Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-19T04:07:09.979Z Has data issue: false hasContentIssue false

Cognitive disorders and negative symptoms as correlates of motivational deficits in psychotic patients1

Published online by Cambridge University Press:  09 July 2009

B. Schmand*
Affiliation:
Academisch Ziekenhuis Utrecht, Department of Psychiatry, Utrecht; Slotervaartziekenhuis, Amsterdam; Psychiatric Hospital Veldwijk, Ermelo; Psychiatric Hospital Rosenburg, The Hague, The Netherlands
T. Kuipers
Affiliation:
Academisch Ziekenhuis Utrecht, Department of Psychiatry, Utrecht; Slotervaartziekenhuis, Amsterdam; Psychiatric Hospital Veldwijk, Ermelo; Psychiatric Hospital Rosenburg, The Hague, The Netherlands
M. Van Der Gaag
Affiliation:
Academisch Ziekenhuis Utrecht, Department of Psychiatry, Utrecht; Slotervaartziekenhuis, Amsterdam; Psychiatric Hospital Veldwijk, Ermelo; Psychiatric Hospital Rosenburg, The Hague, The Netherlands
J. Bosveld
Affiliation:
Academisch Ziekenhuis Utrecht, Department of Psychiatry, Utrecht; Slotervaartziekenhuis, Amsterdam; Psychiatric Hospital Veldwijk, Ermelo; Psychiatric Hospital Rosenburg, The Hague, The Netherlands
F. Bulthuis
Affiliation:
Academisch Ziekenhuis Utrecht, Department of Psychiatry, Utrecht; Slotervaartziekenhuis, Amsterdam; Psychiatric Hospital Veldwijk, Ermelo; Psychiatric Hospital Rosenburg, The Hague, The Netherlands
M. Jellema
Affiliation:
Academisch Ziekenhuis Utrecht, Department of Psychiatry, Utrecht; Slotervaartziekenhuis, Amsterdam; Psychiatric Hospital Veldwijk, Ermelo; Psychiatric Hospital Rosenburg, The Hague, The Netherlands
*
2Address for correspondence: Dr Ben Schmand, Slotervaartziekenhuis, Louwesweg, 6, 1066 EC, Amsterdam, The Netherlands

Synopsis

The problem of a possible lack of motivation to perform cognitive tasks, which is often encountered in psychotic patients, has been approached from the perspective of the ‘energetics’ of cognition (Hockey et al. 1986) and from the broader clinical context of psychosis as an ‘amotivational syndrome’ and its related negative symptoms.

The presence of motivational deficits was investigated in a group of psychotic in-patients (N = 73, and 40 had schizophrenia) compared with a control group of non-psychotic psychiatric in-patients (N = 23). The motivational deficit was operationalized in terms of Sanders's (1983) cognitive–energetic model as a large effect of ‘time-on-task’ during a simple, monotonous reaction test. Significantly more psychotic patients than control patients showed evidence of this type of motivational deficit. The deficit appeared to be related with negative but not with positive symptoms of psychosis. Furthermore, the deficit was shown to be related to the cognitive disorders of psychosis, which have been amply documented in the literature, i.e. disorders of vigilance, verbal memory and distractibility. These results suggest that the cognitive disorders of psychosis are not of a ‘computational’ but of an ‘energetical’, i.e. motivational nature.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1994

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.)

Footnotes

1

This study was presented in a preliminary form at the Biennial Winter Workshop on Schizophrenia, Badgastein, Austria, in February 1990.

