Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-20T03:11:35.477Z Has data issue: false hasContentIssue false
  • English
  • Français

Neurocognitive prediction of illness knowledge after psychoeducation in schizophrenia: results from the Munich COGPIP study

Published online by Cambridge University Press:  19 May 2010

T. Jahn ,
G. Pitschel-Walz ,
A. Gsottschneider ,
T. Froböse ,
S. Kraemer  and
J. Bäuml
T. Jahn*
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
G. Pitschel-Walz
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
A. Gsottschneider
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
T. Froböse
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
S. Kraemer
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
J. Bäuml
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
*
*Address for correspondence: Professor T. Jahn, Clinical and Experimental Neuropsychology, Department of Psychiatry and Psychotherapy, Technische Universität München, Ismaninger Straße 22, D-81675 Munich, Germany. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Many patients with schizophrenia exhibit neurocognitive impairments, namely, in attentional, mnestic and executive functions. While these deficits limit psychosocial rehabilitation, their effect on psychoeducation is unknown. Within the framework of the longitudinal Munich Cognitive Determinants of Psychoeducation and Information in Schizophrenic Psychoses (COGPIP) study, we examined: (a) whether illness knowledge after psychoeducation could be predicted more precisely from the neurocognitive than from the psychopathological status of the patients; (b) which neurocognitive domains are best predictors.

Method

A total of 116 in-patients with schizophrenic or schizoaffective disorders were randomized to a neurocognitive training or control condition (2 weeks) followed by a manualized psychoeducational group programme (4 weeks) and then observed over a 9-month follow-up. Repeated measurements included – among others – the Positive and Negative Syndrome Scale and a comprehensive neuropsychological test battery from which normative T scores were used to calculate one global and five domain-specific neurocognitive composite scores. Illness knowledge was measured by a questionnaire (WFB-52) tailored to the psychoeducational programme.

Results

Multiple linear regression analyses showed that, apart from baseline illness knowledge, neurocognition significantly predicted knowledge outcome as well as knowledge gain (measured by reliable change indices) after psychoeducation. This was not true for psychopathology. Among the domain-specific neurocognitive composite scores, only memory acquisition was a significant predictor of knowledge outcome and gain.

Conclusions

Neurocognition, not psychopathology, is a significant predictor of illness knowledge after psychoeducation in schizophrenia. This finding should guide efforts to tailor psychoeducational interventions more closely to the patient's needs and resources.

