Subjective Scale To Investigate Cognition In Schizophrenia Research Articles

Cognitive complaints in schizophrenia:relationship with clinical symptoms, stigma and insight

IntroductionIn addition to the classic clinical symptoms, patients with schizophrenia suffer from cognitive difficulties, self-stigma and poor insight.ObjectivesThis study aims to evaluate the impact of stigma, symptom severity, and insight on subjective cognitive complaints in patients with schizophrenia.MethodsThis is a cross-sectional, descriptive and analytical study carried out on 72 stabilized patients followed at the post-cure psychiatry consultation ‘A’ at the CHU Hédi Chaker in Sfax diagnosed with schizophrenia according to the DSM 5 criteria.We used the schedule for the Assessment of Insight–Expanded Version(SAI-E) to assess clinical insight, The Internalized Stigma of Mental Illness (ISMI) scale for the assessment of internalized stigma, the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) scale to determine subjective cognitive complaints and the Positive and Negtive Syndroms Scale (PANSS) to assess positive and negatives symptoms.ResultsThe average age of the patients was 46.83 ± 11.6 years, with a sex ratio (M/F) of 2. In our study, 48.5% of the patients were single, 52.8years,% were smokers and 23 6% consumed alcohol. The level of education did not exceed the primary level for 44.4% of the patients. The average age of disease onset was 24.56 ± 5, 82. Our participants had an average score of 25 on the SSTICS total score and 20.1 on the SAI-E. The median ISMI total score and PANSS total score were 2.45 and 46respectivelyThe predominant negative symptoms(p=0.003), stigma(p=0.009), and insight (p<10-3)were significant factors associated with increased cognitive complaints.ConclusionsIn schizophrenia, the combination of cognitive difficulties, self-stigma with a low insight makes the management of these patients more difficult.Disclosure of InterestNone Declared

Validation of Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) in Tamil and its Relationship with Objective Cognition and Psychopathology

Validation of Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) in Tamil and its Relationship with Objective Cognition and Psychopathology

Subjective cognitive complaints in first episode psychosis: A focused follow-up on sex effect and alcohol usage

A network of early psychosis-specific intervention programs at the University of Montreal in Montreal, Quebec, Canada, conducted a longitudinal naturalistic five-year study at two Urban Early Intervention Services (EIS). In this study, 198 patients were recruited based on inclusion/exclusion criteria and agreed to participate. Our objectives were to assess the subjective cognition complaints of schizophrenic patients assessed by Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) in their first-episode psychosis (FEP) in relation to their general characteristics. We also wanted to assess whether there are sex-based differences in the subjective cognitive complaints, as well as differences in cognitive complaints among patients who use alcohol in comparison to those who are abstainers. Additionally, we wanted to monitor the changes in the subjective complaints progress for a period of five years follow-up. Our findings showed that although women expressed more cognitive complaints than men [mean (SD) SSTICS, 28.2 (13.7) for women and 24.7 (13.2) for men], this difference was not statistically significant (r = −0.190, 95 % CI, −0. 435 to 0. 097). We also found that abstainers complained more about their cognition than alcohol consumers [mean (SD) SSTICS, 27.9 (13.4) for abstainers and 23.7 (12.9) for consumers], a difference which was statistically significant (r = −0.166, 95 % CI, −0. 307 to −0.014). Our findings showed a drop in the average score of SSTICS through study follow-up time among FEP patients. In conclusion, we suggest that if we want to set up a good cognitive remediation program, it is useful to start with the patients' demands. This demand can follow the patients' complaints. Further investigations are needed in order to propose different approaches between alcohol users and abstinent patients concerning responding to their cognitive complaints.

A Randomized Control Trial of Cognitive Compensatory Training (CCT) and Computerized Interactive Remediation of Cognition-Training for Schizophrenia (CIRCuiTS).

