Lower Premorbid IQ Research Articles

Premorbid IQ Predicts Postconcussive Symptoms in OEF/OIF/OND Veterans with mTBI.

Extant literature has demonstrated that symptoms of postconcussive syndrome (PCS) persist well beyond the expected 3-month post-injury recovery period in a minority of individuals with mild traumatic brain injury (mTBI). Suboptimal performance on validity measures and pre- and post-injury psychosocial stressors - rather than actual mTBI or current cognitive functioning - have been identified as predictors of chronic PCS. Whether premorbid IQ has any influence on chronic PCS has been understudied, in the context of established psychogenic etiologies. The sample included 31 veterans, who underwent mTBI neuropsychological evaluations six or more months post-injury in a VA outpatient neuropsychology clinic. A two-step multiple linear regression was conducted to examine the effects on the outcome variable, PCS (Neurobehavioral Symptom Inventory), of the following predictors: cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status; Attention, Immediate Memory, and Delayed Memory Indices), performance validity, depression (Beck Depression Inventory-Second Edition), posttraumatic stress disorder (PTSD Checklist, Civilian Version), quality of sleep (Pittsburgh Sleep Quality Index), pain (Brief Pain Inventory), education, and Premorbid IQ (Wechsler Test of Adult Reading). The overall regression model containing all nine predictor variables was statistically significant. Depression (p < .05) and premorbid IQ (p < .05) were the most salient predictors of chronic PCS; in that lower premorbid IQ and greater endorsed symptoms of depression were associated with higher PCS scores. In Step 2 of the multiple linear regression, the WTAR explained an additional 6.7% of the variance in PCS after controlling for psychosocial stressors and current cognitive ability. The findings support premorbid IQ as a unique and relevant predictor of chronic PCS, with significance variance accounted for beyond education, cognitive functioning, and psychosocial variables. Given the predictive relationship between premorbid IQ and PCS, adapting postconcussive interventions to meet the specific needs of individuals with varying levels of intellect may be important in minimizing ongoing symptomatology.

SU54. Shared Architecture of Dimensional Psychotic Symptoms Across Psychosis Spectrum Disorders: Impact on Functional Outcomes and Neurocognition

Abstract Background: Psychosis spectrum disorders share significant overlap in symptoms, biomarkers, genetic factors, outcomes, and treatment response. Moreover, within each disorder, there is significant heterogeneity in symptom profiles, neurocognitive, and everyday functioning. This has lead to recent efforts, in line with the Research Domain Criteria (RDoC), to develop novel classifications based on dimensions that cut across traditional diagnostic boundaries. Whether there are homogeneous subgroups in bipolar disorder (BD) with distinct psychotic symptom profiles is unknown. Moreover, the impact of these subgroups on neurocognitive and everyday functioning is also unknown. We aimed to (1) cluster BD patients in homogeneous subgroups based on psychotic symptom profiles; (2) describe clinical, neurocognitive, and functional characteristics of each subgroup; and (3) test whether the subgroups extend across the psychosis spectrum (to patients with schizotypal personality disorder, SPD). Methods: Sample: 138 patients with BD I or II; 282 patients with SPD. Diagnosis: SCID, SIDP-IV. Psychotic symptoms: Schizotypal Personality Questionnaire, SPQ; a multidimensional measure of psychosis proneness that captures the full range from normal to abnormal, including subthreshold symptoms. Neurocognition: MATRICS Consensus Cognitive Battery (MCCB); Disability: World Health Organization Disability Assessment Schedule (WHODAS-II). With hierarchical cluster analyses, we tested for homogeneous subgroups in each sample (BD, SPD patients) based on the 9 SPQ subscales. To determine the impact of psychosis symptom profile on outcome, we used ANOVAs to compare the clusters on neurocognitive and everyday functioning. Results: In BD, we identified 3 clusters: (1) high propensity to positive symptoms, with significantly higher scores on ideas of reference, suspiciousness, unusual perceptions, odd beliefs, odd behavior, and odd speech than the other 2 clusters; (2) high negative symptoms and social dysfunction, with high scores on excess social anxiety and lack of friends; and (3) mild psychosis symptom profile, with the lowest scores across all SPQ subscales. Subgroup 1 (high positive symptoms) scored significantly lower in all cognitive areas (MATRICS composite, F = 3.72; df = 2; P = .027) and had lower premorbid IQ (F = 5.6; df = 124; P = .005) and significantly higher disability (WHODAS, F = 9.19; df = 2; P < .001) compared with the other 2 subgroups. In the SPD sample, we found a subgroup structure that was highly consistent with that described above. Conclusion: Our finding of a common structure of psychotic symptom profiles across different psychosis spectrum disorders supports the dimensional nature of the propensity to positive symptoms in a continuum across diagnostic boundaries. Our results further highlight the potential implications that this classification system may have on outcome.

