Neurocognitive Impairments in Deficit and Non-Deficit Schizophrenia and Their Relationships with Symptom Dimensions and Other Clinical Variables

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Abstract

Background

Deficit schizophrenia (DS) has been proposed as a pathophysiologically distinct subgroup within schizophrenia. Earlier studies focusing on neurocognitive function of DS patients have yielded inconsistent findings ranging from substantial deficits to no significant difference relative to non-deficit schizophrenia patients (NDS). The present study investigated the severity and characteristic patterns of neurocognitive impairments in DS and NDS patients and their relationships with clinical variables.

Methods

Attention, ideation fluency, cognitive flexibility and visuospatial memory function were assessed in 40 DS patients, 57 NDS patients, and 52 healthy controls by a comprehensive neuropsychological battery.

Results

Both schizophrenia subgroups had overall more severe cognitive impairments than controls while DS performed worse on every neuropsychological measure except the Stroop interference than the NDS patients with age and education as the covariates. Profile analysis found significantly different patterns of cognitive profiles between two patients group mainly due to their differences in attention and cognitive flexibility functions. Age, education, illness duration and negative symptoms were found to have the correlations with cognitive impairments in the NDS group, while only age and the negative symptoms were correlated with the cognitive impairments in the DS group. Multiple regression analyses revealed that sustained attention and cognitive flexibility were the core impaired cognitive domains mediating other cognitive functions in DS and NDS patients respectively.

Conclusions

DS patients exemplified worse in almost all cognitive domains than NDS patients. Sustained attention and cognitive flexibility might be the key impaired cognitive domains for DS and NDS patients respectively. The present study suggested the DS as a specific subgroup of schizophrenia.

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Most cited references 61

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Rethinking schizophrenia.

Thomas Insel (2010)

How will we view schizophrenia in 2030? Schizophrenia today is a chronic, frequently disabling mental disorder that affects about one per cent of the world's population. After a century of studying schizophrenia, the cause of the disorder remains unknown. Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia. These current unsatisfactory outcomes may change as we approach schizophrenia as a neurodevelopmental disorder with psychosis as a late, potentially preventable stage of the illness. This 'rethinking' of schizophrenia as a neurodevelopmental disorder, which is profoundly different from the way we have seen this illness for the past century, yields new hope for prevention and cure over the next two decades.

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Deficit and nondeficit forms of schizophrenia: the concept.

Marshall Carpenter, Joseph Wagman, D Heinrichs (1988)

The authors provide a rationale for distinguishing the primary, enduring negative symptoms of schizophrenia (termed "deficit symptoms") from the more transient negative symptoms secondary to other factors. They argue that the former are more likely to provide a basis for meaningful subtyping of the schizophrenic syndrome, while the latter are more likely to respond to currently available treatments. They describe their experience in using clinical judgment based on longitudinal observations to identify deficit and nondeficit subtypes of schizophrenic patients and propose criteria for defining schizophrenia with the deficit syndrome.

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A separate disease within the syndrome of schizophrenia.

Douglas Ross, Jamie Kirkpatrick, David R Buchanan … (2001)

If schizophrenia is a clinical syndrome rather than a single disease, the identification of specific diseases within the syndrome would facilitate the advance of knowledge and the development of more specific treatments. We propose that deficit psychopathology (ie, enduring, idiopathic negative symptoms) defines a group of patients with a disease different from schizophrenia without deficit features, as the deficit and nondeficit groups differ in their signs and symptoms, course, biological correlates, treatment response, and etiologic factors. These differences cannot be attributed to more severe positive psychotic symptoms or a greater duration of illness in the deficit group. The alternative interpretation that patients with deficit schizophrenia are at the severe end of a single disease continuum is not supported by risk factor and biological features data, but there is a need for independent replication of these findings. We suggest a series of studies designed to falsify one of these hypotheses, ie, multiple diseases vs a single disease.

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Author and article information

Contributors

Kenji Hashimoto: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 18 September 2015

Publication date Collection: 2015

Volume: 10

Issue: 9

Electronic Location Identifier: e0138357

Affiliations

[1 ]Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China

[2 ]Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu, China

[3 ]Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China

[4 ]Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China

[5 ]State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China

[6 ]Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States of America

Chiba University Center for Forensic Mental Health, JAPAN

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: XRZ ZJZ. Performed the experiments: MY XWT XW XBZ WWS SQY. Analyzed the data: MY NS XYZ. Wrote the paper: MY XRZ ZJZ.

* E-mail: drxrz@ 123456hotmail.com (XRZ); janemengzhang@ 123456vip.163.com (ZJZ)

Article

Publisher ID: PONE-D-15-26853

DOI: 10.1371/journal.pone.0138357

PMC ID: 4575183

PubMed ID: 26381645

SO-VID: b95a932f-4914-41a8-8c36-971f6828224e

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 21 June 2015

Date accepted : 28 August 2015

Page count

Figures: 2, Tables: 3, Pages: 16

Funding

This work was supported by National Basic Research Program of China (973 Program 2010CB529602), National Natural Science Foundation of China (NSFC) (No. 81371474, 91132727 and 81571314), Jiangsu Province Natural Science Foundation of China (BK2012747), Program for New Century Excellent Talents of Central South University and Key Program for Clinical Medicine and Science and Technology: Jiangsu Provence Clinical Medical Research Center (No. BL2013025). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Restrictions imposed by the Institutional Ethical Committee for clinical research of Zhangda Hospital, affiliated with Southeast University in relation to participant consent and approved research protocols prevent public deposition of the data. Data are available upon request from Dr. Xiang Rong Zhang, ( drxrz@ 123456hotmail.com ).

Neurocognitive Impairments in Deficit and Non-Deficit Schizophrenia and Their Relationships with Symptom Dimensions and Other Clinical Variables

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Abstract

Background

Methods

Results

Conclusions

Related collections

PLOS Climate

Most cited references 61

Rethinking schizophrenia.

Deficit and nondeficit forms of schizophrenia: the concept.

A separate disease within the syndrome of schizophrenia.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

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Funding

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