BackgroundVarious modes of delivering cognitive remediation (CR) are effective, but there have been few head-to-head trials of different approaches. This trial aimed to evaluate the relative effectiveness of two different programmes, Cognitive Compensatory Training (CCT) and Computerized Interactive Remediation of Cognition—Training for Schizophrenia (CIRCuiTs).MethodsThe study used a single-blind randomized, controlled trial to examine the efficacy and effectiveness of the two therapies. The study aimed to enroll 100 clinically stable patients between the ages of 18 and 65 years who had been diagnosed with a schizophrenia spectrum disorder. Participants were randomized to either the CCT or CIRCuiTs therapy groups. The primary outcome measures were neurocognition using the Brief Assessment of Cognition Scale (BACS) and the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS). The secondary measure was functional outcomes using the Social Functioning Scale (SFS).ResultsThere was no group difference in any of the outcome measures post-intervention or at follow-up. Both groups had a small improvement on their SSTICS scores between baseline (M = 30.52 and SD = 14.61) and post-intervention (M = 23.96 and SD = 10.92). Verbal memory scores as measured by list learning improved for both groups between baseline (z = −1.62) and 3-month follow-up (z = −1.03). Both groups improved on the token motor task between baseline (z = −1.38) and post-intervention (z = −0.69). Both groups had a decline in Symbol Coding scores between baseline (z = 0.05) and 3-month follow-up (z = −0.82).DiscussionThis underpowered study found no difference in effect between the two approaches studied. If future studies confirm this finding, then it has implications for services where cost and lack of computer technology could pose a barrier in addressing the cognitive domain of schizophrenia spectrum disorders. The final sample size compromised the power of the study to conclusively determine a significant effect.

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Background-Cognitive deficits are known to be one of the core features of schizophrenia. Study shows that cognitive impairment was present in up to 75% of patients with schizophrenia. Deficits have been noted in attention/vigilance, processing speed, working memory, verbal learning and memory, visual learning and memory, problem solving and verbal comprehension.Aim-To study neurocognitive status and disability status between first episode and multiple episode schizophrenia patients.Methodology- 120 patients diagnosed with Schizophrenia were included after due consent and divided into two groups (first episode and multiple episode). Neurocognitive status was assessed by Addenbrooke’s cognitive examination III (ACE-III) and Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS). Disability status was assessed using Indian Disability and Assessment Scale (IDEAS). Statistical analysis was done using MS Excel and SPSS software V. 20. Pearson’s correlation and Mann Whitney U test was used for analysis. P value < 0.05 was considered significant.Result-It was found that memory score was significantly impaired in multiple episode patients as compared to first episode patients (U=300.5, p = 0.03) in (ACE-III). (SSTICS) score was better in first episode as compared to multiple episode which was statistically significant (U=979.5, p<0.01). The IDEAS score was significantly more in patients with first episode as compared to multiple episode (U=985.0, p <0.01).Conclusions –It is concluded that greater neuro-cognitive impairment reported in patients with multiple episodes compared with first-episode patients. Hence, Exercises targeting all domains of neurocognition and insight building to be practiced regularly especially in chronic patients.

A prospective multicenter assessor-blinded randomized controlled study to compare the efficacy of short versus long protocols of electroconvulsive therapy as an augmentation strategy to clozapine in patients with ultra-resistant schizophrenia (SURECT study)

BackgroundAlthough clozapine is the most effective antipsychotic drug for treatment-resistant schizophrenia, it leads to a poor or partial response in 40 to 70% of patients. Augmentation of clozapine with electroconvulsive therapy (ECT) is a highly effective and relatively safe treatment for these clozapine-resistant patients. However, parameters are not yet well specified, such as the optimal number of sessions, their frequency, and the relevance of maintenance ECT. Our objective is to compare the efficacy and tolerance between two protocols of combined ECT and clozapine treatment in patients with ultra-resistant schizophrenia (URS): a 6-month protocol (short protocol with 20 ECT sessions) and a 12-month protocol (long protocol with 40 ECT sessions).MethodsSixty-four patients with schizophrenia with persistent psychotic symptoms despite clozapine treatment will be enrolled in a prospective multicentric assessor-blinded randomized controlled trial. Patients will be randomly assigned to the short or the long protocol. The main outcome is the response rate assessed by the Positive and Negative Symptoms Scale (PANSS) 3 months after the end of the treatment in patients following the long protocol compared to those following the short protocol. The response was defined as a 30% reduction on the PANSS baseline. Clinical assessments (PANSS, BPRS, HAMD-21, YMRS, CGI, GAF, Modified Overt Aggression Scale (MOAS), and Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS)) and plasma clozapine concentration will be performed at baseline and at 2, 4, 6, 9, 12, and 15 months. Neuropsychological measures (MMSE, RL/RI-16, Doors test, D2 Test of Attention, Copy of the Rey-Osterrieth complex figure) will be performed at baseline and at 6 and 15 months.DiscussionThe aims of this research are to optimize protocols of combined ECT with clozapine in patients with URS and to offer specific recommendations for these patients’ care.Trial registrationClinicalTrials.gov NCT03542903. Registered on May 31, 2018. Id RCB: 2017-A02657-46