Cognitive deterioration in adult epilepsy: clinical characteristics of “Accelerated Cognitive Ageing”

"Epileptic dementia" is reported in adults with childhood-onset refractory epilepsy. Cognitive deterioration can also occur in a "second-hit model". We studied the clinical and neuropsychological characteristics of patients with cognitive deterioration (≥1 SD discrepancy between current IQ and premorbid IQ). Memory function, reaction time and processing speed were also evaluated. Analyses were performed to investigate which clinical characteristics correlated with cognitive deterioration. Twenty-seven patients were included with a mean age of 55.7years old, an average age at epilepsy onset of 33.9years and a mean duration of 21.8years. Over 40% had experienced at least one status epilepticus. About 77.8% had at least one comorbid disease (most of (cardio)vascular origin). Cognitive deterioration scores were significant for both Performance IQ and Full Scale IQ, but not for Verbal IQ. Impairments in fluid functions primarily affected the IQ-scores. Memory was not impaired. Epilepsy factors explained 7% of the variance in deterioration, whereas 38% was explained by relatively low premorbid IQ and educational level, high age at seizure onset and older age. A subgroup of patients with localization-related epilepsy exhibits cognitive decline characterized by deterioration in PIQ and FSIQ, but with preserved higher order functions (VIQ and memory). Patients typically have epilepsia tarda, comorbid pathology, relatively low educational level and older age. These are factors known to increase the vulnerability of the brain by diminishing cognitive reserve. Cognitive deterioration may develop according to a stepwise "second-hit model", affecting and accelerating the cognitive ageing process.

Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment.

Recent research in the field of cancer-related cognitive impairments (CRCI) has shown CRCI presentation prior to treatment initiation. Some have attributed these problems to worry and fatigue, whereas others have suggested an influence of age, IQ, and other psychosocial and medical factors. Patients (≥18years) with a histologically confirmed diagnosis of a solid cancer or hematological malignancy, scheduled for a curative treatment, were evaluated with a baseline neuropsychological assessment including Patient-Reported Outcome Measures (PROMs). PROMs entailed distress, anxiety and depression, fatigue, and cognitive complaints. The neuropsychological assessment comprised several cognitive domains such as premorbid IQ, attention, processing speed, flexibility, verbal and visual episodic memory, and verbal fluency. Cross-sectional data of 125 patients were collected. Patients had a mean age of 60.9years (range: 30.0-85.0) and comprised primarily females (65.6%). Patients presented with cancer of following sites: breast (44.0%), digestive (28.8%), urological (11.2%), gynecologic (8.0%), hematologic malignancy (4.8%), and lung (3.2%). Patients presented with a premorbid IQ of 105.3 (range: 79.0-124.0). In 29.6% of patients, a CRCI was detected. Binary logistic regression analyses showed that a lower premorbid IQ (β=-.084, P<.01) and a higher level of fatigue (β=-.054, P<.05) predicted baseline CRCI. Premorbid IQ also predicted performance on individual cognitive domains. Some domains were also influenced by age, gender, having a breast cancer diagnosis, and an active treatment for hypertension. Premorbid IQ and fatigue are important predictors of baseline CRCI. Therefore, we advise researchers to implement a short IQ test when conducting clinical trials on CRCI.

