Cognitive Complaints in Schizophrenia: Relationship With Insight and Other Cognitive Measures

Seco, Rosario Bengochea; Sanz, David Gil; Modamio, Mar Fernández; Rodríguez, Marta Arrieta; Calleja, Raúl Sánchez; Solís, Raquel Prat; López, Alexandra Arce; Soltero, Ana Álvarez

doi:10.1016/S2173-5050(10)70010-8

Información del artículo

Resumen

Bibliografía

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Estadísticas

Abstract

Introduction

Individuals diagnosed with schizophrenia have significant cognitive deficits. However, the subjective perception of these deficits do not always coincide with the neuropsychological test and clinical ratings.

Methodology

This study evaluates the cognitive performance of 46 outpatients with schizophrenia, in a Psychosocial Rehabilitation Program, by three different measures: neuropsychological tests (objective assessment), cognitive factor of PANSS (clinical ratings), and subjective scale of cognition, SSTICS (patient self-report). It also studies the possible relationship between subjective assessment of cognitive symptoms and insight of the mental disorder (SUMD).

Results

SSTICS total score correlated only with some neuropsychological subtest, but not with cognitive factor of PANSS. The clinical ratings is more consistent with neuropsychological test than the cognitive complaints. No relationship between SUMD and SSTICS.

Conclusions

Because of the lack of correspondence among several measures, it is possible to think that different cognitive areas have been evaluated. It is therefore important to consider all assessment options in order to create cognitive rehabilitation programs. Cognitive complaints seems to be an independent variable of insight.

Keywords:

Cognitive impairment

Cognitive complaints

Insight

Schizophrenia

Resumen

Introducción

La mayoría de las personas diagnosticadas de esquizofrenia presentan déficit cognitivos. No obstante, la percepción subjetiva de esos déficit no siempre coincide con la evaluación neuropsicológica ni con la evaluación clínica de aquéllos.

Metodología

En este trabajo se evaluó el rendimiento cognitivo de 46 pacientes con esquizofrenia que acuden a un centro de rehabilitación psicosocial, mediante tres pruebas diferentes: una batería neuropsicológica, el test Barcelona (evaluación objetiva), una escala de síntomas cognitivos, el factor cognitivo de la PANSS (evaluación clínica) y una escala subjetiva de cognición, la SSTICS (autoevaluación del paciente). También se estudiaron las relaciones entre la percepción subjetiva de síntomas cognitivos y el insight de la enfermedad, evaluado mediante la SUMD.

Resultados

La puntuación total de la SSTICS se correlacionó sólo con algunos de los subtests del Barcelona, pero no con el factor cognitivo de la PANSS. La evaluación clínica se corresponde con los tests neuropsicológicos en mayor medida que con la percepción subjetiva. No hay relaciones entre la percepción sujetiva de los déficit cognitivos y el insight.

Conclusiones

Dada la falta de correspondencia entre las diferentes medidas, se plantea si podrían estar evaluando ámbitos diferentes del deterioro cognitivo. Se valora la importancia de considerar todas las opciones de evaluación con vistas a elaborar programas de rehabilitación cognitiva. La percepción de déficit cognitivos parece ser independiente del insight.

Palabras clave:

Deterioro cognitivo

Percepción subjetiva

Insight

Esquizofrenia

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References

[1.]

K.H. Nuechterlein, D.M. Barch, J.M. Gold, T.E. Goldberg, M.F. Green, R.K. Heaton.

Identification of separable cognitive factors in schizophrenia.

Schizophr Res, 72 (2004), pp. 29-39

http://dx.doi.org/10.1016/j.schres.2004.09.007 | Medline

[2.]

R.S.E. Keefe, C.E. Eesley, M.P. Poe.

Defining a cognitive function decrement in schizophrenia.

Biol Psychiatry, 57 (2005), pp. 688-691

http://dx.doi.org/10.1016/j.biopsych.2005.01.003 | Medline

[3.]

R.S.E. Keefe.

Should cognitive impairment be included in the diagnostic criteria for schizophrenia?.

World Psychiatry, 7 (2008), pp. 22-28

Medline

[4.]

S. Galderisi.

The added value of including cognitive impairment in the diagnostic criteria for schizophrenia.

World Psychiatry, 7 (2008), pp. 36-37

Medline

[5.]

M.F. Green.

What are the functional consequences of neurocognitive deficits in schizophrenia?.