Investigating subjective cognitive complaints in psychosis: Introducing the brief scale to Investigate cognition in schizophrenia (SSTICS-Brief)

ABSTRACTBackground: Cognitive difficulties are a core deficit for people with schizophrenia and are generally assessed with neuropsychological tests. Self-report assessments are also useful in understanding difficulties from the service user’s perspective. This study aims to introduce and test the shorter version of the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) to improve its acceptability and comprehensibility.Methods: In consultation with service users and clinicians, we identified items from the original 21-item SSTICS that were found difficult and these were excluded. The reduced scale was explored with Confirmatory Factor Analysis (CFA) in two independent samples in the UK and Canada. Convergent validity with symptoms and IQ was assessed and compared between the original and the reduced scale.Results: Six-hundred and seven people with schizophrenia and first-episode psychosis took part in this study. Seven items were removed to produce the SSTICS-Brief. This had good reliability and the CFA confirmed a unidimensional structure. Convergent validity with symptoms and IQ were optimal between the long and short versions.Conclusions: The SSTICS-B has better acceptability than its longer form and could be administered in less time. The resulting measure is likely to be a valuable short self-assessment of cognitive complaints for people with schizophrenia.

Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS): a validation study in Italian population.

Although cognitive deficit in persons with schizophrenia is well documented, the assessment of the patient's perception of its own cognitive functioning is a relevant issue not adequately studied. Several evaluation tools have been elaborated, however none has been validated in Italian. The aim of the study is the validation of the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a rating scale designed to measure subjective cognitive deficits complaints in persons with schizophrenia. < span class="text116">Method. 146 persons meeting the DSM-5 diagnostic criteria for schizophrenia have been recruited. The SSTICS was translated in Italian in accordance with international standard methods. Subjects were also evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Subjective Well-being under Neuroleptic scale (SWN). Cronbach's alpha coefficient was used to assess internal consistency. Constructs were examined using exploratory factor analysis (principal component with varimax rotation). The factorial model was then tested via confirmatory factor analysis. The factorial analysis revealed a 4-factor structure, which is more parsimonious than those obtained in previous studies. Correlations between STICSS and the other rating scales were significant for several domains. The Italian version of the SSTICS showed good psychometric properties and is suitable to measure the patients' subjective perception of cognitive impairment. Subjective evaluation can integrate objective measures of cognitive performances, supporting a multidimensional model of functional impairment in schizophrenia.

Could the severity of symptoms of schizophrenia affect ability of self-appraisal of cognitive deficits in patients with schizophrenia? Lack of insight as a mediator between the two domains.

The relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly affects both factors. Our aim is to further asses the relationship between subjective perception of cognitive deficits, symptom severity and lack of insight as a mediator variable. 109 subjects with schizophrenia were evaluated. Positive and Negative Syndrome Scale (PANSS) was modelled as independent variable, Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) as dependent and "Lack of Insight" (LoI) PANSS Item as mediator one. Mediation was assessed using bootstrap estimation approach. LoI acts as a suppressor variable (i.e., it enhances the relation between the independent and dependent variable) between Negative Symptoms and SSTICS, while showing a mediation effect between Depressive symptoms and SSTICS. LoI has a central role in mediating the relationship between negative and depressed symptoms on the one hand and self-appraisals of cognitive deficits (SACD) assessed with SSTICS on the other. Its suppressor role between negative symptoms and STICSS favour a direct effect of negative symptoms on SACD. On the other hand, its mediator role between depression and SSTICS is consistent with several reports of the 'insight paradox' of an enhanced severity of depression in patients with higher awareness of their disability.