EXPLORING COMORBID OBSESSIVE-COMPULSIVE DISORDER AND ALCOHOL USE DISORDER USING NEUROPSYCHOLOGICAL TOOLS: A PRELIMINARY ANALYSIS

abstract By investigating neuropsychological profiles in patients with obsessive-compulsive disorder (OCD) and OCD with alcohol use disorder (OCD+AUD), focusing on tasks of behavioural inhibition, attentional set-shifting and decision-making, we aimed to elucidate factors contributing to compulsive behaviour. Consenting patients (n=24) were recruited from outpatient clinics and attributed to DSM-IV OCD (n=14) or OCD+AUD (n=10) groups. Healthy controls with no relevant family history (n= 15) were identified through established databases and public advertisement. We used the Barratt Impulsiveness Scale (BIS) to assess behavioural impulsivity, the Stop-Signal Task for motor response inhibition, the Intradimensional-Extradimensional (ID-ED) Set-Shift Task for attentional flexibility and the Cambridge Gamble Task (CGT) for decision-making. Analysis of co-variance was used to test for group differences, controlling for depression (Montgomery-Asberg Depression Rating Scale) and anxiety (State-Trait Anxiety Inventory), for which both patient groups scored significantly higher (p When we co-varied for anxiety and depression, both patient groups showed poorer attentional flexibility on the ID-ED task than controls (p=.01, with large effect size). Motor response inhibition (SST) did not differ between groups, however the OCD+AUD group showed poorer attentional inhibition than both other groups on the attentional subscale of BIS (p=.001). The quality of CGT decision-making was also significantly poorer in the OCD+AUD group than in the pure OCD group and controls (p=.05). Interestingly, significantly higher (p Although our interpretations are limited by small sample size, it appears the impairment in decision-making, set-shifting and attentional impulsivity observed in OCD+AUD may be attributable to between-group differences in intelligence. There is some evidence that lower premorbid IQ may be linked with AUD, specifically in those patients with a strong family history of AUD. On the other hand, questions have been raised as to the validity of the NART as a specific measure of premorbid IQ in AUD. Future such studies should pay close attention to measuring to premorbid intelligence and its relationship with neurocognitive performance.

Impact of duration of untreated psychosis and premorbid intelligence on cognitive functioning in patients with first-episode schizophrenia

BackgroundThe neurotoxic hypothesis suggests that psychosis is toxic to the brain leading to clinical consequences. In this study, we hypothesized that a longer duration of untreated psychosis (DUP) in first episode schizophrenia (FES) patients is associated with poorer cognitive functioning, and that higher premorbid intelligence buffers against DUP-related cognitive impairment. MethodEighty-one FES patients completed a neuropsychological battery, the Brief Assessment of Cognition in Schizophrenia (BACS). Composite scores of the BACS, which were normalized to a matched healthy control of seventy-three subjects, were used as an index of general cognition. A median split using the Wide Range Achievement Test–Reading Test scores was used to divide the patients into low versus high premorbid IQ groups. Hierarchical linear regression was performed to examine predictors of general cognition, including DUP. ResultsLonger DUP was found to be a significant predictor of poorer general cognition. In addition, DUP predicted general cognition in the low premorbid IQ group but not in the high premorbid IQ group. ConclusionsOur findings demonstrate that longer DUP in FES patients is associated with worse cognitive scores, and that this association is more pronounced in a subgroup of patients who have lower premorbid intelligence. Our results suggest the importance of earlier identification and management of patients with low premorbid IQ, given that their cognition may be more vulnerable to the toxicity of psychosis.

