Luca Arduini

Cognitive function in euthymic bipolar patients, stabilized schizophrenic patients, and healthy controls

Abstract Studies on cognitive function in bipolar disorder have led to contrasting results and few data are available on affected subjects during the euthymic phase. In the present study we investigated the cognitive function of a cohort of bipolar ( n =40) and schizophrenic ( n =66) patients compared to healthy controls ( n =64). Patients were evaluated in the outpatient setting over at least 3 months using a computerized version of Wisconsin Card Sorting Test. Schizophrenic patients showed the worst performance while that of the bipolar patients was somewhere between schizophrenic and controls. A discriminant analysis was able to classify correctly 60.59% of the subjects (schizophrenics 48.5%, bipolars 40%; healthy controls 85.9%). The scores of the Wisconsin Card Sorting Test were entered into a principal component analysis, which yielded a 2-factor solution. Even in that analysis bipolar patients showed intermediate features in comparison with the other groups. These data indicate that bipolar patients have subtle neurocognitive deficits even after the resolution of an affective disorder. As well as observing quantitative differences between groups, the results show different dimensions of cognitive performance within groups suggesting that the deficit of euthymic bipolars could be a dishomogeneous entity, probably more heterogeneous than that in schizophrenia. Studies administering a more complete neuropsychological battery could further clarify the nature and meaning of the cognitive deficits in schizophrenia and bipolar disorder.

Insight and neuropsychological function in patients with schizophrenia and bipolar disorder with psychotic features.

Objectives: This study investigates the pattern of association between patient unawareness of illness and neuropsychological tests of frontal lobe function in subjects with schizophrenia and bipolar disorder (BD) with psychotic features. Method: We administered the Wisconsin Card Sort Test (WCST) and a shortened version of the Scale to Assess Unawareness of Mental Disorder (SUMD) to a sample of 64 patients with psychosis (42 with schizophrenia and 22 with BD). Results: None of the correlations between WCST scores and insight scores were statistically significant, either in the total group or in each group analyzed separately. Further, no differences were seen in insight scores between sexes and between the diagnostic groups. Conclusions: The 3 insight dimensions (that is, awareness of mental disorder, awareness of social consequences of mental disorder, and awareness of the benefits of medication) do not appear to be associated with frontal impairment, as measured by the WCST.

A factor analysis of signs and symptoms of the manic episode with Bech–Rafaelsen Mania and Melancholia Scales

BACKGROUND Several factor analyses of signs and symptoms of mania have been reported using different rating scales. We propose here that the use of two instruments well known in the European literature may be useful in detecting the structure of manic episodes. METHOD We investigated the pattern of symptoms in a group of 124 bipolar inpatients hospitalised for a manic episode. We conducted a factor analysis of the broad range of psychiatric symptoms covered by the Bech-Rafaelsen Mania Scale (BRMaS) and Melancholia Scale (BRMeS). RESULTS Five eigen values were greater than unity, which determined the number of factors computed. The five factors captured 66.7% of the total variance. Following rotation, five factors were clinically relevant. CONCLUSION This suggests that both euphoric activation and depression are prominent in this sample.

Awareness of illness and outcome in schizophrenia.

Abstract The purpose of the present study was to investigate whether awareness of illness affects specific measures of outcome in schizophrenia. Patient awareness was evaluated using a shortened version of the Scale to Assess Unawareness of Mental Disorder (SUMD). Patient outcome was assessed by means of the Strauss-Carpenter scale. Our findings indicate that lack of awareness of “negative symptoms” has a considerable impact on outcome: in fact “Social Contacts” highly correlated with Blunt Affect, Anhedonia and Asociality items on the SUMD. Lack of awareness seems then to be a powerful predictor of poor outcome.

Subjective experiences in schizophrenia and bipolar disorders.

Studies comparing ‘subjective experiences’ in schizophrenic and affective disorders have reached inconclusive results. We investigated the pattern of ‘subjective perceived cognitive disturbances’ in a group of 55 schizophrenic patients and 39 bipolar patients hospitalized for an index psychotic episode. The assessment of the subjective experiences was made using the Frankfurter Beschwerde-Fragebogen (FBF). Comparing the two groups on the four FBF factors, schizophrenic patients showed significantly higher scores in the areas of ‘central cognitive disturbances’, ‘perception and motility’ other than a significantly higher FBF total score. Our results suggest that cognitive, perception and motility disturbances are the most characteristic subjective experiences of schizophrenic patients in comparison with bipolar patients. This finding need to be further explored in light of the issue of cognitive dysfunction in schizophrenia.

Wisconsin Card‐Sorting Test performance does not discriminate different patterns of premorbid behavioral abnormalities in schizophrenic patients

Abstract It is well documented that premorbid behavior abnormalities precede the onset of schizophrenia in a large number of patients. The research findings suggest that there are differences in the type and severity of these premorbid dysfunctions. Another research field has shown impairment of preschizophrenic patients in several cognitive domains. The present study reports retrospective childhood and adolescence neurobehavioral assessment in 31 patients with schizophrenia by the Child Behavior Checklist (CBCL) and current Wisconsin Card‐Sorting Test (WCST) evaluation in order to investigate whether specific behavioral abnormality (BA) patterns are related to executive function as evaluated by the WCST. Cluster analysis was conducted on the childhood premorbid behavior ratings for the schizophrenic patients and two subgroups emerged: (i) Cluster I with an initial low level of BA that increased over the years; and (ii) Cluster II with a high level of BA that remained relatively stable until early adulthood. Furthermore, Cluster II showed more severe current negative and total symptoms, but the two groups did not differ in WCST performance. Our results show that the patterns and severity of CBCL upon retrospective evaluation are not related to WCST performance, which seems to be a feature inherent to the disease process. Different factors could be responsible for cognitive and behavioral disturbances in schizophrenia.

Cognitive symptoms of mania in pure and mixed episodes evaluated with the Positive and Negative Syndrome Scale

Abstract To investigate the clinical specificity of mixed affective patients, we compared the clinical characteristics of pure manic patients with those of mixed manic patients. The clinical symptoms of 146 bipolar inpatients hospitalized for a manic episode were assessed by means of the Positive and Negative Syndrome Scale. Mixed patients showed more positive and cognitive symptoms and among these the lack of judgement and insight was prominent. Further studies are needed to clarify the specificity of lack of insight of the mixed bipolar patients.