Vasilis P. Bozikas

Longitudinal studies of cognition in first episode psychosis: a systematic review of the literature.

Although cognitive deficits are recognized as a core feature in schizophrenia, their evolution over the course of the illness is still debated. Longitudinal studies of cognition in patients after a first episode of psychosis (FEP) provide extremely useful information, in that they include an adequate and realistic baseline measure of cognitive performance, while at the same time minimizing the effect of confounding variables associated with chronicity. The aim of this systematic review was to summarize findings of studies assessing the longitudinal course of neuropsychological deficits in patients with FEP for durations of at least one year. Overall, the neuropsychological deficits that are present following a first episode of psychosis appeared to remain stable over time for periods of up to ten years, the only possible exception being verbal memory deficits, where there is some evidence of further deterioration over the long term. However, further studies are needed to confirm this conclusion, especially in the (somewhat inconsistently defined) domain of executive function. Improvements in psychopathology appear to positively influence the course of cognitive deficits, although the effects of antipsychotic medication are not as clear.

Relationship of affect recognition with psychopathology and cognitive performance in schizophrenia.

The purpose of the present study was to explore the relationship between emotion perception and both psychopathology and cognitive functioning in a group of Greek patients with schizophrenia. Thirty-five patients with schizophrenia were assessed with computerized tests of emotion perception, using visual faces (Kinneys Affect Matching Test, KAMT), prosody (Affective Prosody Test, APT), and visual everyday scenarios (Fanties Cartoon Test, FCT), as well as a facial recognition test (Kinneys Identity Matching Test, KIMT). The patients were also evaluated with the symptoms dimensions derived from the PANSS (positive, negative, cognitive, depression, and excitement) and a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and visual scanning/psychomotor speed. The three emotion perception and face recognition tests correlated significantly with each other. The KAMT was significantly related to the cognitive symptoms dimension of the PANSS and executive functions. The FCT was significantly related to level of education and attention. Finally, the APT was significantly related to the cognitive symptoms dimension, executive functions, and attention. Our findings regarding the significant relationships of affect perception, both facial and vocal, as well as in everyday scenarios, with several cognitive abilities support the notion that deficits in decoding affective information in schizophrenia could be attributed to impairment in more basic neurocognitive domains.

Differential Impact of Lacunes and Microvascular Lesions on Poststroke Depression

Background and Purpose— Previous studies have postulated that poststroke depression (PSD) might be related to cumulative vascular brain pathology rather than to the location and severity of a single macroinfarct. We performed a detailed analysis of all types of microvascular lesions and lacunes in 41 prospectively documented and consecutively autopsied stroke cases. Methods— Only cases with first-onset depression <2 years after stroke were considered as PSD in the present series. Diagnosis of depression was established prospectively using DSM-IV criteria for major depression. Neuropathological evaluation included bilateral semiquantitative assessment of microvascular ischemic pathology and lacunes; statistical analysis included Fisher exact test, Mann-Whitney U test, and regression models. Results— Macroinfarct site was not related to the occurrence of PSD for any of the locations studied. Thalamic and basal ganglia lacunes occurred significantly more often in PSD cases. Higher lacune scores in basal ganglia, thalamus, and deep white matter were associated with an increased PSD risk. In contrast, microinfarct and diffuse or periventricular demyelination scores were not increased in PSD. The combined lacune score (thalamic plus basal ganglia plus deep white matter) explained 25% of the variability of PSD occurrence. Conclusions— The cumulative vascular burden resulting from chronic accumulation of lacunar infarcts within the thalamus, basal ganglia, and deep white matter may be more important than single infarcts in the prediction of PSD.

Treatment of alcohol withdrawal with gabapentin

Gabapentin is an anticonvulsant agent, also effective in the treatment of mood disorders and anxiety disorders. Three cases of alcohol withdrawal treated with gabapentin are presented. All patients received gabapentin 400 mg tid for 3 days, 400 mg bid for 1 day, and finally 400 mg for 1 day. Withdrawal symptoms subsided and no adverse effects were observed. The possible effectiveness of gabapentin in the treatment of alcohol withdrawal warrants further investigation by systematic and well-designed studies.

Disproportionate impairment in semantic verbal fluency in schizophrenia: differential deficit in clustering

The purpose of the current study was to investigate whether patients with schizophrenia present disproportionate impairment in semantic, relative to phonemic, fluency. Specifically, we explored whether this impairment could be explained by differential deficits in clustering or switching strategies. The Greek Verbal Fluency Test was administered to 119 patients with schizophrenia and 150 age-, education-, and gender-matched healthy controls. We calculated the total number of words generated, the number of cluster related words, and the number of switches on the semantic and phonological fluency tasks separately. Patients with schizophrenia generated fewer total words, cluster related words and switches than healthy controls on both fluency tasks. When controlling for the total number of words produced, however, the differences between the two groups in the number of cluster related words and switches disappeared. We found a disproportionate impairment in semantic, compared with phonemic, fluency in schizophrenia for total word production and the number of cluster related words, but not for the number of switches. In conclusion, patients with schizophrenia used the same strategies as healthy controls to perform on a word fluency test, but they used them less effectively. Disproportionate impairment in semantic fluency in schizophrenia resulted from a differential deficit only in clustering. Therefore, disproportionately impaired category fluency in schizophrenia may be primarily due to disorganization and not to inefficient access to and retrieval from semantic store.