References

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. Revised. APA: Washington, DC.Google Scholar
Andreasen, N. C. (1981). The Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.Google Scholar
Andreasen, N. C., Flaum, M., Swayze, V. W., Tyrell, G. & Arndt, S. (1990). Positive and negative symptoms in schizophrenia: a critical reappraisal. Archives of General Psychiatry 47, 615621.CrossRefGoogle ScholarPubMed
Åsberg, M., Montgomery, S., Perris, C., Schalling, D. & Sedvall, G. (1978). A Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica, Suppl. 271,CrossRefGoogle Scholar
Benson, D. F. & Stuss, D. T. (1990). Frontal lobe influences on delusions: a clinical perspective. Schizophrenia Bulletin 16, 403411.CrossRefGoogle ScholarPubMed
Bentall, R. P. (1990). The illusion of reality: a review and integration of psychological research on hallucinations. Psychological Bulletin 107, 8295.CrossRefGoogle ScholarPubMed
Bentall, R. P., Jackson, H. F. & Pilgrim, D. (1988). Abandoning the concept of ‘schizophrenia’: some implications of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psychology 27, 303324.CrossRefGoogle ScholarPubMed
Berman, K. F. & Weinberger, D. R. (1990). Lateralisation of cortical function during cognitive tasks: regional cerebral blood flow studies of normal individuals and patients with schizophrenia. Journal of Neurology, Neurosurgery, and Psychiatry, 53, 150160.CrossRefGoogle ScholarPubMed
Birchwood, M., Hallett, S. & Preston, M. (1988). Schizophrenia: An Integrated Approach to Research and Treatment. Longman: London.Google Scholar
Bornstein, R. A., Nasrallah, H. A., Olson, S. C., Coffman, J. A., Torello, M. & Schwarzkopf, S. B. (1990). Neuropsychological deficit in schizophrenic subtypes: paranoid, nonparanoid and schizoaffective subgroups. Psychiatry Research 31, 1524.CrossRefGoogle ScholarPubMed
Braff, D. L. (1993). Information processing and attention dysfunctions in schizophrenia. Schizophrenia Bulletin 19, 233259.CrossRefGoogle ScholarPubMed
Buchsbaum, M. S., Nuechterlein, K. H., Haier, R. J., Wu, J., Sidcotte, N., Harlett, E., Asar, R., Potkin, S. & Guich, S. (1990). Glucose metabolic rate in normals and schizophrenics during the Continuous Performance Test assessed by Positron Emission Tomography. British Journal of Psychiatry 156, 216227.CrossRefGoogle ScholarPubMed
Callaway, E. & Naghdi, S. (1982). An information processing model for schizophrenia. Archives of General Psychiatry 39, 339347.CrossRefGoogle ScholarPubMed
Casali, J. G. & Wierwille, W. W. (1983). A comparison of rating scale, secondary-task, physiological, and primary-task workload estimation techniques in a simulated flight task emphasizing communications load. Human Factors 25, 623641.CrossRefGoogle Scholar
Chapman, L. J. & Chapman, P. (1978). The measurement of differential deficit. Journal of Psychiatric Research 14, 303311.CrossRefGoogle ScholarPubMed
Cohen, J. D. & Servan-Schreiber, D. (1992). Context, cortex and dopamine: a connectionist approach to behavior and biology in schizophrenia. Psychological Review 99, 4577.CrossRefGoogle ScholarPubMed
Cornblatt, B. A. & Erlenmeyer-Kimling, L. (1985). Global attentional deviance as a marker of risk for schizophrenia: specificity and predictive validity. Journal of Abnormal Psychology 94, 470486.CrossRefGoogle ScholarPubMed
Cornblatt, B. A., Risch, N. J., Faris, G., Friedman, D. & Erlenmeyer-Kimling, L. (1988). The Continuous Performance Test, identical pairs version (CPT-IP). 1. New findings about sustained attention in normal families. Psychiatry Research 26, 223238.CrossRefGoogle Scholar
Cornblatt, B. A., Lenzenweger, M. F. & Erlenmeyer-Kimling, L. (1989). The Continuous Performance Test, identical pairs version. II. Contrasting attentional profiles in schizophrenic and depressed patients. Psychiatry Research 29, 6585.CrossRefGoogle ScholarPubMed
