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Neurocognitive Deficits, Negative Symptoms, and Insight in Schizophrenia

  • Adrian PredaEmail author
  • Robert Bota
  • Philip Harvey
Chapter

Abstract

The symptom domains of primary negative symptoms, insight and cognitive deficits in schizophrenia appear to overlap on a number of aspects. These domains are: (1) relatively independent of the psychotic, affective and secondary negative symptoms domains; (2) relatively persistent; (3) show only marginal improvement with the available antipsychotic treatments; (4) are strongly correlated in cross sectional measures, and (5) associated with outcome measures. Despite such similarities the relationship between insight, negative and cognitive symptoms is yet to be clarified. Are we looking at independent categories of symptoms, at a primary versus secondary symptoms type of correlation – e.g. insight deficits secondary to cognitive deficits – or maybe at a common neuropathological “lesion” or endophenotype with multiple manifestations? Is the functional deficit an effect, a cause or just another category that correlates with insight, negative and cognitive symptoms? In this chapter we will selectively review cross-sectional and longitudinal data to clarify the relationship between these schizophrenia domains. We conclude that the evidence to date suggests that we are in fact looking at independent symptoms domains. This conclusion has important applications. At a theoretical level the implication is that, similarly to its clinical presentation, the underlying neurocircuitry and pathophysiology of schizophrenia is diffuse and heterogeneous rather than localized and homogeneous. At a more pragmatic level the relative independence of the cognitive and negative symptoms suggests that effective interventions might need to selectively target each of the domains.

Keywords

Cognitive deficits Negative symptoms Deficit Insight Schizophrenia 

Abbreviations

AMPA

α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate

BDNF

Brain-derived neurotrophic factor

BP-I

Bipolar disorder type I

COGS

The consortium on genetics of schizophrenia

COMT

Catechol-O-methyl transferase

CPT

Continuous performance tests

DTI

Diffusion tensor imaging

DSM

Diagnostic and statistic manual

FA

Fractional anisotropy

FE

First episode

FGA

First generation antipsychotic

GABA

γ-amino-butyric acid

GAF

Global assessment of function

ICD

International classification of disease

IP

Identical pairs

MRI

Magnetic resonance imaging

NMDA

N-methyl D-aspartate

PANSS

Positive and negative syndrome scale

PD

Personality disorder

PSP

Personal and social performance

QOL

Quality of life

rTMS

repetitive transcranial magnetic stimulation

SATCI

The schedule for assessing the three components of insight

SCID

Structured clinical interview for DSM disorders

SGA

Second generation antipsychotic

STG

Superior temporal gyri

VBM

Voxel-based morphometry

WCST

Wisconsin card sorting test

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineUSA
  2. 2.University of MissouriKansas CityUSA
  3. 3.Kaiser PermanenteRiversideUSA
  4. 4.Miller School of Medicine, University of MiamiEdgemontUSA

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