The impact of neuropsychological functioning and coping style on perceived stress in individuals with first-episode psychosis and healthy controls

Stress is implicated in the development and course of psychotic illness, but the factors that influence stress levels are not well understood. The aim of this study was to examine the impact of neuropsychological functioning and coping styles on perceived stress in people with first-episode psychosis (FEP) and healthy controls (HC). Thirty-four minimally treated FEP patients from the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, and 26 HC participants from a similar demographic area participated in the study. Participants completed a comprehensive neuropsychological test battery as well as the Coping Inventory for Stressful Situations (task-, emotion- and avoidance-focussed coping styles) and Perceived Stress Scale (PSS). Linear regressions were used to determine the contribution of neuropsychological functioning and coping style to perceived stress in the two groups. In the FEP group, higher levels of emotion-focussed and lower levels of task-focussed coping were associated with elevated stress. Higher premorbid IQ and working memory were also associated with higher subjective stress. In the HC group, higher levels of emotion-focussed coping, and contrary to the FEP group, lower premorbid IQ, working memory and executive functioning, were associated with increased stress. Lower intellectual functioning may provide some protection against perceived stress in FEP.

Poster #M94 ARE THE RELATIONSHIPS OF COGNITIVE PERFORMANCE TO PSYCHOSOCIAL FUNCTIONING AT FIVE YEAR OUTCOME MEDIATED BY DISORGANIZATION SYMPTOMS?

and meeting thresholds for each of its criteria. It was also significantly associated with body mass index, smoking and level of physical activity, but not with fruit and vegetable consumption. Lower premorbid IQ was significantly associated with smoking only. Further analysis was undertaken to assess the independent contribution of cognition and modifiable lifestyle risk factors to metabolic syndrome. In the unadjusted multivariate model, current smoking, body mass index and current cognitive function were significant (ORs and CIs: 1.8 (1.3-2.6), 4.8 (3.1-7.5), 15.8 (10.1-24.6) and 0.98 (0.96-0.99) respectively). After adjustment for sex, age, illness duration, socioeconomic status, diagnosis and medication use, cognition was no longer significant. Discussion: Our data support a reported association between metabolic disturbance and cognitive deficits, including speed of processing deficits, in schizophrenia. Current but not premorbid cognitive function was associated with metabolic syndrome and its component risks in people with psychotic illness. However, the effect size was small relative to the impact of modifiable lifestyle risk factors. We were unable to explore directionality in our cross-sectional data. Further investigation is warranted of underlying mechanisms and possible bidirectionality in psychosis where cognitive impairment antedates the onset of metabolic disorders.

Abstract T P105: Cognitive Impairment is Common After Both Lacunar and Non-Lacunar Stroke and Persists at One Year

Background: Few data exist on long term cognitive outcome after lacunar stroke. We assessed cognition 1-6 weeks and 1 year after lacunar and mild cortical stroke, whilst correcting for age, SVD, depression and pre-morbid IQ. Methods: We recruited consecutive patients with lacunar and mild cortical stroke, diagnosed with DWI-MRI and careful clinical assessment. At 4-6 weeks and 1 year after index stroke we assessed white matter hyperintensities (WMH; Fazekas scale), cognition (Addenbrookes Cognitive Assessment, ACE-R), pre-morbid IQ (National Adult Reading Test, NART) and depression (Beck Depression Index, BDI). We defined 'dementia' as an ACE-R&lt;88. Results: At 4-6 weeks post-stroke, 61/157 (38%) had dementia; at 1 year 56/151 (37%) had dementia; 136 were tested twice. Of the 45 who had dementia at first assessment &amp; 9(20%) no longer had dementia at 1 year; of the 91 who did not have dementia at 4-6 weeks, 13 (14%) had become demented by 1 year. Patients with lacunar stroke had similar risk of cognitive impairment as patients with cortical stroke when adjusted for age, Fazekas score, BDI and NART in multivariable analyses (OR 0.91, 95%CI 0.32-2.13 at 1st assessment &amp; 0.81, 95%CI 0.46-2.27 at 1 year). Previous stroke, low pre-morbid IQ and depression increased risk of dementia at both time points, but not vascular risk factors, sex, NIHSS or Fazekas score. Conclusion: Over one third of patients with a non-disabling stroke had dementia at 4-6 weeks post stroke, most of these (80%) remained demented at one year and 13% of those who were cognitively intact ay 4-6 weeks developed dementia by 1 year. Patients with lacunar stroke are equally likely to have dementia as those with cortical stroke, despite the small lesion size and good prognosis. Low pre-morbid IQ increases dementia risk. Future research should account for pre-morbid IQ, age and depression.

