2021-12-09 10:12

Cognitive impairment and its improvement after six months in adolescents with schizophrenia


Studies evaluating the connitive impairment in schizophrenic adolescents reported a variable course following antipsychotic treatment, with improvement being associated to patients#39; demographic or clinical characteristics.


To examine the cognitive impairments of a Mexican sample of adolescents with schizophrenia using the MATRICS Consensus Cognitive Battery (MCCB) before and after six months of antipsychotic treatment and to determine which demographic or clinical characteristics could be associated to cognitive improvement.


A sample of 87 Mexican patients was evaluated with the MCCB. Domain scores for three age groups (12–13, 14–15 and 16–17 years.) were obtained at baseline, and after 3 and 6 months of treatment. The groups were compared for demographic and clinical variables (sex, school attendance, years of education, being on their first psychotic episode, duration of illness and mean dose of antipsychotic), and a logistic regression analysis was performed to determine which variables predicted larger improvement.


The baseline performance showed scores below the standardized mean, with improvement in all domains except for social cognition female adolescents showed a larger improvement in attention/vigilance and visual learning domains.


We observed cognitive impairments on schizophrenic adolescents, which improved after six months of treatment in almost all domains.

1. Introduction

Schizophrenia is a persistent mantal illness characterized by disturbances in thought, perception and behavior (American Psychiatric Association,2013) which are associated with a significant cognitive and functional disability (Green , 1996,Green et al, 2005 ). Up to 30% of patients have an illness onset before 18 years old (Krausz and Muuml;ller-Thomsen, 1993 ), this group shows greater impairment than adult-onset patients (Fleischhaker et al, 2005, Fraguas et al, 2014, Marshall et al,2005).

Studies evaluating adolescents with schizophrenia reported deficits in a wide range of cognitive functions including memory, visual and verbal learning, attention, planning and psychomotor speed (Holmen et al., 2010; Kravariti et al., 2007; Puig et al., 2012; Rhinewine et al., 2005; Ueland et al., 2004). These cognitive impairments exhibit a variable course: while some studies did not find changes (De la Serna et al., 2011; Frangou et al., 2008), a 2 year follow up study in adolescents reported a significant increase for attention, learning and memory, and global cognitive performance, with no significant changes for working memory and executive function (Mayoral et al., 2008). Recent investigations reported improvements following pharmacological treatment (e.g., aripiprazole was associated with fewer total errors and perseverative errors in the Wisconsin Card Sorting Test; Yeh et al., 2014) or cognitive remediation (particularly in verbal memory (Puig et al., 2014), working memory (Puig et al., 2014; Revell et al., 2015), learning (Revell et al., 2015), inhibition and reasoning (Urben et al., 2012)). Studies in adult samples have investigated demographics (sex, age, and education), duration of illness, antipsychotic dose, and symptoms as predictors of cognitive improvement (Farreny et al., 2016) and reported that improvement in the MATRICS Consensus Cognitive Battery (MCCB) domains was associated with younger age, higher education level, lower scores on the Positive and Negative Syndrome Scale (PANSS) (Lindenmayer et al., 2017) and low doses of antipsychotics (Vita et al., 2013). However, these factors have not been fully explored in adolescents; furthermore, the discrepancies in the results of studies with adolescent samples could also be explained by the use of different neuropsychological tests.

The MCCB is currently considered the gold standard for the assessment of patients with schizophrenia (Holmen et al., 2010; Nuechterlein et al., 2008; Silverstein et al., 2010) and has been used to compare schizophrenic adolescents with healthy controls (Holmen et al., 2010). Authors who standardized MCCB values using T scores (Nitzburg et al., 2014; Stone et al., 2016), reported important differences in age and sex and advised to consider these groups in further analysis. More recently, the scores of the tests that integrate all cognitive domains assessed by MCCB were compared in a multinational study comprising samples from Ireland, Norway, Sweden, and the USA (Smelror et al., 2018). Results included age effects for all tests and sex differences in scores related to reasoning and problem solving and speed of processing. Although site differences that would be expected to impact cognitive performance were not identified, the authors mentioned that it#39;s unknown whether those findings could be related to the cognitive performance of youngsters from other countries (Smelror et al., 2018).

Taking this in account, as well as the lack of reports of the use of MCCB in Latin American samples, the objectives of present study were (i) to examine the cognitive impairments of a Mexican sample of adolescents with schizophrenia using the MCCB before and after six months of antipsychotic treatment, (ii) to compare the MCCB scores according to age, and (iii) to determine if the patients demographic or clinical characteristics are associated with cognitive improvement.

