Three dimensions of clinical symptoms in elderly patients with schizophrenia: Prediction of six-year cognitive and functional status

Eran Chemerinski, Abraham Reichenberg, Brian Kirkpatrick, Christopher R. Bowie, Philip D Harvey

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: A three-syndrome categorization of schizophrenia has been recently proposed [Arndt, S., Alliger R.J., Andreasen, N.C., 1991. The distinction of positive and negative symptoms: the failure of a two-dimensional model. Br. J. Psychiatry 158, 317-322; Miller, D.D., Arndt, S., Andreasen, N.C., 1993. Alogia, attentional impairment, and inappropriate affect: their status in the dimensions of schizophrenia. Comp. Psychiatry 34, 221-226; Gur, R.E., Mozley, D., Resnick, S.M., Levick, S., Erwin, R., Saykin, A.J., Gur, R.C., 1991. Relations among clinical scales in schizophrenia. Am. J. Psychiatry 148, 472-478. Brown, K.W., White, T., 1992. Syndromes of chronic schizophrenia and some clinical correlates. Br. J. Psychiatry 161, pp. 317-322]. Methods: Chronic, elderly, schizophrenia patients with deficit (N = 111), nondeficit with High reality distortion/Low conceptual disorganization (nondeficit-delusional) (N = 40) and nondeficit with Low reality distortion/High conceptual disorganization (nondeficit-disorganized) (N = 56) were followed-up for 6 years. Assessment included the Positive and Negative Syndrome Scale (PANSS), the Mini-mental Status Examination (MMSE) and the Alzheimer's Disease Assessment-Late Stage Cognitive and Non-Cognitive Subscale (ADAS-L Cog and ADAS-L Self care). Results: At initial assessment, MMSE scores were significantly lower, while the ADAS-L Cog and Negative symptoms were significantly higher in the deficit and nondeficit-disorganized groups compared with the nondeficit-delusional group (all p values < 0.05). Positive symptoms were significantly lower in the deficit group than in both nondeficit syndrome groups (p < 0.05). On the ADAS-L Self Care scale the nondeficit-delusional group was the most impaired while the nondeficit-disorganized was the least impaired. There was a significant decline over time in MMSE scores in the deficit and the nondeficit-delusional groups (p < 0.01), but no change in the nondeficit-disorganized group. ADAS-L Cog and ADAS-L Self Care functions worsened over time in all three groups (p < 0.0001). Severity of negative symptoms was stable over time in deficit patients and in nondeficit-disorganized patients but worsened in nondeficit-delusional patients (p < 0.001). There was also a significant worsening of positive symptoms over time in deficit patients (p = 0.04). Conclusion: Deficit, nondeficit-delusional and nondeficit-disorganized patients with schizophrenia may represent distinct subgroups discriminated by different courses in negative and positive symptoms and cognitive status.

Original languageEnglish
Pages (from-to)12-19
Number of pages8
JournalSchizophrenia Research
Volume85
Issue number1-3
DOIs
StatePublished - Jul 1 2006
Externally publishedYes

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Schizophrenia
Psychiatry
Self Care
Neurobehavioral Manifestations
Aphasia
Alzheimer Disease
Gur

Keywords

  • Cognition
  • Deficit symptoms
  • Functional status
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Behavioral Neuroscience
  • Biological Psychiatry
  • Neurology
  • Psychology(all)

Cite this

Three dimensions of clinical symptoms in elderly patients with schizophrenia : Prediction of six-year cognitive and functional status. / Chemerinski, Eran; Reichenberg, Abraham; Kirkpatrick, Brian; Bowie, Christopher R.; Harvey, Philip D.

In: Schizophrenia Research, Vol. 85, No. 1-3, 01.07.2006, p. 12-19.