Keywords

Illness knowledgeneurocognitionpsychoeducationschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 3 , March 2011 , pp. 533 - 544
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, AJ, Griss, ME, Folley, BS, Hawkins, KA, Pearlson, GD (2009). Endophenotypes in schizophrenia: a selective review. Schizophrenia Research 109, 24–37.CrossRefGoogle ScholarPubMed
APA (2004). Practice Guideline for the Treatment of Patients with Schizophrenia. American Psychiatric Association: Washington, DC.Google Scholar
Barbato, A, d'Avanzo, B (2000). Family interventions in schizophrenia and related disorders: a critical review of clinical trials. Acta Psychiatrica Scandinavica 102, 81–97.CrossRefGoogle ScholarPubMed
Barch, DM (2005). The cognitive neuroscience of schizophrenia. Annual Review of Clinical Psychology 1, 321–353.CrossRefGoogle ScholarPubMed
Bäuml, J, Froböse, T, Kraemer, S, Rentrop, M, Pitschel-Walz, G (2006). Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families. Schizophrenia Bulletin 32, S1–S9.CrossRefGoogle ScholarPubMed
Bäuml, J, Pitschel-Walz, G (2008). Psychoedukation bei schizophrenen Erkrankungen. Konsensuspapier der Arbeitsgruppe ‘Psychoedukation bei schizophrenen Erkrankungen’. Schattauer: Stuttgart.Google Scholar
Bäuml, J, Pitschel-Walz, G, Berger, H, Gunia, H, Heinz, A, Juckel, G (2005). Arbeitsbuch PsychoEdukation bei Schizophrenie (APES). Schattauer: Stuttgart.Google Scholar
Bäuml, J, Pitschel-Walz, G, Volz, A, Engel, RR, Kissling, W (2007). Psychoeducation in schizophrenia: 7-year follow-up concerning rehospitalization and days in hospital in the Munich Psychosis Information Project Study. Journal of Clinical Psychiatry 68, 854–861.CrossRefGoogle ScholarPubMed
Bäumler, G (1985). Farbe-Wort-Interferenztest (FWIT) nach J. R. Stroop. Hogrefe: Göttingen.Google Scholar
Brekke, JS, Hoe, M, Long, J, Green, MF (2007). How neurocognition and social cognition influence functional change during community-based psychosocial rehabilitation for individuals with schizophrenia. Schizophrenia Bulletin 33, 1247–1256.CrossRefGoogle ScholarPubMed
Collins, AA, Remington, GJ, Coulter, K, Birkett, K (1997). Insight, neurocognitive function and symptom clusters in chronic schizophrenia. Schizophrenia Research 27, 37–44.CrossRefGoogle ScholarPubMed
de Zubicaray, G, Ashton, R (1996). Nelson's (1976) Modified Card Sorting Test: a review. Clinical Neuropsychologist 10, 245–254.CrossRefGoogle Scholar
DGPPN (2006). S-3 Praxisleitlinien in Psychiatrie und Psychotherapie. Band 1: Behandlungsleitlinie Schizophrenie. Steinkopff: Darmstadt.Google Scholar
Dickinson, D, Ragland, JD, Calkins, ME, Gold, JM, Gur, RC (2006). A comparison of cognitive structure in schizophrenia patients and healthy controls using confirmatory factor analysis. Schizophrenia Research 85, 20–29.CrossRefGoogle ScholarPubMed
Dickinson, D, Ramsey, ME, Gold, JM (2007). Overlooking the obvious. A meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry 64, 532–542.CrossRefGoogle ScholarPubMed
Engel, RR (2007). KTN – Konsolidierte Testnormen Neuropsychologie: Trail-Making-Tests (http://psytest.psy.med.uni-muenchen.de/dokuwiki/doku.php?id_tests:trail_making-tests). Accessed 5 September 2007.Google Scholar
Fioravanti, M, Carlone, O, Vitale, B, Cinti, ME, Clare, L (2005). A meta-analysis of cognitive deficits in adults with a diagnosis of schizophrenia. Neuropsychology Review 15, 73–95.CrossRefGoogle ScholarPubMed
Genderson, MR, Dickinson, D, Diaz-Asper, CM, Egan, MF, Weinberger, DR, Goldberg, TE (2007). Factor analysis of neurocognitive tests in a large sample of schizophrenic probands, their siblings, and healthy controls. Schizophrenia Research 94, 231–239.CrossRefGoogle Scholar
Getachew, H, Dimic, S, Priebe, S (2009). Is psychoeducation routinely provided in the UK? Survey of community mental health teams. Psychiatric Bulletin 33, 102–103.CrossRefGoogle Scholar
Gladsjo, JA, McAdams, LA, Palmer, BW, Moore, DJ, Jeste, DV, Heaton, RK (2004). A six-factor model of cognition in schizophrenia and related psychotic disorders: relationships with clinical symptoms and functional capacity. Schizophrenia Bulletin 30, 739–754.CrossRefGoogle ScholarPubMed