2. Methods

The study was approved by the Institutional Ethics Committee and followed the guidelines o












  1. 介绍

精神分裂症是一种持续性精神疾病,其特征是思维、知觉和行为障碍(美国精神病学协会,2013年),与显著的认知和功能残疾有关(Green,1996年;Green等人,2000年;Peuskens等人,2005年)。高达30%的患者在18岁之前发病(Krausz和M_ler Thomsen,1993年),这组患者显示出比成人发病患者更严重的损伤(Fleischhaker等人,2005年;Fraguas等人,2014年;Marshall等人,2005年)。

评估精神分裂症青少年的研究报告了包括记忆、视觉和语言学习、注意力、计划和心理运动速度在内的广泛认知功能的缺陷(Holmen等人,2010年;Kravariti等人,2007年;Puig等人,2012年;Rhinewine等人,2005年;Ueland等人,2004年)。这些认知障碍表现出一个可变的过程:虽然一些研究没有发现变化(de la serna等人,2011年;frangou等人,2008年),但一项为期2年的青少年随访研究表明,注意力、学习和记忆以及整体认知能力显著增加,工作记忆和执行力没有显著变化。功能(Mayoral等人,2008)。最近的研究报告,药物治疗(如阿立哌唑)后的改善与威斯康星卡片分类测试、Yeh等人,2014年)或认知修复(尤其是语言记忆(Puig等人,2014年)、工作记忆(Puig等人,2014年;Revel等人,2015年)中的总错误和持续性错误较少相关。)、学习(Revel等人,2015)、抑制和推理(Urben等人,2012))。对成人样本的研究调查了人口统计学(性别、年龄和教育程度)、疾病持续时间、抗精神病药物剂量和症状作为认知改善的预测因素(Farreny等人,2016年),并报告称,Matrics共识认知电池(MCCB)领域的改善与较年轻的年龄、较高的教育水平、较低的阳性和阴性综合征量表(PANSS)评分(Lindenmayer等人,2017年)和低剂量抗精神病药物评分(Vita等人,2013年)。然而,这些因素尚未在青少年中得到充分探讨;此外,使用不同的神经心理学测试也可以解释青少年样本研究结果的差异。



  1. 方法



    1. 仪器


Mini Kid是一个结构化的诊断访谈,用于评估儿童和青少年的精神病理学(Sheehan等人,2010年)。根据DSM-IV和国际疾病分类(ICD-10)标准(世界卫生组织,1992年),它检查了23种精神疾病的存在。





    1. 数据分析

使用IBM SPSS统计(版本21)软件进行分析。首先,将当前样本的MCCB测试原始分数与Holmen等人报告的分数进行比较。(2010)对于健康受试者,使用一个样本t检验。然后,根据MCCB的指导原则,将认知测试的原始分数转换为T分数。描述性统计用于基线临床和人口统计学变量。根据先前研究的方法(Stone等人,2016年),将样本分为三个年龄组(12–13 y.o.n 18、14–15 y.o.n 35和16–17 y.o.、n 34),然后使用重复测量的一般线性模型(年龄组)和时间(基线、第3个月和第6个月)作为因素进行比较,包括学校教育作为一种协变量,以评估随时间变化的群体差异。为了检验改进程度,根据Cohen(1969)计算每个领域变化的影响大小,分别考虑低、中、高影响大小分别为0.2、0.5和0.8。


  1. 原因

这项研究包括87名患者(69%的男性,平均年龄14.9 1.5岁),其中8.2 1.6学年,42.9%上学。大多数患者(83.9%)出现第一次精神病发作,平均病程为13.6 15.2个月。他们的平均PANSS评分在基线时为93.3_19.9,在第3个月为56.1_20.3,在第6个月为52.2_20.1。他们的药物治疗主要基于非典型抗精神病药物(93%),平均剂量为219.8 72.9 mg氯丙嗪当量;没有接受认知修复治疗。


二元逻辑回归显示,女性预测注意力/警惕性(OR 7.93,95%C.I.1.92–32.75)和视觉学习(OR 4.00,95%C.I.1.14–13.98)有很大改善。



病人(14.8 plusmn; 1.5 y.o.)

健康 项目 (16.0 plusmn; 1.9 y.o)g





TMT: part A

77.7 (56.6)a

53.4 (34.3)e

27.7 (10)

t = 8.054
df = 82
p = 0.000

t = 6.082
df = 65
p = 0.000

BACS symbol coding

33.9 (13.5)b

40.2 (12.1)e

61.9 (11.8)

t = minus;18.972
df = 83
p = 0.000

t = minus;14.460
df = 65
p = 0.000


19.3 (6.7)b

22.8 (5.6)e

28.9 (3.5)

t = minus;12.834
df = 83
p = 0.000

t = minus;8.705
df = 65
p = 0.000

WMS-III spatial span

12.1 (4.5)b

14.6 (3.2)e

19.1 (2.9)

t = minus;13.918
df = 83
p = 0.000

t = minus;11.123
df = 65
p = 0.000

Letter-number span

8.5 (3.5)a

10.3 (3.3)e

16.1 (3)

t = minus;19.329
df = 82
p = 0.000

t = minus;14.054
df = 65
p = 0.000

NAB mazes

10.8 (5.7)a

14.9 (6.0)e

21.7 (4.2)

t = minus;17.045
df = 82

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