Lack of insight as a third variable between subjective appraisal of cognitive impairment and psychotic symptoms

BackgroundThe relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly impacts on both factors. Our aim is to further asses the relationship between the subjective perception of cognitive deficits, symptom severity and lack of Insight as a mediator variable.MethodsA total of 109 subject diagnosed with schizophrenia. Positive and Negative Syndrome Scale (PANSS) was modelled as dependent variable; Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) was modeled as independent variable and “Lack of Insight” (LoI) PANSS Item was tested as a mediator variable. Mediation was assessed using the Sobel Mediation Test.ResultsLoI acts as a suppressor variable (i.e. it enhances the relation between the independent and dependent variable) between SSTICS and negative symptoms, while showing a mediator effect between SSTICS and depressive symptoms.DiscussionLoI has a central role in mediating the relationship between subjective appraisal of cognitive deficits on the one hand and positive and depressed symptoms on the other. Its suppressor role between SSTICS and depression is consistent with several reports of an enhanced risk of depression in patients fully aware of their disability. Its mediator role between STICSS and positive symptoms supports the centrality of LoI as a metacognitive function whose failure may worsen psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

L’insight neurocognitif dans la schizophrénie

ObjectivesGiven the extent, magnitude and functional significance of the neurocognitive deficits of schizophrenia, growing attention has been paid recently to patients’ self-awareness of their own deficits. Thus far, the literature has shown either that patients fail to recognize their cognitive deficits or that the association between subjective and objective cognition is weak in schizophrenia. The reasons for this lack of consistency remain unexplained but may have to do, among others, with the influence of potential confounding clinical variables and the choice of the scale used to measure self-awareness of cognitive deficits. In the current study, we sought to examine the relationships between subjective and objective cognitive performance in schizophrenia, while controlling for the influence of sociodemographic and psychiatric variables. MethodsEighty-two patients with a schizophrenia-spectrum disorder (DSM-IV criteria) were recruited. Patients’ subjective cognitive complaints were evaluated with the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), the most frequently used scale to measure self-awareness of cognitive deficits in schizophrenia. Neurocognition was evaluated with working memory, planning and visual learning tasks taken from Cambridge Neuropsychological Tests Automated Battery. The Stroop Color-Word test was also administered. Psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia. The relationships between subjective and objective cognition were evaluated with multivariate hierarchic linear regression analyses, taking into consideration potential confounders such as sociodemographic and psychiatric variables. Finally, a factor analysis of the SSTICS was performed. ResultsFor the SSTICS total score, the regression analysis produced a model including two predictors, namely visual learning and Stoop interference performance, explaining a moderate portion of the variance. Visual learning performance was the most consistent predictor of most SSTICS subscores (e.g. episodic memory, attention, executive functioning, language and praxis). Modest associations were found between the PANSS cognitive factor and objective cognition (e.g. Stroop interference, visual learning, and working memory). Finally, the factor analysis revealed a 6-factor solution that echoes the classification of the items of the SSTICS based on the neuropsychological literature. ConclusionsUsing a scale having good internal validity, as shown by the factor analysis, the current study highlighted modest associations between subjective and objective cognitive performance, which suggests that schizophrenia patients are only partially aware of their own cognitive deficits. The results also showed a lack of correspondence between the impaired cognitive domain and the domain of cognitive awareness. It should be noted that clinicians were not better than patients at evaluating their cognitive deficits. Future research will need to determine if the observations reported here are schizophrenia-specific or not.