Am J Psychiatry, 153 (1996), pp. 321-330

http://dx.doi.org/10.1176/ajp.153.3.321 | Medline

[6.]

D.I. Velligan, C.C. Bow-Thomas, R.K. Mahurin, A.L. Miller, L.C. Halgunseth.

Do specific neurocognitive deficits predict specific domains of community function in schizophrenia?.

J Nerv Ment Dis, 188 (2000), pp. 518-524

Medline

[7.]

P.F. Liddle.

Cognitive impairment in schizophrenia: its impact on social functioning.

Acta Psychiatr Scand (Suppl), 400 (2000), pp. 11-16

[8.]

S.L. Rossell, J. Coakes, J. Shapleske, P.W.R. Woodruff, A.S. David.

Insight: Its relationship with cognitive function, brain volume and symptoms in schizophrenia.

Psychol Med, 33 (2003), pp. 111-119

Medline

[9.]

K.E. Wilder-Willis, P.K. Shear, J.J. Steffen, J. Borkin.

The relationship between cognitive dysfunction and coping abilities in schizophrenia.

Schizophr Res, 55 (2002), pp. 259-267

Medline

[10.]

M.D. Bell, P.H. Lysaker, R.M. Milstein, J.L. Beam-Goulet.

Concurrent validity of the cognitive component of schizophrenia: the relationship of PANSS scores to neuropsychological assessments.

Psychiatry Res, 54 (1994), pp. 51-58

Medline

[11.]

S.R. Kay, A. Fiszbein, L.A. Opler.

The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.

Schiz Bull, 13 (1987), pp. 261-276

[12.]

P.D. Harvey, M.R. Serper, L. White, M.J. Parrella, S.R. McGurk, P.J. Moriarty, et al.

The convergence of neuropsychological testing and clinical ratings of cognitive impairment in patients with schizophrenia.

Compr Psychiatry, 42 (2001), pp. 306-313

http://dx.doi.org/10.1053/comp.2001.24587a | Medline

[13.]

A. Hofer, B. Niedermayer, G. Kemmler, M.A. Rettenbacher, E. Trebo, C.G. Windschwendter, et al.

Cognitive impairment in schizophrenia: clinical ratings are not a suitable alternative to neuropsychological testing.

Schizopr Res, 92 (2007), pp. 126-131

[14.]

S. Moritz, S. Ferahli, D. Naber.

Memory and attention performance in psychiatric patients: Lack of correspondence between clinician-rated and patient-rated functioning with neuropsychological test results.

J Int Neuropsychol Soc, 10 (2004), pp. 623-633

http://dx.doi.org/10.1017/S1355617704104153 | Medline

[15.]

W.B. Barr.

Neurobehavioral disorders of awareness and their relevance to schizophrenia.

Insight and psychosis,

[16.]

S. Moritz, M. Krausz, E. Gottwaiz, M. Lambert, C. Perro, S. Ganzer, et al.

Cognitive dysfunction at baseline predicts 1 year outcome in first episode schizophrenia.

Psychopathology, 33 (2000), pp. 48-51

http://dx.doi.org/29119 | Medline

[17.]

A. Medalia, R.W. Lim.

Self-awareness of cognitive functioning in schizophrenia.

Schizophr Res, 71 (2004), pp. 331-338

http://dx.doi.org/10.1016/j.schres.2004.03.003 | Medline

[18.]

I.S. Marková.

Insight in psychiatry.

Cambidge University Press, (2005),

[19.]

R. Chan, Y. Wang, Z. Ma, X. Hong, Y. Yuan, Z. Yu, et al.

Objective measures of prospective memory do not correlate with subjective complaints in schizophrenia.

Schizophr Res, 103 (2008), pp. 229-239

http://dx.doi.org/10.1016/j.schres.2008.02.019 | Medline

[20.]

A. Zanello, P. Huguelet.

Relationship between cognitive subjective symptoms and frontal executive abilities in chronic schizophrenic outpatients.

Psychopathology, 34 (2001), pp. 153-158

http://dx.doi.org/49299 | Medline

[21.]

R.J. Van den Bosch, R.P. Rombouts.

Causal mechanisms of subjective cognitive dysfunction in schizophrenic and depressed patients.

J Nerv Ment Dis, 186 (1998), pp. 364-368

Medline

[22.]

A. Prouteau, H. Verdoux, C. Briand, A. Lesage, P. Lalonde, L. Nicole, et al.

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program.

