Skip to main content

Advertisement

Log in

Cognitive functioning in severe psychiatric disorders: a general population study

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

In clinical samples, patients with severe psychiatric disorders are found to have cognitive impairments. Less is known whether this applies to samples derived from the general population. We aimed to study cognitive functioning in a population-based sample comprising individuals with schizophrenia, other non-affective psychoses, bipolar disorders, major depressive disorder, and controls derived from the same population. The current analysis was based on 148 persons with severe mental disorders and 66 control subjects, derived from the Psychoses in Finland study. All subjects were interviewed with SCID, and a neuropsychological test battery was administered. Subjects with schizophrenia had a generalized cognitive impairment (d = 0.43–1.07), while those with other non-affective psychoses were impaired in verbal memory and processing speed (d = 0.43–0.59). Subjects with bipolar disorders were not impaired. Unipolar major depressive disorder associated with slowed processing speed (d = 0.64). Our findings on cognitive impairments in subjects with schizophrenia and other non-affective psychoses derived from the general population support previous findings of a generalized cognitive dysfunction in these subjects. However, our results suggest that subjects with bipolar disorders from non-clinical populations may not have significant cognitive impairments. Our results emphasize the importance of using control samples derived from the same population and studied similarly as those with disorders in evaluating cognitive functioning of subjects with severe mental disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dickinson D, Ramsey ME, Gold JM (2007) Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Arch Gen Psychiatry 64:532–542

    Article  PubMed  Google Scholar 

  2. Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12:426–445

    Article  PubMed  CAS  Google Scholar 

  3. Heaton RK, Gladsjo JA, Palmer BW, Kuck J, Marcotte TD, Jeste DV (2001) Stability and course of neuropsychological deficits in schizophrenia. Arch Gen Psychiatry 58:24–32

    Article  PubMed  CAS  Google Scholar 

  4. Kurtz MM (2005) Neurocognitive impairment across the lifespan in schizophrenia: an update. Schizophr Res 74:15–26

    Article  PubMed  Google Scholar 

  5. McIntosh AM, Harrison LK, Forrester K, Lawrie SM, Johnstone EC (2005) Neuropsychological impairments in people with schizophrenia or bipolar disorder and their unaffected relatives. Br J Psychiatry 186:378–385

    Article  PubMed  Google Scholar 

  6. Antila M, Tuulio-Henriksson A, Kieseppä T, Eerola M, Partonen T, Lönnqvist J (2007) Cognitive functioning in patients with familial bipolar I disorder and their unaffected relatives. Psychol Med 37:679–687

    Article  PubMed  Google Scholar 

  7. Mur M, Portella MJ, Martínez-Arán A, Pifarré J, Vieta E (2007) Persistent neuropsychological deficit in euthymic bipolar patients: executive function as a core deficit. J Clin Psychiatry 68:1078–1086

    Article  PubMed  Google Scholar 

  8. Robinson LJ, Thompson JM, Gallagher P, Goswami U, Young AH, Ferrier IN, Moore PB (2006) A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 93:105–115

    Article  PubMed  Google Scholar 

  9. Krabbendam L, Arts B, van Os J, Aleman A (2005) Cognitive functioning in patients with schizophrenia and bipolar disorder: a quantitative review. Schizophr Res 80:137–149

    Article  PubMed  Google Scholar 

  10. Rossi A, Arduini L, Daneluzzo E, Bustini M, Prosperini P, Stratta P (2000) Cognitive function in euthymic bipolar patients, stabilized schizophrenic patients, and healthy controls. J Psychiatr Res 34:333–339

    Article  PubMed  CAS  Google Scholar 

  11. Martínez-Arán A, Vieta E, Reinares M, Colom F, Torrent C, Sánchez-Moreno J, Benabarre A, Goikolea JM, Comes M, Salamero M (2004) Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 161:262–270