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119–136.CrossRefGoogle ScholarPubMed
Gur, RE, Calkins, ME, Gur, RC, Horan, WP, Nuechterlein, KH, Seidman, LJ, Stone, WS (2007). The consortium on the genetics of schizophrenia: neurocognitive endophenotypes. Schizophrenia Bulletin 33, 49–68.CrossRefGoogle Scholar
Hafkenscheid, A (2000). Psychometric measures of individual change: An empirical comparison with the Brief Psychiatric Rating Scale (BPRS). Acta Psychiatrica Scandinavica 10, 235–242.CrossRefGoogle Scholar
Haro, JM, Kamath, SA, Ochoa, S, Novick, D, Rele, K, Fargas, A, Rodriguez, MJ, Rele, R, Orta, J, Kharbeng, A, Araya, S, Gervin, M, Alonso, J, Mavreas, V, Lavrentzou, E, Liontos, N, Gregor, K, Jones, PB, SOHO Study Group (2003). The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatrica Scandinavica Supplement 416, 16–23.CrossRefGoogle Scholar
Härting, C, Markowitsch, HJ, Neufeld, H, Calabrese, P, Deisinger, K, Kessler, J (2000). WMS-R. Wechsler Gedächtnistest – Revidierte Fassung. Huber: Bern.Google Scholar
Heaton, RK, Miller, SW, Taylor, MJ, Grant, I (2004). Revised Comprehensive Norms for an Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African, American, and Caucasian Adults. Professional Manual. Psychological Assessment Resources: Lutz/FL.Google Scholar
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445.CrossRefGoogle ScholarPubMed
Hoff, AL, Svetina, C, Shields, G, Stewart, J, deLisi, LE (2005). Ten year longitudinal study of neuropsychological functioning subsequent to a first episode of schizophrenia. Schizophrenia Research 78, 27–34.CrossRefGoogle ScholarPubMed
Jacobson, NS, Truax, P (1992). Clinical significance: a statistical appraoch to defining meaningful change in psychotherapy research. In Methodological Issues and Strategies in Clinical Research (ed. Kazdin, A. E.), pp. 631–648. American Psychological Association: Washington.CrossRefGoogle Scholar
Joyce, EM, Roiser, JP (2007). Cognitive heterogeneity in schizophrenia. Current Opinion in Psychiatry 20, 268–272.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, K, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Keefe, RSE, Bilder, RM, Harvey, PD, Davis, SM, Palmer, BW, Gold, JM, Meltzer, HY, Green, MF, Miller, DD, Canive, JM, Adler, LW, Manschreck, TC, Swartz, M, Rosenheck, R, Perkins, DO, Walker, TM, Stroup, TS, McEvoy, JP, Lieberman, JA (2006). Baseline neurocognitive deficits in the CATIE schizophrenia trail. Neuropsychopharmacology 31, 2033–2046.CrossRefGoogle Scholar
Kern, RS, Nuechterlein, KH, Green, MF, Baade, LE, Fenton, WS, Gold, JM, Keefe, RSE, Mesholam-Gately, R, Mintz, J, Seidman, LJ, Stover, E, Marder, SR (2008). The MATRICS Consensus Cognitive Battery, part 2: co-norming and standardization. American Journal of Psychiatry 165, 214–220.CrossRefGoogle ScholarPubMed
Krabbendam, L, Aleman, A (2003). Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology 169, 376–382.CrossRefGoogle ScholarPubMed
Leucht, S, Kane, JM, Kissling, W, Hamann, J, Etschel, E, Engel, RR (2005). What does the PANSS mean? Schizophrenia Research 79, 231–238.CrossRefGoogle ScholarPubMed
Lincoln, TM, Wilhelm, K, Nestoriuc, Y (2007). Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in psychotic disorders: a meta-analysis. Schizophrenia Research 96, 232–245.CrossRefGoogle ScholarPubMed
Lineweaver, TT, Bondi, MW, Thomas, RG, Salmon, DP (1999). A normative study of Nelson's (1976) modified version of the Wisconsin Card Sorting Test in healthy older adults. Clinical Neuropsychologist 13, 328–347.CrossRefGoogle ScholarPubMed
MacCabe, JH, Aldouri, E, Fahy, TA, Sham, PC, Murray, RM (2002). Do schizophrenic patients who managed to get to university have a non-developmental form of illness? Psychological Medicine 32, 535–544.CrossRefGoogle ScholarPubMed
McGurk, SR, Mueser, KT (2006). Strategies for coping with cognitive impairments of clients in supported employment. Psychiatric Services 57, 1421–1429.CrossRefGoogle ScholarPubMed
McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry 164, 1791–1802.CrossRefGoogle ScholarPubMed
Marker, K (2003). Handbuch zum Programmpaket COGPACK, Version 5.9. Marker Software: Ladenburg.Google Scholar