Criminal offending before and after the onset of psychosis: Examination of an offender typology

ObjectiveClinicians often consider whether or not offenders with psychosis have a history of offending pre-dating the onset of their illness. The typology of offenders based on age at first offence, developed in the field of criminology, has been recently extended to mentally disordered groups, but this ignores the potential role of illness onset. MethodUsing a large UK cohort of individuals with both psychosis and offending histories (n=331), we compared those with a history of offending pre-dating their illness (pre-morbid offenders) to those who commenced offending after becoming unwell (post-morbid offenders). We compared the demographic, clinical and offending pattern characteristics of the two groups. Results198 (60%) had offended before the onset of psychosis. These pre-morbid offenders were more likely to be male, have a lower pre-morbid IQ and have had a history of neurological abnormality. Pre-morbid offenders also committed more crime overall, but this was due to an excess of acquisitive, drug and minor offending, rather than violent offending, which was comparable to the post-morbid offending group. ConclusionCurrently, standardised clinical risk assessment tools view offenders with mental illness as a homogenous group with respect to life-course patterns of offending in relation to illness. Taking account of an individual's pathway to offending may improve risk assessment and management.

Mobile Assessment and Treatment for Schizophrenia (MATS): A Pilot Trial of An Interactive Text-Messaging Intervention for Medication Adherence, Socialization, and Auditory Hallucinations

Mobile Assessment and Treatment for Schizophrenia (MATS) employs ambulatory monitoring methods and cognitive behavioral therapy interventions to assess and improve outcomes in consumers with schizophrenia through mobile phone text messaging. Three MATS interventions were developed to target medication adherence, socialization, and auditory hallucinations. Participants received up to 840 text messages over a 12-week intervention period. Fifty-five consumers with schizophrenia or schizoaffective disorder were enrolled, but 13 consumers with more severe negative symptoms, lower functioning, and lower premorbid IQ did not complete the intervention, despite repeated prompting and training. For completers, the average valid response rate for 216 outcome assessment questions over the 12-week period was 86%, and 86% of phones were returned undamaged. Medication adherence improved significantly, but only for individuals who were living independently. Number of social interactions increased significantly and a significant reduction in severity of hallucinations was found. In addition, the probability of endorsing attitudes that could interfere with improvement in these outcomes was also significantly reduced in MATS. Lab-based assessments of more general symptoms and functioning did not change significantly. This pilot study demonstrated that low-intensity text-messaging interventions like MATS are feasible and effective interventions to improve several important outcomes, especially for higher functioning consumers with schizophrenia.

Brief Report: Childhood Intelligence Predicts Hospitalization with Personality Disorder in Adulthood: Evidence from a Population-Based Study in Sweden

Although low pre-morbid IQ is an established risk factor for severe mental illness, its association with personality disorder (PD) is unclear. We set out to examine whether there is a prospective association between childhood intelligence and PD in adulthood. Using a population-based prospective cohort study, we linked childhood IQ scores to routinely collected hospital discharge records in adulthood. Lower IQ scores were related to higher risk of being hospitalized with a PD across the full range of IQ scores, (odds ratio per one SD increase in IQ was 0.60; 95% CI: 0.49-0.75; p(trend) = 0.001). Adjusting for potential confounding variables had virtually no impact. We conclude that low childhood IQ predicts hospitalization with PD and may be an important factor in the development of PD.