Research output: Contribution to journalArticle

Chemerinski, Eran ; Reichenberg, Abraham ; Kirkpatrick, Brian ; Bowie, Christopher R. ; Harvey, Philip D. / Three dimensions of clinical symptoms in elderly patients with schizophrenia : Prediction of six-year cognitive and functional status. In: Schizophrenia Research. 2006 ; Vol. 85, No. 1-3. pp. 12-19.
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abstract = "Background: A three-syndrome categorization of schizophrenia has been recently proposed [Arndt, S., Alliger R.J., Andreasen, N.C., 1991. The distinction of positive and negative symptoms: the failure of a two-dimensional model. Br. J. Psychiatry 158, 317-322; Miller, D.D., Arndt, S., Andreasen, N.C., 1993. Alogia, attentional impairment, and inappropriate affect: their status in the dimensions of schizophrenia. Comp. Psychiatry 34, 221-226; Gur, R.E., Mozley, D., Resnick, S.M., Levick, S., Erwin, R., Saykin, A.J., Gur, R.C., 1991. Relations among clinical scales in schizophrenia. Am. J. Psychiatry 148, 472-478. Brown, K.W., White, T., 1992. Syndromes of chronic schizophrenia and some clinical correlates. Br. J. Psychiatry 161, pp. 317-322]. Methods: Chronic, elderly, schizophrenia patients with deficit (N = 111), nondeficit with High reality distortion/Low conceptual disorganization (nondeficit-delusional) (N = 40) and nondeficit with Low reality distortion/High conceptual disorganization (nondeficit-disorganized) (N = 56) were followed-up for 6 years. Assessment included the Positive and Negative Syndrome Scale (PANSS), the Mini-mental Status Examination (MMSE) and the Alzheimer's Disease Assessment-Late Stage Cognitive and Non-Cognitive Subscale (ADAS-L Cog and ADAS-L Self care). Results: At initial assessment, MMSE scores were significantly lower, while the ADAS-L Cog and Negative symptoms were significantly higher in the deficit and nondeficit-disorganized groups compared with the nondeficit-delusional group (all p values < 0.05). Positive symptoms were significantly lower in the deficit group than in both nondeficit syndrome groups (p < 0.05). On the ADAS-L Self Care scale the nondeficit-delusional group was the most impaired while the nondeficit-disorganized was the least impaired. There was a significant decline over time in MMSE scores in the deficit and the nondeficit-delusional groups (p < 0.01), but no change in the nondeficit-disorganized group. ADAS-L Cog and ADAS-L Self Care functions worsened over time in all three groups (p < 0.0001). Severity of negative symptoms was stable over time in deficit patients and in nondeficit-disorganized patients but worsened in nondeficit-delusional patients (p < 0.001). There was also a significant worsening of positive symptoms over time in deficit patients (p = 0.04). Conclusion: Deficit, nondeficit-delusional and nondeficit-disorganized patients with schizophrenia may represent distinct subgroups discriminated by different courses in negative and positive symptoms and cognitive status.",
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AU - Harvey, Philip D