Costello, G. C. (1992). Research on symptoms versus research on syndromes: arguments in favor of allocating more time to the study of symptoms. British Journal of Psychiatry 160, 304308.CrossRefGoogle Scholar
Everett, J., Laplante, L. & Thomas, J. (1989). The selective attention deficit in schizophrenia: limited resources or cognitive fatigue? Journal of Nervous and Mental Disease 177, 735738.CrossRefGoogle ScholarPubMed
Frith, C. D. (1987). The positive and negative symptoms of schizophrenia reflect impairments in the perception and initiation of action. Psychological Medicine 17, 631648.CrossRefGoogle ScholarPubMed
Frith, C. D. & Done, D. J. (1988). Towards a neuropsychology of schizophrenia. British Journal of Psychiatry 153, 437443.CrossRefGoogle ScholarPubMed
Frith, C. D. & Done, D. J. (1989). Experiences of alien control in schizophrenia reflect a disorder in the central monitoring of action. Psychological Medicine 19, 359363.CrossRefGoogle ScholarPubMed
Goldstein, G. (1986). The neuropsychology of schizophrenia. In Neuropsychological Assessment of Neuropsychiatric Disorders (ed. Grant, I. and Adams, K. M.), pp. 147171. Oxford University Press: New York.Google Scholar
Green, D. M. & Swets, J. A. (1966). Signal Detection Theory and Psychophysics. Wiley: New York.Google Scholar
Green, M. & Walker, E. (1985). Neuropsychological performance and Positive and Negative symptoms in schizophrenia. Journal of Abnormal Psychology 94, 460469.CrossRefGoogle ScholarPubMed
Harvey, P. D. (1987). Laboratory research: its relevance to positive and negative symptoms. In Positive and Negative Symptoms of Psychosis (ed. Harvey, P. D. and Walker, E. F.), pp. 6894. Erlbaum: Hillsdale, NJ.Google Scholar
Harvey, P. D., Earle-Boyer, E. A. & Levinson, J. C. (1988). Cognitive deficits and thought disorder: a retest study. Schizophrenia Bulletin 14, 5765.CrossRefGoogle ScholarPubMed
Harvey, P. D., Earle-Boyer, E. A., Wielgus, M. S. & Levinson, J. C. (1986). Encoding, memory, and thought disorder in schizophrenia and mania. Schizophrenia Bulletin 12, 252261.CrossRefGoogle ScholarPubMed
Hasher, L. & Zacks, R. T. (1979). Automatic and effortful processes in memory. Journal of Experimental Psychology: General 108, 356388.CrossRefGoogle Scholar
Heaton, R. K. & Crowley, T. J. (1981). Effects of psychiatric disorders and their somatic treatments on neuropsychological test results. In Handbook of Clinical Neuropsychology (ed. Filskov, S. B. and Boll, T. J.), pp. 481525. Wiley: New York.Google Scholar
Hemsley, D. R. (1992). Disorders of perception and cognition in schizophrenia. Revue européenne de Psychologie Appliquée, 42, 105114.Google Scholar
Heslinga, H., Burg, W. van der & Saan, R. J. (1983). Het coderen van het opleidingsnivo. Neuropsychologie RU: Groningen.Google Scholar
Hockey, G. R. J., Gaillard, A. & Coles, M. G. H. (1986). Energetics and Human Information Processing. Nijhoff: Dordrecht.CrossRefGoogle Scholar
Hoff, A. L., Shukla, S., Aronson, T., Cook, B., Olio, C., Baruch, S., Jandorf, L. & Schwartz, J. (1990). Failure to differentiate bipolar disorder from schizophrenia on measures of neuropsychological function. Schizophrenia Research 3, 253260.CrossRefGoogle ScholarPubMed
Jahn, T. & Mussgay, L. (1989). Die statistische Kontrolle möglicher Medikamenteneinflüsse in experimentalpsychologischen Schizophreniestudien: ein Vorschlag zur Berechnung von Chlorpromazinaequivalenten. [The statistical control of possible medication effects in experimental–psychological research on schizophrenia: a proposal for the calculation of chlorpromazine equivalents.] Zeitschrift für Klinische Psychologie, 18, 257267.Google Scholar
Johnstone, E. C., Crow, T. J., Frith, C. D., Stevens, M., Kreel, L. & Husband, J. (1978). The dementia of dementia praecox. Acta Psychiatrica Scandinavia, 57, 305324.CrossRefGoogle ScholarPubMed