Heterogeneity in cognitive functioning among patients with bipolar disorder

Background Nowadays it is not clear if in bipolar disorders (BD) cognitive impairments are heterogeneous and if so which are the variables that determine it. Methods Fifty patients with BD and thirty healthy controls were clinically evaluated including measures of obstetric complications history. All subjects completed an extensive neuropsychological battery selected to asses premorbid IQ and different cognitive domains. Results Compared with standardized norms, 38% of patients had none cognitive domain affected, while 40% had 1 to 2, and 22% had 3 to 5. Patients with cognitive functioning within normal limits had higher psychosocial functioning and premorbid IQ, and lower history of obstetric complications. Limitations The small sample size could limit the generalizability of the results; since these data should be taken as preliminaries. Conclusions The extension and severity of cognitive impairments may be heterogeneous in patients with BD, and it might contribute to explain the variability in functional outcome. Bipolar patients with low premorbid IQ and history of obstetric complications may represent a subgroup with lower cognitive performance and psychosocial functioning.

Neuropsychological and Neurobehavioral Correlates of Aggression Following Traumatic Brain Injury

This study aimed to establish the neuropsychological and neurobehavioral profile of individuals who develop aggression following traumatic brain injury. In a prospective cohort study, 134 brain-injured individuals who exhibited aggression were compared to 153 individuals who had sustained comparable injuries but were not aggressive. In the aggressive group, specific deficits were identified in verbal memory and visuo-perceptual skills. Compared to normative data, this group had impaired executive-attention function. It is tentatively suggested that significant impairment in verbal memory and visuospatial abilities against a background of diminished executive-attention functioning is associated with the development of aggression after brain injury, especially when other risk factors such as low premorbid IQ, low socioeconomic status, and male gender are present.

The Maudsley Family Study: Premorbid and Current General Intellectual Function Levels in Familial Bipolar I Disorder and Schizophrenia

The distinction of psychosis into schizophrenia and bipolar disorder has been increasingly challenged with some evidence suggesting that the two conditions may have common etiologic and pathogenic mechanisms. We compared the premorbid and current intellectual function of bipolar patients from multiply affected families, and those of their first-degree relatives, with those of a similar series of schizophrenic subjects, as well as their relatives, and normal controls. Only schizophrenic subjects showed lower premorbid IQ, suggesting that they, but not the bipolar patients or either relative group, had suffered neurodevelopmental impairment. However, both groups of patients had comparably poor current general intellectual levels, implying that some common pathogenic process operates once illness has begun. The two groups of relatives showed distinct differences in intellectual function but we cannot exclude the possibility that these were a function of our sampling methods.

Cognitive heterogeneity in first-episode schizophrenia

Studies of chronic schizophrenia suggest that there are subgroups with different profiles of cognitive impairment. To determine whether such heterogeneity is present at illness onset and any relationship to clinical variables. Ninety-three community patients with first-episode schizophrenia and 50 healthy volunteers were assessed for premorbid (Revised National Adult Reading Test) and current IQ, memory and executive function. Half of those with schizophrenia had preserved IQ in the normal range but there was evidence of a specific impairment in spatial working memory even in those with high/average IQ; 37 out of 93 (40%) had generalised cognitive decline. Those with low premorbid IQ were significantly younger at illness onset. For the entire group, age at onset correlated positively with premorbid but not current IQ. At illness onset, cognitive heterogeneity is present in people with schizophrenia, with a high proportion having undergone general cognitive decline. However, working memory impairment may be a common feature. Lower premorbid IQ is a risk factor for an earlier onset.

Predicting violence in schizophrenia: a prospective study

Background: People with schizophrenia are more violent than the general population, but this increased risk is attributable to the actions of a small subgroup. Identifying those at risk has become an essential part of clinical practice. Aims: To estimate the risk factors for assault in patients with schizophrenia. Methods: Two hundred seventy-one patients with schizophrenia were interviewed using an extensive battery of instruments. Assault was measured from multiple data sources over the next 2 years and criminal records were obtained. Multiple sociodemographic and clinical variables measured at baseline were examined as possible predictors of assault during follow-up. Results: Sixty-nine (25%) patients committed assault during the 2-year follow-up. The model that best predicted assault included a history of recent assault (OR 2.33, 95% CI 1.17–4.61), a previous violent conviction (OR 2.02, 95% CI 1.04–3.87), having received special education (OR 2.76, 95% CI 1.22–6.26) and alcohol abuse (OR 3.55, 95% CI 1.24–10.2). Conclusions: Previously established risk factors including a history of violence and alcohol abuse are replicated in this study. Although low premorbid IQ did not predict violence, a need for special education did.

