Massimiliano Bustini

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.

Processing of context information in schizophrenia: relation to clinical symptoms and WCST performance

Failure in contextual information processing has been hypothesized as being the single function responsible for several impairments in cognitive tasks and symptoms, through an involvement of the prefrontal cortex, in patients with schizophrenia. A variant of the Continuous Performance Test (CPT) designed specifically to elicit deficits in the processing of contextual information has been administered to 20 schizophrenic patients and 20 healthy controls. The relation to Wisconsin Card Sorting Test (WCST), relatively specific to prefrontal damage and executive dysfunctioning, and clinical status by using scales for the assessment of positive, negative symptoms and outcome has been investigated. The data show that multi-episode schizophrenic patients manifest inability to use contextual information to inhibit habitual response to an ambiguous stimulus and to maintain information across delay, without a general attention deficit. We also found a relationship between contextual reasoning and WCST unique errors, hallucinations, formal thought disorders, and outcome evaluation. Our results further support the hypothesis that the deficit of contextual reasoning could account for cognitive impairments and symptoms of patients with schizophrenia.

Tower of Hanoi and WCST performance in schizophrenia: problem-solving capacity and clinical correlates

We administered a computerized version of WCST, a well established test, sensitive to executive function deficits in schizophrenia that involves many features of cognitive processing, and of Tower of Hanoi, a test that may offer cognitive challenges more specifically related to planning and sequencing, to 28 schizophrenic patients and 28 matched controls to examine a worthwhile question regarding the relative ability of these two tasks to differentiate schizophrenia and normal groups as well as exploring the relationship of these two instruments to clinical variables. The schizophrenic patients performed significantly worse than normal subjects both on Tower of Hanoi test and on WCST. The discriminant analysis identified in a multivariate way a pattern of indexes that differentiate the two groups. This pattern, characterized by specific indexes of WCST and TOH, could suggest the existence of a common underlying factor that determines the cognitive impairment in problem-solving of schizophrenics. These findings and the relationship with positive and negative symptoms have been discussed in the light of the model of the impairment in the internal representation of context information.

No deficit in Wisconsin Card Sorting Test performance of schizophrenic patients' first-degree relatives.

The Wisconsin Card Sorting Test (WCST) was administered to 92 schizophrenic patients, 25 first-degree relatives and 60 normal subjects in order to investigate whether this task could be considered a trait marker of vulnerability to schizophrenia. The schizophrenic patients performed significantly worse than either their relatives or normal subjects, but unaffected relatives did not differ from controls. Our results suggest that WCST performance is more likely a feature inherent to the disease process rather than an index of the genetic susceptibility to the illness.

Schizotypal personality questionnaire and wisconsin card sorting test in a population of DSM-III-R schizophrenic patients and control subjects

Phenomenological, biological, genetic, treatment-response, and outcome data support a link between schizotypal personality disorder (SPD) and schizophrenia. Furthermore, SPD and normal schizotypy also seem connected, although the relationship can at times be ambiguous. In this regard, this study was conducted to test the hypothesis of a possible association between neurocognitive performance evaluated by the Wisconsin Card Sorting Test (WCST) and schizotypal personality traits evaluated by the Schizotypal Personality Questionnaire (SPQ) in a nonclinical sample and a sample of schizophrenic patients. The main finding of the study was that WCST performance was correlated with SPQ (total and subscale) scores in the control group; on the contrary, in the patients, the relationship between WCST and SPQ scores was weaker. Taken together, our results seem to support the hypothesis that different cognitive aspects (i.e., elementary WCST subcomponent scores) correlate differentially with some SPQ schizotypal traits in a group of nonclinical subjects. This report underlines the relevance of studying normal subjects within the brain-behavior paradigm to highlight the brain-behavior relationship in the mental illness.

Humiliation and interpersonal sensitivity in depression.

BACKGROUND The aim of this study is to explore the relationship between humiliation and protective psychosocial factors in a sample of depressed patients. METHOD We assessed humiliation, psychiatric symptoms, negative primary familial environment and resilience in 70 depressed patients, 33 male and 37 female, and analyzed the correlations between these variables. Then to better understand the relations among the assessed variables we controlled for the depression severity and replicated the correlational analyses. RESULTS A pattern of significant correlations among all the constructs emerged. Correlations between humiliation, interpersonal sensitivity, negative primary familial environment and resilience persisted after controlling for depression severity. LIMITATIONS The cross sectional nature of this study; the use of self-report instruments; the lack of personality assessment. CONCLUSIONS This study provides a contribution to the understanding of the relationship between the experience of humiliation and negative primary familial environment, protective factors and clinical interpersonal sensitivity in depressed patients.