    Article  PubMed  Google Scholar 

  12. Bora E, Vahip S, Akdeniz F, Gonul AS, Eryavuz A, Ogut M, Alkan M (2006) The effect of previous psychotic mood episodes on cognitive impairment in euthymic bipolar patients. Bipolar Disord 9:468–477

    Article  Google Scholar 

  13. Gualtieri CT, Johnson LG, Benedict KB (2006) Neurocognition in depression: patients on and off medication versus healthy comparison subjects. J Neuropsychiatry Clin Neurosci 18:217–225

    Article  PubMed  Google Scholar 

  14. Porter RJ, Bourke C, Gallagher P (2007) Neuropsychological impairment in major depression: its nature, origin and clinical significance. Aust N Z J Psychiatry 41:115–128

    Article  PubMed  Google Scholar 

  15. Airaksinen E, Larsson M, Lundberg I, Forsell Y (2004) Cognitive functions in depressive disorders: evidence from a population-based study. Psychol Med 34:83–91

    Article  PubMed  CAS  Google Scholar 

  16. Fleming SK, Blasey C, Schatzberg AF (2004) Neuropsychological correlates of psychotic features in major depressive disorders: a review and meta-analysis. J Psychiatr Res 38:27–35

    Article  PubMed  Google Scholar 

  17. Zanelli J, Reichenberg A, Morgan K, Fearon P, Kravariti E, Dazzan P, Morgan G, Zanelli C, Demjaha A, Jones PB, Doody GA (2010) Specific and generalized neuropsychological deficits: a comparison of patients with various first-episode psychosis presentations. Am J Psychiatry 167:78–85

    Article  PubMed  Google Scholar 

  18. Koenen KC, Moffitt TE, Roberts AL, Martin LT, Kubzansky L, Harrington H, Poulton R, Caspi A (2009) Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. Am J Psychiatry 166:50–57

    Article  PubMed  Google Scholar 

  19. Tiihonen J, Haukka J, Henriksson M, Cannon M, Kieseppä T, Laaksonen I, Sinivuo J, Lönnqvist J (2005) Premorbid intellectual functioning in bipolar disorder and schizophrenia: results from a cohort study of male conscripts. Am J Psychiatry 162:1904–1910

    Article  PubMed  Google Scholar 

  20. MacCabe JH, Lambe MP, Cnattingius S, Sham PC, David AS, Reichenberg A, Murray RM, Hultman CM (2010) Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. Br J Psychiatry 196:109–115

    Article  PubMed  Google Scholar 

  21. Perälä J, Suvisaari J, Saarni SI, Kuoppasalmi K, Isometsä E, Pirkola S, Partonen T, Tuulio-Henriksson A, Hintikka J, Kieseppä T, Härkänen T, Koskinen S, Lönnqvist J (2007) Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry 64:19–28

    Article  PubMed  Google Scholar 

  22. Aromaa A, Koskinen S (eds) (2004) Health and functional capacity in Finland. Baseline results of the health 2000 health examination survey. Publications of the National Public Health Institute, B12. Available in English at http://www.ktl.fi/terveys2000/index.uk.html. Accessed 2 November 2009

  23. Wittchen HU, Pfister H (1997) Dia-X-interviews: manual fur screening-Verfahren und interview. Swets und Zeitlinger, Frankfurt

    Google Scholar 

  24. First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured clinical interview for DSM-IV axis I disorders—clinician version (SCID-CV). American Psychiatric Press, Washington, DC

    Google Scholar 

  25. Kendler KS, McGuire M, Gruenberg AM, O’Hare A, Spellman M, Walsh D (1993) The roscommon family study I. Methods, diagnosis of probands, and risk of schizophrenia in relatives. Arch Gen Psychiatry 50:527–540