The relationship between predisposing factors, premorbid function and symptom dimensions in psychosis: an integrated approach

Background. Increasing evidence suggests psychosis may be more meaningfully viewed in dimensional terms rather than as discrete categorical states and that specific symptom clusters may be identified. If so, particular risk factors and premorbid factors may predict these symptom clusters. Aims. (i) To explore, using principal component analysis, whether specific factors for psychotic symptoms can be isolated. (ii) To establish the predictors of the different symptom factors using multiple regression techniques. Method. One hundred and eighty-nine inpatients with psychotic illness were recruited and information on family history, premorbid factors and current symptoms obtained from them and their mothers. Results. Seven distinct symptom components were identified. Regression analysis failed to identify any developmental predictors of depression or mania. Delusions/hallucinations were predicted by a family history of schizophrenia and by poor school functioning in spite of normal premorbid IQ ( F = 6.5; P < 0.001); negative symptoms by early onset of illness, developmental delay and a family history of psychosis ( F = 4.1; P = 0.04). Interestingly disorganisation was predicted by the combination of family history of bipolar disorder and low premorbid IQ ( F = 4.9; P = 0.003), and paranoia by obstetric complications (OCs) and poor school functioning ( F = 4.2; P = 0.01). Conclusion. Delusions and hallucinations, negative symptoms and paranoia all appeared to have a developmental origin though they were associated with different childhood problems. On the other hand, neither mania nor depression was associated with childhood dysfunction. Our most striking finding was that disorganisation appeared to arise when a familial predisposition to mania was compounded by low premorbid IQ.

Long-term predictors of cognitive outcome in a cohort of older people with hypertension.

Deteriorating cognitive function in late life substantially increases the risk for dementia, for other non-cognitive morbidity, for dependency, and early death. To identify early predictors of late-life cognitive outcome. Cognitive function, premorbid IQ, and cardiovascular risk exposure were recorded on 1083 subjects on entry to a hypertension treatment trial in 1983-1984. We followed up this cohort 9-12 years later to assess cognitive function with the Mini-Mental State Examination (MMSE), to update exposure status, and to obtain genomic material. Multivariate analysis was used to identify independent baseline predictors of cognitive outcome 9-12 years later. We followed up 387 subjects (58.6% of survivors). After adjusting for baseline cognition, poorer cognitive outcome was found to be independently associated with a family history of dementia, increasing age, less decline in systolic blood-pressure, lower premorbid IQ (rather than limited education), and abstinence from alcohol. Reduction in systolic blood pressure (among hypertensives) and moderate alcohol intake could protect against cognitive deterioration in late life.

Correlation of auditory 'oddball' P300 with verbal memory deficits in schizophrenia.

The study attempts to recruit well known 'cognitive' event related potential measures as an objective estimate of cognitive and specific memory impairment in schizophrenia. We examined 19 schizophrenic patients and 28 healthy controls using an auditory discrimination task to elicit event related potentials, and a number of neuropsychological tests, including tests of general intellectual ability, putative frontal lobe function and verbal memory. The late positive deflection presumed to be associated with stimulus evaluation (P300) was of lower amplitude and had a longer latency in the patients compared with controls of similar age and sex. We found correlations between P300 amplitude and latency, and neuropsychological performance scores in patients. There were correlations between decreased P300 amplitude and lower IQ and poorer memory performance, in particular, abnormal semantic clustering, discriminability and intrusion errors. Increased P300 latency was correlated with lower pre-morbid IQ, poorer total memory scores and serial clustering, but paradoxically less relative retrieval deficit and fewer intrusion errors. These findings suggest that abnormal P300 is generally more likely to occur in patients with memory impairment.