Nelson, HE (1976). A modified card sorting test sensitive to frontal lobe defects. Cortex 12, 313–324.CrossRefGoogle ScholarPubMed
Niemann, H, Sturm, W, Thöne-Otto, AIT, Willmes, K (2008). California Verbal Learning Test (CVLT) – Deutsche Adaptation. Pearson Assessment & Information: Frankfurt.Google Scholar
Nuechterlein, KH, Barch, DM, Gold, JM, Goldberg, TE, Green, MF, Heaton, RK (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research 72, 29–39.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Green, MF, Kern, RS, Baade, LE, Barch, DM, Cohen, JD, Essock, S, Fenton, WS, Frese, FJ, Gold, JM, Goldberg, T, Heaton, RK, Keefe, RSE, Kraemer, H, Mesholam-Gately, R, Seidman, LJ, Stover, E, Weinberger, DR, Young, AS, Zalcman, S, Marder, SR (2008). The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity. American Journal of Psychiatry 165, 203–213.CrossRefGoogle ScholarPubMed
Pekkala, E, Merinder, L (2002). Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews. Published online: 22 April 2002. doi:10.1002/14651858.CD002831.CrossRefGoogle ScholarPubMed
Pitschel-Walz, G (1997). Die Einbeziehung der Angehörigen in die Behandlung schizophrener Patienten und ihr Einfluß auf den Krankheitsverlauf. Peter Lang: Frankfurt.Google Scholar
Pitschel-Walz, G, Bäuml, J, Bender, W, Engel, RR, Wagner, M, Kissling, W (2006). Psychoeducation and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study. Journal of Clinical Psychiatry 67, 443–452.CrossRefGoogle ScholarPubMed
Pitschel-Walz, G, Leucht, S, Bäuml, J, Kissling, W, Engel, RR (2001). The effect of family interventions on relapse and rehospitalization in schizophrenia – a meta-analysis. Schizophrenia Bulletin 27, 73–92.CrossRefGoogle ScholarPubMed
Priebe, S, McCabe, R (2008). Therapeutic relationships in psychiatry: the basis of therapy or therapy in itself? International Review of Psychiatry 20, 521–526.CrossRefGoogle ScholarPubMed
Roder, V, Mueller, DR, Mueser, KT, Brenner, HD (2006). Integrated Psychological Therapy (IPT) for schizophrenia: is it effective? Schizophrenia Bulletin 32, S81–S93.CrossRefGoogle ScholarPubMed
Rummel-Kluge, C, Kissling, W (2008). Psychoeducation for patients with schizophrenia and their families. Expert Review of Neurotherapeutics 8, 1067–1077.CrossRefGoogle ScholarPubMed
Rummel-Kluge, C, Pitschel-Walz, G, Bäuml, J, Kissling, W (2006). Psychoeducation in schizophrenia – results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophrenia Bulletin 32, 765–775.CrossRefGoogle Scholar
Schuhfried, G (2005). Wiener Testsystem. Computergestützte psychologische Diagnostik (version 6.32.020). Schuhfried GmbH: Mödlingen/Österreich.Google Scholar
Shad, MU, Tamminga, CA, Cullum, M, Haas, GL, Keshavan, MS (2006). Insight and frontal cortical function in schizophrenia: a review. Schizophrenia Research 86, 54–70.CrossRefGoogle ScholarPubMed
Simon, V, de Hert, M, Wampers, M, Peuskens, J, van Winkel, R (2009). The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia. European Psychiatry 24, 239–243.CrossRefGoogle ScholarPubMed
Snitz, BE, MacDonald, AW, Carter, CS (2006). Cognitive deficits in unaffected first-degree relatives of schizophrenia patients: a meta-analytic review of putative endophenotypes. Schizophrenia Bulletin 32, 179–194.CrossRefGoogle ScholarPubMed
Streiner, DL (1994). Regression in the service of the superego: the do's and don'ts of stepwise multiple regression. Canadian Journal of Psychiatry 39, 191–196.CrossRefGoogle ScholarPubMed
Tarrier, N, Barrowclough, C, Porceddu, K, Fitzpatrick, E (1994). The Salford Family Intervention Project: relapse rates of schizophrenia at five and eight years. British Journal of Psychiatry 165, 829–832.CrossRefGoogle ScholarPubMed
Townsend, LA, Norman, RM (2004). Course of cognitive functioning in first episode schizophrenia spectrum disorders. Expert Review of Neurotherapeutics 4, 61–68.CrossRefGoogle ScholarPubMed
Zakzanis, KK, Leach, L, Kaplan, E (1999). Neuropsychological Differential Diagnosis. Swets & Zeitlinger: Lisse, NL.Google Scholar
Zimmermann, P, Fimm, B (2002). Testbatterie zur Aufmerksamkeitsprüfung (TAP). Version 1.7c. Psychologische Testsysteme: Herzogenrath.Google Scholar