    PubMed  CAS  Google Scholar 

  26. Andreasen N (1984) The scale for the assessment of positive symptoms (SAPS). The University of Iowa, Iowa City

    Google Scholar 

  27. Andreasen NC (1982) Negative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry 39:784–788

    PubMed  CAS  Google Scholar 

  28. Suvisaari J, Perälä J, Saarni SI, Juvonen H, Tuulio-Henriksson A, Lönnqvist J (2009) The epidemiology and descriptive and predictive validity of DSM-IV delusional disorder and subtypes of schizophrenia. Clin Schizophr Relat Psychoses 2:289–297

    Article  Google Scholar 

  29. Wechsler D (1987) Wechsler memory scale—revised (WMS-R), manual. The psychological corporation. Harcourt Brace Jovanovich, Inc., San Antonio

    Google Scholar 

  30. Delis DC, Kramer JH, Kaplan E, Ober BA (1987) California verbal learning test. Manual. Research edition. Harcourt Brace & Company, San Antonio

    Google Scholar 

  31. Wechsler D (1981) Wechsler adult intelligence scale—revised (WAIS-R), manual. The psychological corporation. Harcourt Brace Jovanovich, Inc., San Antonio

    Google Scholar 

  32. Reitan RM, Wolfson D (1993) The Halstead-Reitan neuropsychological test battery: theory and clinical interpretation. Neuropsychology Press, Tucson

    Google Scholar 

  33. Lezak MD, Howieson DB, Loring DW (2004) Neuropsychological assessment. Oxford University Press, New York

    Google Scholar 

  34. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision. American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  35. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Earlbaum Associates, Hillsdale

    Google Scholar 

  36. SPSS Inc (2007) SPSS 16.0 for Windows. Chicago

  37. Kravariti E, Morgan K, Fearon P, Zanelli JW, Lappin JM, Dazzan P, Morgan G, Doody GA, Harrison G, Jones PB, Murray RM, Reichenberg A (2009) Neuropsychological functioning in first-episode schizophrenia. Br J Psychiatry 195:336–345

    Article  PubMed  Google Scholar 

  38. Aleman A, Hijman R, de Haan EH, Kahn RS (1999) Memory impairment in schizophrenia: a meta-analysis. Am J Psychiatry 156:1358–1366

    PubMed  CAS  Google Scholar 

  39. Cirillo MA, Seidman LJ (2003) Verbal declarative memory dysfunction in schizophrenia: from clinical assessment to genetics and brain mechanisms. Neuropsychol Rev 13:43–77

    Article  PubMed  Google Scholar 

  40. Zilles D, Gruber E, Falkai P, Gruber O (2010) Patients with schizophrenia show deficits of working memory maintenance components in circuit-specific tasks. Eur Arch Psychiatry Clin Neurosci 260:519–525

    Article  PubMed  Google Scholar 

  41. Greenwood TA, Braff DL, Light GA, Cadenhead KS, Calkins ME, Dobie DJ, Freedman R, Green MF, Gur RE, Gur RC, Mintz J, Nuechterlein KH, Olincy A, Radant AD, Seidman LJ, Siever LJ, Silverman JM, Stone WS, Swerdlow NR, Tsuang DW, Tsuang MT, Turetsky BI, Schork NJ (2007) Initial heritability analyses of endophenotypic measures for schizophrenia: the consortium on the genetics of schizophrenia. Arch Gen Psychiatry 64:1242–1250

    Article  PubMed  Google Scholar 

  42. Cuesta MJ, Peralta V, Zarzuela A (2007) Empirical validation of competing definitions of schizophrenia: a poly-diagnostic study of cognitive impairment in non-affective psychosis. Schizophr Res 95:39–47

    Article  PubMed  Google Scholar 

  43. Goldstein G, Shemansky WJ, Allen DN (2005) Cognitive function in schizoaffective disorder and clinical subtypes of schizophrenia. Arch Clin Neuropsychol 20:153–159

    Article  PubMed  Google Scholar 

  44. Hasler G, Drevets WC, Gould TD, Gottesman II, Manji HK (2006) Toward constructing an endophenotype strategy for bipolar disorders. Biol Psychiatry 60:93–105