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N2 - Background: A three-syndrome categorization of schizophrenia has been recently proposed [Arndt, S., Alliger R.J., Andreasen, N.C., 1991. The distinction of positive and negative symptoms: the failure of a two-dimensional model. Br. J. Psychiatry 158, 317-322; Miller, D.D., Arndt, S., Andreasen, N.C., 1993. Alogia, attentional impairment, and inappropriate affect: their status in the dimensions of schizophrenia. Comp. Psychiatry 34, 221-226; Gur, R.E., Mozley, D., Resnick, S.M., Levick, S., Erwin, R., Saykin, A.J., Gur, R.C., 1991. Relations among clinical scales in schizophrenia. Am. J. Psychiatry 148, 472-478. Brown, K.W., White, T., 1992. Syndromes of chronic schizophrenia and some clinical correlates. Br. J. Psychiatry 161, pp. 317-322]. Methods: Chronic, elderly, schizophrenia patients with deficit (N = 111), nondeficit with High reality distortion/Low conceptual disorganization (nondeficit-delusional) (N = 40) and nondeficit with Low reality distortion/High conceptual disorganization (nondeficit-disorganized) (N = 56) were followed-up for 6 years. Assessment included the Positive and Negative Syndrome Scale (PANSS), the Mini-mental Status Examination (MMSE) and the Alzheimer's Disease Assessment-Late Stage Cognitive and Non-Cognitive Subscale (ADAS-L Cog and ADAS-L Self care). Results: At initial assessment, MMSE scores were significantly lower, while the ADAS-L Cog and Negative symptoms were significantly higher in the deficit and nondeficit-disorganized groups compared with the nondeficit-delusional group (all p values < 0.05). Positive symptoms were significantly lower in the deficit group than in both nondeficit syndrome groups (p < 0.05). On the ADAS-L Self Care scale the nondeficit-delusional group was the most impaired while the nondeficit-disorganized was the least impaired. There was a significant decline over time in MMSE scores in the deficit and the nondeficit-delusional groups (p < 0.01), but no change in the nondeficit-disorganized group. ADAS-L Cog and ADAS-L Self Care functions worsened over time in all three groups (p < 0.0001). Severity of negative symptoms was stable over time in deficit patients and in nondeficit-disorganized patients but worsened in nondeficit-delusional patients (p < 0.001). There was also a significant worsening of positive symptoms over time in deficit patients (p = 0.04). Conclusion: Deficit, nondeficit-delusional and nondeficit-disorganized patients with schizophrenia may represent distinct subgroups discriminated by different courses in negative and positive symptoms and cognitive status.

AB - Background: A three-syndrome categorization of schizophrenia has been recently proposed [Arndt, S., Alliger R.J., Andreasen, N.C., 1991. The distinction of positive and negative symptoms: the failure of a two-dimensional model. Br. J. Psychiatry 158, 317-322; Miller, D.D., Arndt, S., Andreasen, N.C., 1993. Alogia, attentional impairment, and inappropriate affect: their status in the dimensions of schizophrenia. Comp. Psychiatry 34, 221-226; Gur, R.E., Mozley, D., Resnick, S.M., Levick, S., Erwin, R., Saykin, A.J., Gur, R.C., 1991. Relations among clinical scales in schizophrenia. Am. J. Psychiatry 148, 472-478. Brown, K.W., White, T., 1992. Syndromes of chronic schizophrenia and some clinical correlates. Br. J. Psychiatry 161, pp. 317-322]. Methods: Chronic, elderly, schizophrenia patients with deficit (N = 111), nondeficit with High reality distortion/Low conceptual disorganization (nondeficit-delusional) (N = 40) and nondeficit with Low reality distortion/High conceptual disorganization (nondeficit-disorganized) (N = 56) were followed-up for 6 years. Assessment included the Positive and Negative Syndrome Scale (PANSS), the Mini-mental Status Examination (MMSE) and the Alzheimer's Disease Assessment-Late Stage Cognitive and Non-Cognitive Subscale (ADAS-L Cog and ADAS-L Self care). Results: At initial assessment, MMSE scores were significantly lower, while the ADAS-L Cog and Negative symptoms were significantly higher in the deficit and nondeficit-disorganized groups compared with the nondeficit-delusional group (all p values < 0.05). Positive symptoms were significantly lower in the deficit group than in both nondeficit syndrome groups (p < 0.05). On the ADAS-L Self Care scale the nondeficit-delusional group was the most impaired while the nondeficit-disorganized was the least impaired. There was a significant decline over time in MMSE scores in the deficit and the nondeficit-delusional groups (p < 0.01), but no change in the nondeficit-disorganized group. ADAS-L Cog and ADAS-L Self Care functions worsened over time in all three groups (p < 0.0001). Severity of negative symptoms was stable over time in deficit patients and in nondeficit-disorganized patients but worsened in nondeficit-delusional patients (p < 0.001). There was also a significant worsening of positive symptoms over time in deficit patients (p = 0.04). Conclusion: Deficit, nondeficit-delusional and nondeficit-disorganized patients with schizophrenia may represent distinct subgroups discriminated by different courses in negative and positive symptoms and cognitive status.

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KW - Functional status

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