Psychopathology and Wisconsin Card Sorting Test Performance in Male Schizophrenic Patients: Influence of Dual Diagnosis

Abstract

Background: Different neuropsychological studies have shown schizophrenic patients to have executive function deficits, as illustrated by their performance in neuropsychological tasks such as the Wisconsin Card Sorting Test (WCST); certain studies have described a relationship between these deficits and negative symptoms. Schizophrenic patients also exhibit a high lifetime prevalence (40–50%) of comorbid substance use disorders (SUDs). However, little attention has been paid to this comorbidity (dual diagnosis) in studies associating executive functions and negative symptoms. Sampling and Methods: Our objective is to investigate the relationship between performance in the WCST and psychopathology as measured by the Positive and Negative Syndrome Scale (PANSS) in a sample of 65 male schizophrenic patients with a history of SUDs (Sch SUD+) and in a sample of 48 male schizophrenic patients without such history (Sch SUD–). Results: In the Sch SUD– group, patients who completed 4 or more categories in the WCST (‘good performers’) obtained a mean score of 21.2 ± 8.8 on the negative subscale of the PANSS, compared with a mean score of 27.8 ± 8.6 in those who completed 3 or less (‘poor performers’); these differences were statistically significant (p = 0.015). In the Sch SUD+ group, however, no association was found between WCST performance and the PANSS negative subscale score. Conclusions: The presence of a history of comorbid SUDs should be taken into consideration in studies investigating executive functions and negative symptoms in schizophrenia.

Wisconsin Card Sorting Test scores and clinical and sociodemographic correlates in Schizophrenia: multiple logistic regression analysis

“…This is an important new finding. Comparing the three main previous studies 9 10 23 with the current study, we summarised shared and different findings, shown in table 4.…”

“…In a different study, age affected PE score but education years did not affect either CA or PE scores 10. Additional two studies showed age of onset affected PE score23 and the positive and negative syndrome scale (PANSS) negative scale score affected CA score in patients with schizophrenia 9. These findings indicate that it is important to consider all clinical and sociodemographic factors to clarify which affect WCST scores in patients with schizophrenia.…”

“…A steady (non-significant) progression of impairment on WCST perseverative errors (PE) was demonstrated from basic symptom at-risk (BS), ultra high-risk (UHR) and first-episode (FE) groups (BS: z=−0.74; UHR: z=−0.88; FE: z=−0.97) 3. However, negative and depressive symptoms may modify WCST performance in patients with schizophrenia,9 18 and many other factors (eg, premorbid IQ) may modify WCST scores 11…”

Negative Symptoms and Executive Function in Schizophrenia: Does Their Relationship Change with Illness Duration?

“…Inconsistency of findings could also be due to differing sociodemographic or clinical characteristics of the samples, such as age, intelligence or general cognitive functioning [60], treatment, clinical state at the time of the study, or comorbidity with other disorders. In this respect, our group has recently reported that the association between negative symptoms and executive function is found in schizophrenic patients without substance use disorder history, but not in patients with this history [63,64]. …”

Paradoxical Cognitive Capacities in Dual Diagnosis Schizophrenia: The Quest for Explanatory Factors

“…Of the 18 studies involving schizophrenia and abuse of mixed psychoactive substances, almost half (n = 8) did not find differences in cognitive functioning between patients with schizophrenia and comorbid substance use disorders compared to those without comorbid substance use disorders (Addington & Addington, 1997;Barnes, Mutsatsa, Hutton, Watt, & Joyce, 2006;Cleghorn et al, 1991;Harrison et al, 2008;Krysta, Krupka-Matsuszczyk, & Klaslik, 2005;Pencer & Addington, 2003;Rodriguez-Jimenez et al, 2008;Thoma & Daum, 2008). On another note, six studies showed that mixed psychoactive substance abuse was associated with better cognitive functioning in schizophrenia (Herman et al, 2004;Joyal et al, 2003;McCleery et al, 2006;Potvin et al, 2005;Sevy et al, 2001;Thoma et al, 2007), especially for speed of processing (four studies) and language/verbal abilities (fluency; four studies).…”