Jones, S. H., Gray, J. A. & Hemsley, D. R. (1992). Loss of the Kamin blocking effect in acute but not chronic schizophrenics. Biological Psychiatry 32, 739755.CrossRefGoogle Scholar
Kahneman, D. (1973). Attention and Effort. Prentice Hall: Englewood Cliffs, NJ.Google Scholar
King, H. E. (1991). Psychomotor dysfunction in schizophrenia. In Handbook of Schizophrenia, Volume 5: Neuropsychology, Psychophysiology and Information Processing (ed. Steinhauer, S. R., Gruzelier, J. H. and Zubin, J.), pp. 273301. Elsevier: Amsterdam.Google Scholar
Koelega, H. S. (1989). Benzodiazepines and vigilance performance: a review. Psychopharmacology 98, 145156.CrossRefGoogle ScholarPubMed
Koh, S. D. (1978). Remembering of verbal materials by schizophrenic young adults. In Language and Cognition in Schizophrenia (ed. Schwartz, S.), pp. 5599. Erlbaum: Hillsdale, NJ.Google Scholar
Kraepelin, E. (1913). Psychiatrie. Ein Lehrbuch für Studierende und Ärzte (Achte Auflage, III. Band, II. Teil). Verlag von J. A. Barth: Leipzig.Google Scholar
Lewine, R. (1985). Schizophrenia: an amotivational syndrome in men. Canadian Journal of Psychiatry 30, 316318.CrossRefGoogle ScholarPubMed
Lezak, M. D. (1983). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Liddle, P. F. (1987). Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine 17, 4957.CrossRefGoogle ScholarPubMed
Liddle, P. & Morris, D. L. (1991). Schizophrenic symptoms and frontal lobe performance. British Journal of Psychiatry 158, 340345.CrossRefGoogle ScholarPubMed
Lubow, R. E., Weiner, I., Schlossberg, A. & Baruch, I. (1987). Latent inhibition and schizophrenia. Bulletin of the Psychonomic Society 25, 464467.CrossRefGoogle Scholar
Luckner, N. von, Woggon, B., Åsberg, M., Wiesel, F. A. & Bjerkenstedt, L. (1985). Scale construction of the Swedish CPRS version. Neuropsychobiology 13, 180186.CrossRefGoogle Scholar
Luria, A. R. (1966). Higher Cortical Functions in Man. Tavistock: London.Google Scholar
McGuinness, D. & Pribram, K. (1980). The neuropsychology of attention: emotional and motivational controls. In The Brain and Psychology (ed. Wittrock, M. C.), pp. 95139. Academic Press: New York.CrossRefGoogle Scholar
Maller, O. (1978). Amotivational syndrome in chronic schizophrenics. A biophysiological model of schizophrenic impairment. Neuropsychobiology 4, 229247.CrossRefGoogle ScholarPubMed
Medalia, A., Gold, J. & Merriam, A. (1988). The effects of neuroleptics on neuropsychological test results of schizophrenics. Archives of Clinical Neuropsychology 3, 249272.CrossRefGoogle ScholarPubMed
Nachmani, G. & Cohen, B. D. (1969). Recall and recognition free learning in schizophrenics. Journal of Abnormal Psychology 74, 511516.CrossRefGoogle ScholarPubMed
Neale, J. M. & Oltmanns, T. F. (1980). Schizophrenia. Wiley: New York.Google Scholar
Nestor, P. G., Faux, S. F., McCarley, R. W., Sands, S. F., Horvath, T. B. & Peterson, A. (1991). Neuroleptics improve sustained attention in schizophrenia. A study using signal detection theory. Neuropsychopharmacology 4, 145149.Google ScholarPubMed
Nuechterlein, K. H. (1991). Vigilance in schizophrenia and related disorders. In Handbook of Schizophrenia, vol. 5: Neuropsychology, Psychophysiology and Information Processing (ed. Steinhauer, S. R., Gruzelier, J. H. and Zubin, J.). pp. 397433. Elsevier: Amsterdam.Google Scholar
Nuechterlein, K. H. & Dawson, M. E. (1984). Information processing and attentional functioning in the development course of schizophrenic disorders. Schizophrenia Bulletin 10, 160203.CrossRefGoogle Scholar
Nuechterlein, K. H., Parasuraman, R. & Jiang, Q. (1983). Visual sustained attention: Image degradation produces rapid sensitivity decrement over time. Science 220, 327329.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Edel, W. S., Norris, M. & Dawson, M. E. (1986). Attentional vulnerability indicators, thought disorders, and negative symptoms. Schizophrenia Bulletin 12, 408426.CrossRefGoogle ScholarPubMed