La conscience des déficits neurocognitifs dans la schizophrénie : une méta-analyse

Background Schizophrenia is well-known to be associated with a lack of insight into symptoms. Comparatively, little is known on insight into neurocognitive deficits in schizophrenia, despite the fact that these dysfunctions are undoubtedly core features of the disorder. Recently, growing interest has been paid to subjective cognition, and thus far, results have been heterogeneous. The objectives of current meta-analysis were to determine the magnitude of subjective complaints in schizophrenia; to examine the association between subjective cognitive complaints and objective cognition, as well psychiatric symptoms and insight into illness. The meta-analysis also sought to determine if results are influenced by the choice of the scale used to measure subjective cognition. Methods A search was performed with PubMed, PsycInfo and EMBASE, using the following key words: schizophrenia OR psychosis AND cognition OR memory OR attention OR "executive functions" AND insight OR "subjective cognition" OR awareness. Studies involving patients with schizophrenia-spectrum disorders and measuring subjective cognition with a validated self-report scale were included. Studies using scales measuring insight into thinking processes (e.g. Beck Cognitive Insight Scale) were excluded. Statistical analyses were performed with the Comprehensive Meta-Analysis-2 software. Cognitive scores were grouped into 6 cognitive domains (as recommended by the MATRICS group): attention, problems solving, speed of processing, verbal memory, visual memory and working memory. The difference in cognitive complaints between schizophrenia patients and healthy controls was examined using Cohen's d. The associations between subjective cognition and objective cognition, psychiatric symptoms and insight into illness were examined using Pearson's correlation coefficients. Results Twenty-two studies were retrieved, including a total of 1609 patients and 294 controls. Patients reported increased subjective cognitive complaints, compared to controls (moderate effect size). A weak association was observed between subjective and objective (global) cognition. The association was larger in studies using the Subjective Scale To Investigate Cognition in Schizophrenia (SSTICS), compared to studies using other scales. The largest association was observed between subjective complaints and problem solving. The association between subjective complaints and depressive symptoms was in the same range as the association between subjective complaints (measured with the SSTICS) and objective cognition. No association was found between subjective complaints and positive / negative symptoms. Finally, a weak association was found between subjective complaints and insight into illness. Discussion Taken together, these results suggest that schizophrenia patients report significant subjective cognitive complaints. However, patients have a poor understanding of these deficits, since subjective complaints are as strongly associated with depressive symptoms as they are associated with objective cognitive deficits. Schizophrenia patients may be more aware of their problem solving deficits. However, this observation is based on a limited number of studies and will need to be replicated in future studies. Our results also show that insight into neurocognitive deficits is largely independent from insight into illness. Finally, the results of the current meta-analysis may have methodological implications, since they suggest that the SSTICS produces stronger associations between subjective and objective cognition than other scales. In the future, greater attention will need to be paid to the domains of subjective complaints, as well as to subjective cognitive complaints in other psychiatric disorders.

Subjective Cognitive Complaints in Schizophrenia: Relation to Antipsychotic Medication Dose, Actual Cognitive Performance, Insight and Symptoms

BackgroundSubjective cognitive complaints are prevalent in those affected by functional psychoses and a variety of possible associated factors have been investigated. However, few studies have examined these potential factors within single studies or analyses.MethodsPatients with a history of a schizophrenia spectrum disorder (n = 115) and a non-clinical comparison group (n = 45) completed the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) and the Brief Assessment of Cognition in Schizophrenia (BACS). The patient group also completed the Positive and Negative Syndromes Scale (PANSS), the Birchwood Insight Scale (IS), and the Hospital Anxiety and Depression Scale (HADS).ResultsThe BACS and SSTICS scores were associated in the non-clinical comparison group, but not in the patient group. In the patient group worse subjective cognition was associated positively with good insight, greater dysphoria and greater positive symptoms. Linear regression revealed that, once other variables had been accounted for, dysphoria (HADS anxiety and depression factor) was the only significant predictor of SSTICS scores.ConclusionsSubjective cognitive impairment in patients with psychosis in the absence of formal testing should not be taken as evidence of impaired cognitive functioning. Mood should be investigated when patients present with subjective cognitive complaints.

