizoaffective disorder in terms of standard tasks measuring verbal and non-verbal cognitive ability, auditory working memory, verbal declarative memory and visual processing speed. Research participants included 103 outpatients with a diagnosis of schizophrenia, 48 with schizoaffective disorder, and 72 non-patients from the community. Schizophrenia patients were impaired on all cognitive measures relative to schizoaffective patients and non-psychiatric participants. Regression-based prediction models revealed that cognitive measures classified schizophrenia patients accurately (91%), but not patients with schizoaffective disorder (35%). In addition, there was no statistical evidence for the unique predictive validity of any specific cognitive task. Patients with schizophrenia were significantly more symptomatic and had greater community support requirements than those with schizoaffective disorder. However, group differences in cognitive performance are insufficient to separate these syndromes of psychotic illness.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adulto , Trastornos del Conocimiento/psicología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría/estadística & datos numéricos , Trastornos Psicóticos/psicología , Reproducibilidad de los Resultados