Oltmanns, T. F. & Neale, J. M. (1975). Schizophrenic performance when distractors are present: attentional deficit or differential task difficulty? Journal of Abnormal Psychology 84, 205209.CrossRefGoogle ScholarPubMed
Oltmanns, T. F., Ohayon, J. & Neale, J. M. (1978). The effect of antipsychotic medication and diagnostic criteria on distractability in schizophrenia. Journal of Psychiatric Research 14, 8191.CrossRefGoogle ScholarPubMed
Orzack, M. H. & Kornetsky, C. (1966). Attention dysfunction in chronic schizophrenia. Archives of General Psychiatry 14, 323326.CrossRefGoogle ScholarPubMed
Orzack, M. H. & Kornetsky, C. (1971). Environmental and familial predictors of attention behavior in chronic schizophrenics. Journal of Psychiatric Research 9, 2129.CrossRefGoogle ScholarPubMed
Persons, J. (1986). The advantages of studying psychological phenomena rather than psychiatric diagnoses. American Psychologist 41, 12521260.CrossRefGoogle ScholarPubMed
Pribram, K. & McGuinness, D. (1975). Arousal, activation and effort in the control of attention. Psychological Review 82, 116149.CrossRefGoogle ScholarPubMed
Rey, A. (1964). L'examen Clinique en Psychologie. Presses Universitaires de France: Paris.Google Scholar
Robertson, G. & Taylor, P. J. (1985). Some cognitive correlates of schizophrenic illnesses. Psychological Medicine 15, 8198.CrossRefGoogle ScholarPubMed
Rodnick, E. H. & Shakow, D. (1940). Set in the schizophrenic as measured by a composite reaction time index. American Journal of Psychiatry 97, 214225.CrossRefGoogle Scholar
Rosvold, H. E., Mirsky, A., Sarason, I. & Bransome, E. D. (1956). A continuous performance test of brain damage. Journal of Consulting Psychology 20, 343350.CrossRefGoogle Scholar
Rund, B. R. & Landro, N. I. (1990). Information processing: a new model for understanding cognitive disturbances in psychiatric patients. Acta Psychiatrica Scandinavica 81, 305316.CrossRefGoogle ScholarPubMed
Sagawa, K., Kawakatsu, S., Shibuya, I., Oija, A., Morinobu, S., Komatani, A., Yazaki, M. & Totsuka, S. (1990). Correlation of regional cerebral blood flow with performance on neuropsychological tests in schizophrenic patients. Schizophrenia Research 3, 241246.CrossRefGoogle ScholarPubMed
Sanders, A. F. (1983). Towards a model of stress and human performance. Acta Psychologica 53, 6197.CrossRefGoogle Scholar
Saykin, A. J., Gur, R. C., Gur, R. E., Mozley, P. D., Mozley, L. H., Resnick, S. M., Kester, D. B. & Stafniak, P. (1991). Neuropsychological function in schizophrenia. Selective impairment in memory and learning. Archives of General Psychiatry 48, 618624.CrossRefGoogle ScholarPubMed
Schwartz, F., Carr, A. C., Munich, R. L., Glauber, S., Lesser, B. & Murray, J. (1989). Reaction time impairment in schizophrenia and affective illness: the role of attention. Biological Psychiatry 25, 540548.CrossRefGoogle ScholarPubMed
Schwartz, F., Munich, R. L., Carr, A., Bartuch, E., Lesser, B., Rescigno, D. & Viegener, B. (1991). Negative symptoms and reaction time in schizophrenia. Journal of Psychiatry Research 25, 131140.CrossRefGoogle ScholarPubMed
Schwartz-Place, E. J. & Gilmore, G. C. (1980). Perceptual organization in schizophrenia. Journal of Abnormal Psychology 89, 409418.CrossRefGoogle Scholar
Shallice, T. (1988). From Neuropsychology to Mental Structure. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Shallice, T., Burgess, P. W. & Frith, C. D. (1991). Can the neuropsychological case-study approach be applied to schizophrenia? Psychological Medicine 21, 661673.CrossRefGoogle ScholarPubMed
Shiffrin, R. M. & Schneider, W. (1977). Controlled and automatic human information processing: perceptual learning, automatic attending and a general theory. Psychological Review 84, 127190.CrossRefGoogle Scholar
