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Neurocognitive Deficits, Negative Symptoms, and Insight in Schizophrenia

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Book cover Handbook of Schizophrenia Spectrum Disorders, Volume II

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.

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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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Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA

    Adrian Preda

  2. University of Missouri, Kansas City, MO, USA

    Robert Bota

  3. Kaiser Permanente, Riverside, CA, USA

    Robert Bota

  4. Miller School of Medicine, University of Miami, Edgemont, PA, USA

    Philip Harvey

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  1. Adrian Preda
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  2. Robert Bota
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  3. Philip Harvey
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Correspondence to Adrian Preda .

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  1. , Rappaport Faculty of Medicine, Technion - Israel Institute of Technolog, Haifa, Israel

    Michael Ritsner

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Preda, A., Bota, R., Harvey, P. (2011). Neurocognitive Deficits, Negative Symptoms, and Insight in Schizophrenia. In: Ritsner, M. (eds) Handbook of Schizophrenia Spectrum Disorders, Volume II. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0831-0_2

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