Caractéristiques et impact des déficits métacognitifs dans la schizophrénie. Revue de la littérature

The aim of this review of the literature is to summarise the definitions of metacognition, the measurement tools, the results of studies investigating metacognition in persons with schizophrenia and the therapeutic perspectives. This review is based upon a selection of articles identified using a PubMed search containing the terms "schizophrenia" and "metacognition". Cognitive deficits are present in 75 to 85% of persons with schizophrenia. According to the disability model of the World Health Organization, these cognitive deficits have an impact on social functioning, community integration and quality of life. However, heterogeneous results have been obtained by studies exploring the functional impact of cognitive deficits, suggesting that there is no direct relationship between these two characteristics. One possible explanation is that subjective factors, notably metacognition, may play an intermediate role moderating the link between cognitive deficits and functional impairment. Metacognition is defined as the evaluation and regulation of its own cognitive processes. The evaluation (or monitoring) monitors the accuracy and reliability of the cognitive task performance. Regulation (or control) promotes behavioural adjustment. Studies carried out in persons with schizophrenia show that most of them experience deficits in metacognitive performance. These metacognitive deficits are thought to be a key barrier to functioning in schizophrenia. Measurement tools are classified into two types: "independent" measurement of the cognitive task and "on line" measurements performed during the cognitive task. The subjective scale to investigate cognition in schizophrenia (SSTIC) and the metacognitive assessment scale (MAS) are two examples of questionnaires measuring metacognition independently of the cognitive task. Online measurements assess the metacognitive "monitoring" by asking the subject to evaluate between 0 and 100% of his/her degree of confidence in his/her response to a question. The metacognitive "control" is assessed by asking the subject to validate his/her answer. Convergent findings are reported by studies exploring metacognitive persons in people with schizophrenia. Dissociation between metacognitive monitoring and metacognitive control has been reported. Regarding metamemory, which has been currently the most studied area, no difference is observed between persons with schizophrenia and controls with respect to the metamemory judgement. However, subgroups of persons with schizophrenia differ significantly from controls: they are over-confident in their response if it is incorrect and they estimate more frequently than the controls if they do not know when their answer is correct. The relationships between metacognitive and cognitive deficits are complex in persons with schizophrenia, with poor matching between subjective and objective deficits. Several studies have reported that metacognitive difficulties strongly interfere with social functioning. It has been suggested that metacognitive deficits more strongly predict community functioning in persons with schizophrenia than cognitive deficits. Metacognitive skills may hence be viewed as a key factor in translating cognitive performance skills in daily life. These data suggest that remediation programs specifically targeting metacognitive deficits have to be further developed.

Subjective and Objective Cognitive Dysfunction in Schizophrenia – is there a Link?

Cognitive dysfunction is a well recognized symptom of schizophrenia, as well as patients having poor insight into their illness. The subjective scale to investigate cognition in schizophrenia (SSTICS) is one of several scales that have been developed to study subjective cognitive dysfunction and has been compared to patients’ objective cognitive level. A literature search was performed using PubMed, psychINFO, Web of Science, and cross-referencing to find 26 articles which used 14 different subjective cognitive dysfunction scales to investigate the relationship between subjective and objective measures of cognition in schizophrenia. Although the majority of studies using the SSTICS found significant correlations between subjective and objective measures of cognition, the findings from the other scales were less clear. From this review, the issue of whether or not schizophrenic patients have good cognitive insight remains unsure. However, due to the heterogeneous nature of the study designs and their outcome measures, continued work in this area with consistency on these points is necessary; on the path to better provide management options for a very debilitating component of this illness.

Cognition, functioning and quality of life in schizophrenia treatment: Results of a one-year randomized controlled trial of olanzapine and quetiapine

Background Cognitive deficits are recognized as a critical determinant of functional outcomes in schizophrenia; and second generation antipsychotic drugs have been touted for their potential to enhance cognitive functioning and community tenure. Objectives The study examined the relative merits of olanzapine and quetiapine in improving cognitive deficits and enhancing psychosocial functioning in a sample of community dwelling adults previously treated with first generation antipsychotic drugs for schizophrenia. Methods In a prospective, rater-blinded study, 86 participants were randomized to receive either olanzapine or quetiapine, and assessed at baseline and after 3, 6, 9 and 12 months. Outcome measures included, besides symptoms and side effects rating scales, the subjective scale to investigate cognition in schizophrenia (SSTICS), a computer-assisted cognitive test battery (COGLAB), the sickness impact profile (SIP), the global assessment of functioning (GAF) scale, and the drug attitude inventory (DAI). Results Both olanzapine and quetiapine were equally effective in improving symptom severity and decreasing the neurological side effects. Quetiapine was significantly better tolerated ( p = 0.002), improved self-rated cognitive dysfunction ( p = 0.002) and subjects' performance on selected neurocognitive tasks ( p = 0.01). Olanzapine use was associated with greater symptom stability, fewer drop outs ( p = 0.01) and frequent metabolic aberrations ( p = 0.001). The accrued benefits of drug therapy, however, were not reflected as significant gains in daily functioning and quality of life. Conclusions Quetiapine is noted to have specific cognition enhancing properties in schizophrenia that warrants further exploration. The observed clinical and cognitive benefits associated with quetiapine may likely be attributable to its loose binding to, and fast dissociation from the dopamine receptors. Olanzapine has proved to be a reliable antipsychotic drug with a greater liability to cause metabolic abnormalities.