Strauss, M. E. (1993). Relations of symptoms to cognitive deficits in schizophrenia. Schizophrenia Bulletin 19, 215231.CrossRefGoogle ScholarPubMed
Strauss, M. E., Prescott, C. A., Gutterman, D. F. & Tune, L. E. (1987). Span of apprehension deficits in schizophrenia and mania. Schizophrenia Bulletin 13, 699704.CrossRefGoogle ScholarPubMed
Summerfelt, A. T., Alphs, L. D., Funderburk, F. R. & Strauss, M. E. (1991). Impaired Wisconsin Card Sort performance in schizophrenia may reflect motivational deficits. Archives of General Psychiatry 48, 282283.CrossRefGoogle ScholarPubMed
Sweeney, J. A., Keilp, J. G., Haas, G. L., Hill, J. & Weiden, P. J. (1991). Relationships between medication treatments and neuropsychological test performance in schizophrenia. Psychiatry Research 37, 297308.CrossRefGoogle ScholarPubMed
Tucker, D. M. & Williamson, P. A. (1984). Asymmetric neural control systems in human self-regulation. Psychological Review 91, 185215.CrossRefGoogle ScholarPubMed
Van der Burg, W., Saan, R. J. & Deelman, B. G. (1986). 15-Woordentest. Provisional manual. Department of Neuropsychology, University Hospital Groningen.Google Scholar
Van der Gaag, M. (1992). The results of cognitive training in schizophrenic patients. Ph. D. thesis, University of Groningen.Google Scholar
Van Praag, H. M. (1976). About the impossible concept of schizophrenia. Comprehensive Psychiatry 17, 481497.CrossRefGoogle ScholarPubMed
Venables, P. H. (1959). Factors in the motor behavior of functional psychotics. Journal of Abnormal and Social Psychology 58, 153156.CrossRefGoogle ScholarPubMed
Venables, P. H. (1963). Selectivity of attention, withdrawal and cortical activation. Archives of General Psychiatry 9, 7478.CrossRefGoogle ScholarPubMed
Venables, P. H. & Tizard, J. (1956). Performance of functional psychotics on a repetitive task. Journal of Abnormal and Social Psychology 52, 2326.CrossRefGoogle Scholar
Walker, E. & Harvey, P. D. (1986). Positive and negative symptoms in schizophrenia: attentional correlates. Psychopathology 19, 294302.CrossRefGoogle Scholar
Walker, E. & Lewine, R. J. (1988). The positive/negative symptom distinction in schizophrenia. Validity and ecological relevance. Schizophrenia Research 1, 315328.CrossRefGoogle Scholar
Walker, E. & Shaye, J. (1982). Familial schizophrenia: a predictor of neuromotor and attentional abnormalities. Archives of General Psychiatry 39, 11531156.CrossRefGoogle ScholarPubMed
Weinberger, D. R. & Berman, K. F. (1988). Speculations on the meaning of cerebral metabolic ‘hypofrontality’ in schizophrenia. Schizophrenia Bulletin 14, 157168.CrossRefGoogle ScholarPubMed
Weinberger, D. R., Berman, K. F. & Zec, R. F. (1986). Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. II. Role of neuroleptic treatment, attention, and mental effort. Archives of General Psychiatry 43, 126135.Google Scholar
Weinberger, D. R., Berman, K. F. & Illkowsky, B. P. (1988). Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia. III. A new cohort and evidence for a monoaminergic mechanism. Archives of General Psychiatry 45, 609615.CrossRefGoogle Scholar
Westenberg, H. (1989). Equivalenten van Orale Neuroleptica, Depot Neuroleptica en Benzodiazepinen. Rijksuniversiteit, Vakgroep Psychiatrie: Utrecht.Google Scholar
Wykes, T. & Dunn, G. (1992). Cognitive deficit and the prediction of rehabilitation success in a chronic psychiatric group. Psychological Medicine 22, 389398.CrossRefGoogle Scholar
Wykes, T., Sturt, E. & Katz, R. (1990). The prediction of rehabilitation success after three years: the use of social, symptomatic and cognitive variables. British Journal of Psychiatry 157, 865870.CrossRefGoogle Scholar
Zijlstra, F., Cavalini, P., Wiethoff, M. & Meijman, T. (1990). Mental effort: strategies and efficiency. In European Perspectives in Psychology, vol. 1 (ed. Drenth, P. J. D. et al. ), pp. 435447. Wiley: New York.Google Scholar