Farzin Irani

A meta-analysis of emotion perception and functional outcomes in schizophrenia

INTRODUCTION Emotion perception (EP) is impaired in schizophrenia, is stable across clinical state, resistant to antipsychotic treatment and linked to symptom severity. Given its pervasive nature, there is a need to quantitatively examine whether this dysfunction impacts functional outcomes. We used a meta-analytic strategy to combine results from several studies and examine synthesized effect sizes. METHODS A Meta-analysis of Observational Studies in Epidemiology standard was used to extract data following a PubMed and PsychInfo search. Studies reporting correlations between measures of EP and functional outcomes in schizophrenia spectrum disorders were selected. The impact of potential methodological (task type), demographic (sex, age, race, education, marital status) and clinical (age of onset, duration of illness, setting, symptoms, anti-psychotic medication) moderators on effect sizes were examined. RESULTS Twenty-five studies met inclusion criteria and included 1306 patients who were 37 years old, with 12 years of education, 64% male and 63% Caucasian. There was a significant relationship between EP and functional outcomes in individuals with schizophrenia or schizoaffective disorder, with effect sizes in the medium range. Medium to large range positive correlations were observed between emotion identification and functional outcome domains involving social problem solving, social skills and community functioning. Significant moderators included task type (emotion identification tasks), sex (% male in sample), race (% Caucasian in sample) and clinical symptoms (negative and positive). CONCLUSIONS Emotion identification deficits are associated with functional impairments in schizophrenia and moderated by sex, race and symptoms. This has implications for treatment efforts to improve outcomes.

Neuropsychological Performance in Older Patients With Schizophrenia: A Meta-Analysis of Cross-sectional and Longitudinal Studies

OBJECTIVE Cognitive deficits are among the most reliable predictors of functional impairment in schizophrenia and a particular concern for older individuals with schizophrenia. Previous reviews have focused on the nature and course of cognitive impairments in younger cohorts, but a quantitative meta-analysis in older patients is pending. METHOD A previously used search strategy identified studies assessing performance on tests of global cognition and specific neuropsychological domains in older patients with schizophrenia and age-matched comparison groups. Both cross-sectional and longitudinal studies were included. Potential methodological, demographic, and clinical moderators were analyzed. RESULTS Twenty-nine cross-sectional (2110 patients, 1738 comparison subjects) and 14 longitudinal (954 patients) studies met inclusion criteria. Patients were approximately 65 years old, with 11 years of education, 53% male and 79% Caucasian. Longitudinal analysis (range 1-6 years) revealed homogeneity with small effect sizes (d = -0.097) being observed. Cross-sectional analyses revealed large and heterogeneous deficits in global cognition (d = -1.19) and on specific neuropsychological tests (d = -0.7 to -1.14). Moderator analysis revealed a significant role for demographic (age, sex, education, race) and clinical factors (diagnosis, inpatient status, age of onset, duration of illness, positive and negative symptomology). Medication status (medicated vs nonmedicated) and chlorpromazine equivalents were inconsequential, albeit underrepresented. CONCLUSIONS Large and generalized cognitive deficits in older individuals with schizophrenia represent a robust finding paralleling impairments across the life span, but these deficits do not decline over a 1-6 year period. The importance of considering demographic and clinical moderators in cross-sectional analyses is highlighted.

Challenges in the Neuropsychological Assessment of Ethnic Minorities: Summit Proceedings

Challenges in the Neuropsychological Assessment of Ethnic Minorities: Summit Proceedings Heather R. Romero a , Sarah K. Lageman b , Vidya (Vidyulata) Kamath c , Farzin Irani d , Anita Sim e , Paola Suarez f , Jennifer J. Manly g , Deborah K. Attix a & the Summit participants a Duke University Medical Center , Durham, NC b Emory University , Atlanta, GA c University of Central Florida , Orlando, FL d University of Pennsylvania , Philadelphia, PA e Minneapolis VA Medical Center , Columbia University Medical Center , Minneapolis, MN f HIV Neurobehavioral Research Center , Columbia University Medical Center , San Diego, CA g G. H. Sergievsky Center and Taub Institute for Research on Alzheimers Disease and the Aging Brain , Columbia University Medical Center , New York, USA Published online: 15 Jun 2009.

More than just tapping: Index finger-tapping measures procedural learning in schizophrenia

BACKGROUND Finger-tapping has been widely studied using behavioral and neuroimaging paradigms. Evidence supports the use of finger-tapping as an endophenotype in schizophrenia, but its relationship with motor procedural learning remains unexplored. To our knowledge, this study presents the first use of index finger-tapping to study procedural learning in individuals with schizophrenia or schizoaffective disorder (SCZ/SZA) as compared to healthy controls. METHODS A computerized index finger-tapping test was administered to 1169 SCZ/SZA patients (62% male, 88% right-handed), and 689 healthy controls (40% male, 93% right-handed). Number of taps per trial and learning slopes across trials for the dominant and non-dominant hands were examined for motor speed and procedural learning, respectively. RESULTS Both healthy controls and SCZ/SZA patients demonstrated procedural learning for their dominant hand but not for their non-dominant hand. In addition, patients showed a greater capacity for procedural learning even though they demonstrated more variability in procedural learning compared to healthy controls. Left-handers of both groups performed better than right-handers and had less variability in mean number of taps between non-dominant and dominant hands. Males also had less variability in mean tap count between dominant and non-dominant hands than females. As expected, patients had a lower mean number of taps than healthy controls, males outperformed females and dominant-hand trials had more mean taps than non-dominant hand trials in both groups. CONCLUSIONS The index finger-tapping test can measure both motor speed and procedural learning, and motor procedural learning may be intact in SCZ/SZA patients.

Challenges and Opportunities for Genomic Developmental Neuropsychology: Examples from the Penn-Drexel Collaborative Battery

Genomics has been revolutionizing medicine over the past decade by offering mechanistic insights into disease processes and engendering the age of “individualized medicine.” Because of the sheer number of measures generated by gene sequencing methods, genomics requires “Big Science” where large datasets on genes are analyzed in reference to electronic medical record data. This revolution has largely bypassed the behavioral neurosciences, mainly because of the paucity of behavioral data in medical records and the labor-intensity of available neuropsychological assessment methods. We describe the development and implementation of an efficient neuroscience-based computerized battery, coupled with a computerized clinical assessment procedure. This assessment package has been applied to a genomic study of 10,000 children aged 8–21, of whom 1000 also undergo neuroimaging. Results from the first 3000 participants indicate sensitivity to neurodevelopmental trajectories. Sex differences were evident, with females outperforming males in memory and social cognition domains, while for spatial processing males were more accurate and faster, and they were faster on simple motor tasks. The study illustrates what will hopefully become a major component of the work of clinical and research neuropsychologists as invaluable participants in the dawning age of Big Science neuropsychological genomics.

Functional Near-Infrared Spectroscopy

Functional near-infrared spectroscopy (fNIRS) is an emerging optical brain-imaging technology that offers a relatively non-invasive, safe, portable, and low-cost method of both indirect and direct monitoring of brain activity. Most exciting is its potential to allow more ecologically valid investigations that can translate laboratory work into more realistic, everyday settings and clinical environments. Here, the unique and beneficial characteristics of fNIRS are presented by reviewing the relative merits and limitations of this technique vis-a-vis other brain-imaging technologies such as functional magnetic resonance imaging (fMRI). Cross-validation efforts between fMRI and fNIRS as well as the possible hesitations for its deployment in clinical research and practice are discussed.