Rivastigmine treatment as an add‑on to antipsychotics in patients with schizophrenia and cognitive deficits

ABSTRACTObjective: Although new atypical antipsychotic agents have been found to improve overall cognitive function in patients with schizophrenia (SZ), some aspects of memory, attention and executive functions still remain impaired. Acetylcholinesterase (AChE) inhibitors, such as rivastigmine, have been shown to improve cognition in other disorders, particularly Alzheimer's disease. Dysfunctions in cholinergic systems, especially in the prefrontal cortex, have been identified in SZ, suggesting that cholinesterase inhibitors may be effective in treating cognitive deficits in this disease.Research design and methods: Using a randomized crossover design, we assessed SZ patients with stable symptoms and poor cognitive functioning. Fifty-eight patients with memory deficits, according to subjective complaints or based on clinicians’ observations, were assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS). Only 24 of these subjects met the inclusion criteria. Twenty patients took part in the study (four dropped out). All subjects meeting the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‑IV) criteria for SZ were maintained on their current antipsychotic medication (18 atypicals and two typicals) and were randomly assigned to treatment with rivastigmine. Dosage was a function of tolerability, beginning at 3 mg/day and progressively increasing to 9 mg/day. Subjects were given the Cambridge Neuropsychological Test Automated Battery (CANTAB) at baseline and 3 and 6 months.Results: The results revealed no significant improvement in any of the cognitive variables investigated following rivastigmine treatment and symptom severity scores remained unchanged over all recorded time periods.Conclusion: Rivastigmine treatment did not appear to enhance cognition in SZ patients with important cognitive impairments. This finding needs to be interpreted with care and requires substantiation with larger sample size studies with patients treated with cognitive enhancer for longer periods.

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program

Objective: To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. Method: The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. Results: Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. Conclusion: These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.

Exploring cognitive complaints in schizophrenia: the subjective scale to investigate cognition in schizophrenia.

While it has become commonplace to test the various components of memory in schizophrenia with paper-and-pencil or in-lab tasks, very little data exist on the subjective complaints of patients regarding their memory. Few instruments have been designed to collect systematically the complaints of patients with schizophrenia. We present a work in progress on the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a 21-item, Likert-type scale that is simple and easy to use. It allows a quantitative approach to the subjective and cognitive dimensions of schizophrenia. Stip constructed the scale based on a questionnaire covering several cognitive domains: memory (working memory, explicit long-term memory), attention (divided, distractibility, alertness, sustained), language, and praxia. We evaluated the psychometric properties of the SSTICS in a population of 114 French-speaking patients in Montreal. Patients were recruited in the community and assessed with the Structured Clinical Interview for DSM-III-R (SCID), the Positive and Negative Syndrome Scale (PANSS), and the Extrapyramidal Symptoms Rating Scale (ESRS). Cognition was measured using the Rey Auditory Verbal Learning Test (RAVLT) (long-term memory), Controlled Oral Word Association Test (verbal fluency), and Trails A and B. Preliminary analyses showed very good internal consistency for the global score (alpha=0.88), and alphas varying from 0.57 to 0.72 for the subscales. Stability over time was very good. The principal components analysis accounted for a multiple structure. Correlations between subjective scores and objective cognitive assessment were significant for several domains. Validation of the SSTICS needs to be completed through further exploration of the factorial structure and testing of the English version.