Community dysfunction in schizophrenia: rate-limiting factors.

The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.

Smoking impact on CYP1A2 activity in a group of patients with schizophrenia

The purpose of the present study was to assess the impact of smoking on the metabolism of psychotropic drugs in a group of patients with schizophrenia, by measuring CYP1A2 activity. This activity was assessed by the molar ratio (MR) of caffeine metabolites in urine [(AFMU+1U+1X)/17U] and saliva (17X/137X). Participants were 40 patients with schizophrenia: 30 current cigarette smokers and 10 nonsmokers. The two groups (smokers and nonsmokers) differed significantly in their ratio of men to women (83% men and 17% women were among smokers compared with 50% men and 50% women nonsmokers). No other group differences were found regarding age, level of education, PANSS, extrapyramidal symptoms, age of symptoms onset, antipsychotic doses (chloropromazine equivalents), and anticholinergic drug used. Smokers had significant higher MR in urine (P<0.001) as well as in saliva (P=0.001) than nonsmokers, suggesting a higher activity of CYP1A2 dependent on smoking. When gender was used as a covariate, the differences between the two groups remained significant for MR. Cigarette smoking may be a factor influencing the plasma levels of antipsychotics that metabolized through CYP1A2. Clinicians should weight the possibility that smoking and the subsequent modulation of antipsychotic metabolism may be the main reason of treatment resistance. Furthermore, any attempt to reduce or cease smoking in patients with schizophrenia necessitates close monitoring of drug doses, because untoward adverse effects may emerge.

Impaired emotion perception in schizophrenia: A differential deficit

We investigated previously reported contradictory findings regarding the nature of deficits in emotion perception among patients with schizophrenia. Some studies have concluded that such deficits are due to a generalized impairment in visual processing of faces, while others have found it to be restricted to facial emotional expressions. We examined 37 patients and 32 healthy controls, matched on age and education, using three computerized tests: matching facial identity, matching facial emotional expressions, and discrimination of subtle differences in the valence of facial emotional expressions. Our results showed impaired matching of emotions in patients with schizophrenia. This impairment did not manifest on tasks that depended on perceiving the identity of faces or cues of the relative valence of facial emotional expressions. Our findings support the differential deficit hypothesis of emotion perception in schizophrenia.

Deficits in sustained attention in schizophrenia but not in bipolar disorder

The aim of the present study was to investigate sustained attention in remitted patients with bipolar disorder and in patients with schizophrenia, as compared to each other and to healthy controls; a secondary aim was to investigate the correlations of different symptom dimensions with performance on sustained attention in the two patient groups. Participants were 29 (18 men) outpatients with schizophrenia (SZ), 19 (8 men) patients with bipolar disorder I (BP) in remission, and 30 (15 men) healthy controls (HC); all three groups were matched on age, sex ratio, and level of education. Symptom severity (positive symptoms, negative symptoms, and general psychopathology) of patients with SZ were assessed with the Greek version of the Positive and Negative Syndrome Scale (PANSS); residual affective symptoms of patients with BP were assessed with the Young Mania Rating Scale (YMRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Sustained attention was measured by means of the Penn Continuous Performance Test (PCPT). The three groups differed significantly on the PCPT scores. Patients with SZ performed more poorly than both the BP and HC groups, whereas patients with BP did not differ significantly from HC. Performance on the PCPT did not correlate significantly with scores on the YMRS and MADRS in patients with BP. Also, scores on the PCPT did not correlate significantly with scores on any of the three subscales of the PANSS. Outpatients with schizophrenia presented deficits in sustained attention, whereas patients with bipolar disorder I in remission did not manifest such impairment. These results imply that impaired sustained attention might be a more enduring deficit in schizophrenia than it appears to be in bipolar disorder.

The predictive significance of neurocognitive factors for functional outcome in bipolar disorder.

Purpose of review Poor psychosocial functioning in bipolar disorder often persists even after affective symptom remission. Cognitive deficits, which have emerged as a core feature of bipolar disorder in the past few years, are among the factors implicated in adverse psychosocial outcomes of patients suffering from bipolar disorder. This review aims to overview recent literature on the association of neurocognition and psychosocial functioning in bipolar disorder. Recent findings Cognitive deficits (mainly general neurocognitive functioning, attention and verbal learning and memory) are important determinants of poor psychosocial functioning in bipolar disorder, although to a lesser extent than in schizophrenia. Although affective symptoms appear to be a more important predictor of functional outcome in symptomatic patients, cognitive deficits also play a significant role, more readily recognizable in euthymic or chronic patients. Summary Given the importance of cognitive impairments for psychosocial outcomes in bipolar disorder, the development of interventions targeting cognitive impairments is imperative for improving recovery rates and quality of life in patients, even after adequate symptom control.