    Article  PubMed  Google Scholar 

  45. Kravariti E, Schulze K, Kane F, Kalidindi S, Bramon E, Walshe M, Marshall N, Hall MH, Georgiades A, McDonald C, Murray RM (2009) Stroop-test interference in bipolar disorder. Br J Psychiatry 194:285–286

    Article  PubMed  Google Scholar 

  46. Juselius S, Kieseppä T, Kaprio J, Lönnqvist J, Tuulio-Henriksson A (2009) Executive functioning in twins with bipolar I disorder and healthy co-twins. Arch Clin Neuropsychol 24(6):599–606

    Article  PubMed  Google Scholar 

  47. Zabala A, Rapado M, Arango C, Robles O, de la Serna E, Gonzáles C, Rodríguez-Sánchez JM, Andrés P, Mayoral M, Bombín I (2010) Neuropsychological functioning in early-onset first-episode psychosis: comparison of diagnostic subgroups. Eur Arch Psychiatry Clin Neurosci 260:225–233

    Article  PubMed  Google Scholar 

  48. Robinson LJ, Ferrier IN (2006) Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disord 8:103–116

    Article  PubMed  Google Scholar 

  49. Kravariti E, Reichenberg A, Morgan K, Dazzan P, Morgan C, Zanelli JW, Lappin JM, Doody GA, Harrison G, Jones PB, Murray RM, Fearon P (2009) Selective deficits in semantic verbal fluency in patients with a first affective episode with psychotic symptoms and a positive history of mania. Bipolar Disord 11:323–339

    Article  PubMed  Google Scholar 

  50. Jamrozinski K, Gruber O, Kemmer C, Falkai P, Scherk H (2009) Neurocognitive functions in euthymic bipolar patients. Acta Psychiatr Scand 119:365–374

    Article  PubMed  CAS  Google Scholar 

  51. Dickinson D (2008) Digit symbol coding and general cognitive ability in schizophrenia: worth another look? Br J Psychiatry 193:354–356

    Article  PubMed  Google Scholar 

  52. Rund BR, Sundet K, Asbjørnsen A, Egeland J, Landrø NI, Lund A, Roness A, Stordal KI, Hugdahl K (2006) Neuropsychological test profiles in schizophrenia and non-psychotic depression. Acta Psychiatr Scand 113:350–359

    Article  PubMed  CAS  Google Scholar 

  53. Hill SK, Keshavan MS, Thase ME, Sweeney JA (2004) Neuropsychological dysfunction in antipsychotic-naive first-episode unipolar psychotic depression. Am J Psychiatry 161:996–1003

    Article  PubMed  Google Scholar 

  54. Gottesman II, Gould TD (2003) The endophenotype concept in psychiatry: etymology and strategic intentions. Am J Psychiatry 160:636–645

    Article  PubMed  Google Scholar 

  55. Saperstein AM, Fuller RL, Avila MT, Adami H, McMahon RP, Thaker GK, Gold JM (2006) Spatial working memory as a cognitive endophenotype of schizophrenia: assessing risk for pathophysiological dysfunction. Schizophr Bull 32:498–506

    Article  PubMed  Google Scholar 

  56. Tuulio-Henriksson A, Arajärvi R, Partonen T, Haukka J, Varilo T, Schreck M, Cannon T, Lönnqvist J (2003) Familial loading associates with impairment in visual span among healthy siblings of schizophrenia patients. Biol Psychiatry 54:623–628

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding support: The study was supported by grants from the Academy of Finland (ATH #117159 and #131332; JL #200894; JS #118415).

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Annamari Tuulio-Henriksson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tuulio-Henriksson, A., Perälä, J., Saarni, S.I. et al. Cognitive functioning in severe psychiatric disorders: a general population study. Eur Arch Psychiatry Clin Neurosci 261, 447–456 (2011). https://doi.org/10.1007/s00406-010-0186-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-010-0186-y

Keywords

Navigation