The existence of small numbers of schizophrenia patients with superior ability in specific cognitive domains is implied by meta-analytic evidence as well as by occasional empirical reports. The authors identified 25 patients with superior (i.e., > or =90th percentile) ability on the Vocabulary subtest of the Wechsler Adult Intelligence Scale 3rd edition (Wechsler, 1997). These cognitively advantaged patients were compared with 22 healthy participants performing at the superior level and with 126 schizophrenia patients and 50 healthy participants scoring below the superior range. Verbally superior schizophrenia patients and verbally superior healthy participants had similar cognitive profiles and life skills performance, but diverged markedly in terms of independent "real-world" functioning. Verbally superior patients significantly outperformed more typical patients in other aspects of cognitive performance, life skills, and support requirements. However, severity of positive and negative symptoms was equivalent in the patient groups. Detailed biobehavioral study of cognitively exceptional patients may offer new insights into mechanisms mediating psychotic disorders.
patients with ICD-9CM codes for schizophrenia (295.xx). Records were assessed for a period of 18 months (6-month pre-index period with no antipsychotics plus 12month post-index period). A medication possession ratio (MPR) of Ն 80% or a proportion of days covered (PDC) of Ն 80% was considered adherent. RESULTS: A total of 1,470 patients met inclusion criteria; 31% (nϭ462) had an MPR Ն 80%. Based on MPR, 30% (405/1338) in the oral cohort and 43% (57/132) in the injectable cohort were adherent. Logistic regression analyses adjusting for demographic covariates (age, gender, race) showed that patients in the injectable cohort were about 77% more likely to be adherent based on MPR (ORϭ1.77, 95% CIϭ1.22-2.56, pϽ0.05) compared to the oral cohort. Of the demographic covariates, race (Blacks ϭ less adherent; pϽ0.001) was the only significant covariate. Similarly, increased adherence in the injectable cohort (ORϭ1.81, 95% CIϭ1.24-2.63, pϽ0.05) was also found using PDC, where race (Blacks ϭ less adherent; pϽ0.001) and gender (women ϭ less adherent; pϽ0.05) were significant. CONCLUSIONS: Overall, less than one-third of all patients were adherent (MPR Ն 80%) one year after their index date. Patients taking long-acting injectable risperidone had higher rates of adherence compared to patients taking oral risperidone alone. In addition, this finding was confirmed by PDC, which has been shown to be a more conservative calculation of adherence in patients with schizophrenia.
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