Schizophr Res, 69 (2004), pp. 85-91

http://dx.doi.org/10.1016/j.schres.2003.08.011 | Medline

[23.]

F. Schultze-Lutter, J. Klosterkotter, E.M. Steinmeyer.

Application of the “rough set” model for the evaluation of self experienced nueropsychological deficits as predictors for schizophrenia. Results of an 8-year follow-up prospective study.

Schizophr Res, 29 (1998), pp. 61-62

[24.]

L. Lecardeur, C. Briand, A. Prouteau, P. Lalonde, L. Nicole, A. Lesage, et al.

Preserved awareness of their cognitive deficits in patients with schizophrenia: Convergent validity of the SSTICS.

Schizophr Res, 107 (2009), pp. 303-306

http://dx.doi.org/10.1016/j.schres.2008.09.003 | Medline

[25.]

E. Stip, J. Caron, S. Renaud, T. Pampoulova, Y. Lecomte.

Exploring cognitive complaints in schizophrenia: the subjective scale to investigate cognition in schizophrenia.

Compr Psychiatry, 44 (2003), pp. 331-340

http://dx.doi.org/10.1016/S0010-440X(03)00086-5 | Medline

[26.]

S. Bayard, D. Capdevielle, J.P. Boulenger, S. Raffard.

Dissociating self reported cognitive complaint from clinical insight in schizophrenia.

Eur Psychiatr, 24 (2009), pp. 251-258

[27.]

Lee SW. Subjective cognitive impairments in Schizophrenia and related disorders. Theses Online. University of Hong Kong; 2005. Available online: http://hub.hku.hk/handle/123456789/39980.

[28.]

J. Sanjuan, E.J. Aguilar, J.M. Olivares, S. Ros, A.L. Montejo, F. Mayoral, et al.

Subjective perception of cognitive deficit in psychotic patients.

J Nerv Ment Dis, 194 (2006), pp. 58-60

http://dx.doi.org/10.1097/01.nmd.0000195308.62107.31 | Medline

[29.]

X.F. Amador, D.H. Strauss, S.A. Yale, M.M. Flaunm, J. Endicott, J.M. Gorman.

Assessment of insight in psychosis.

Am J Psychiatry, 150 (1993), pp. 873-879

http://dx.doi.org/10.1176/ajp.150.6.873 | Medline

[30.]

Soriano MF, Jiménez JF. Escala Subjetiva para investigar la Cognición en la Esquizofrenia. Portal de Salud Mental [citado 19 Mar 2010]. Available online: http://portalsaludmental.com/pdf/Evaluacion/Escala cognitiva subjetiva.pdf.

[31.]

V. Peralta, M.J. Cuesta.

Validación de la Escala de los Síndromes Positivo y Negativo (PANSS) en una muestra de esquizofrénicos españoles.

Actas Luso Esp Neurol Psiquiatr Cienc Afines, 222 (1994), pp. 171-177

[32.]

D. Gil, D. Bengochea, M. Arrieta, M. Fernández, A. Álvarez, R. Sánchez, et al.

Validez del factor cognitivo de la PANSS como medida del rendimiento cognitivo en esquizofrenia.

Rev Psiquiatr Salud Ment, 2 (2009), pp. 160-168

http://dx.doi.org/10.1016/S1888-9891(09)73234-3 | Medline

[33.]

J. Peña-Casanova.

Programa integrado de exploración neuropsicológica.

Masson, (1990),

[34.]

X.F. Amador, D.H. Strauss.

The scale to assess unawareness of mental disorder.

Columbia University and New York State, Psychiatric Institute, (1990),

[35.]

A.I. Ruiz, E. Pousa, R. Duñó, J.M. Crosas, S. Cupp, C. García-Ribera.

Adaptación al español de la escala de valoración de la no conciencia de trastorno mental (SUMD).

Actas Esp Psiquiatr, 36 (2008), pp. 111-119

Medline

[36.]

SPSS for Windows. Release 13.0. Chicago: SPSS; 2004.

[37.]

R.S. Keefe, M. Poe, T.M. Walker, J.W. Kang, P.D. Harvey.

The Schizophrenia Cognition Rating Scale: an interview-based assessment and its relationship to cognition, real-world functioning, and functional capacity.

Am J Psychiatry, 163 (2006), pp. 426-432

http://dx.doi.org/10.1176/appi.ajp.163.3.426 | Medline

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