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The puzzle of schizophrenia: Tracking the core role of cognitive deficits

Published online by Cambridge University Press:  17 April 2012

Keith H. Nuechterlein ,
Kenneth L. Subotnik ,
Joseph Ventura ,
Michael F. Green ,
Denise Gretchen-Doorly  and
Robert F. Asarnow
Keith H. Nuechterlein*
Affiliation:
University of California, Los Angeles
Kenneth L. Subotnik
Affiliation:
University of California, Los Angeles
Joseph Ventura
Affiliation:
University of California, Los Angeles
Michael F. Green
Affiliation:
University of California, Los Angeles
Denise Gretchen-Doorly
Affiliation:
University of California, Los Angeles
Robert F. Asarnow
Affiliation:
University of California, Los Angeles
*
Address correspondence and reprint requests to: Keith H. Nuechterlein, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 300 UCLA Medical Plaza, Room 2240, Los Angeles, CA 90095-6968; E-mail: keithn@ucla.edu.
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Abstract

Cognitive deficits in schizophrenia are increasingly accepted as core features of this disorder that play a role as vulnerability indicators, as enduring abnormalities during clinical remission, and as critical rate-limiting factors in functional recovery. This article demonstrates the lasting influence of Norman Garmezy through his impact on one graduate student and then through his later collaborative research with colleagues. The promise of core cognitive deficits as vulnerability indicators or endophenotypes was demonstrated in research with children born to a parent with schizophrenia as well as with biological parents and siblings of individuals with schizophrenia. In studies of patients with a recent onset of schizophrenia, cognitive deficits were found to endure across psychotic and clinically remitted periods and to have a strong predictive influence on likelihood of returning successfully to work or school. Converging lines of evidence for the enduring core role of cognitive deficit in schizophrenia have led in recent years to a burgeoning interest in developing new interventions that target cognition as a means of improving functional recovery in this disorder.

Type
Special Section Articles
Information
Development and Psychopathology , Volume 24 , Issue 2 , May 2012 , pp. 529 - 536
Copyright
Copyright © Cambridge University Press 2012

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References

Asarnow, R. F., Granholm, E. L., & Sherman, T. (1991). Span of apprehension in schizophrenia. In Steinhauer, S. R., Gruzelier, J. H., & Zubin, J. (Eds.), Neuropsychology, psychophysiology and information processing (Vol. 5, pp. 335–370). Amsterdam: Elsevier Science.Google Scholar
Asarnow, R. F., Nuechterlein, K. H., Subotnik, K. L., Fogelson, D. L., Torquato, R. D., Payne, D. L., et al. (2002). Neurocognitive impairments in nonpsychotic parents of children with schizophrenia and attention-deficit/hyperactivity disorder: The University of California, Los Angeles Family Study. Archives of General Psychiatry, 59, 1053–1060.CrossRefGoogle ScholarPubMed
Bellissimo, A., & Steffy, R. A. (1972). Redundancy-associated deficit in schizophrenic reaction time performance. Journal of Abnormal Psychology, 80, 299–307.CrossRefGoogle ScholarPubMed
Bleuler, E. (1950). Dementia praecox or the group of schizophrenias (Zinkin, J., Trans.). New York: International Universities Press. (Original work published 1911)Google Scholar
Carter, C. S., Barch, D. M., Buchanan, R. W., Bullmore, E., Krystal, J. H., Cohen, J., et al. (2008). Identifying cognitive mechanisms targeted for treatment development in schizophrenia: An overview of the first meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia Initiative. Biological Psychiatry, 64, 4–10.CrossRefGoogle ScholarPubMed
Couture, S. M., Penn, D. L., & Roberts, D. L. (2006). The functional significance of social cognition in schizophrenia: A review. Schizophrenia Bulletin, 32(Suppl. 1), S44–S63.CrossRefGoogle ScholarPubMed
Driscoll, R. M. (1984). Incidental and intentional learning in children vulnerable to psychopathology. In Watt, N. F., Anthony, E. J., Wynne, L. C., & Rolf, J. E. (Eds.), Children at risk for schizophrenia: A longitudinal perspective (pp. 320–326). New York: Cambridge University Press.Google Scholar
Erlenmeyer-Kimling, L., & Cornblatt, B. (1987). High-risk research in schizophrenia: A summary of what has been learned. Journal of Psychiatric Research, 21, 401–411.CrossRefGoogle ScholarPubMed
Fett, A. K., Viechtbauer, W., Dominguez, M. D., Penn, D. L., van Os, J., & Krabbendam, L. (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis. Neuroscience and Biobehavioral Reviews, 35, 573–588.CrossRefGoogle ScholarPubMed
Fogelson, D. L., Nuechterlein, K. H., Asarnow, R. F., Subotnik, K. L., & Talovic, S. A. (1991). Interrater reliability of the Structured Clinical Interview for DSM-III-R, Axis II: schizophrenia spectrum and affective spectrum disorders. Psychiatry Research, 39, 55–63.CrossRefGoogle ScholarPubMed
Garmezy, N. (1952). Stimulus differentiation by schizophrenic and normal subjects under conditions of reward and punishment. Journal of Personality, 20, 253–276.CrossRefGoogle ScholarPubMed
Garmezy, N. (1966). The prediction of performance in schizophrenia. Proceedings of the Annual Meeting of the American Psychopathological Association, 54, 129–181.Google ScholarPubMed
Garmezy, N. (1974). Children at risk: The search for the antecedents of schizophrenia. Part II: Ongoing research programs, issues, and intervention. Schizophrenia Bulletin, 1, 55–125.CrossRefGoogle Scholar
Garmezy, N. (1978). Attentional processes in adult schizophrenia and children at risk. Journal of Psychiatric Research, 14, 3–34.CrossRefGoogle ScholarPubMed
Garmezy, N., & Devine, V. T. (1984). Project Competence: The Minnesota studies of children vulnerable to psychopathology. In Watt, N., Rolf, J., & Anthony, E. J. (Eds.), Children at risk for schizophrenia (pp. 287–303). Cambridge: Cambridge University Press.Google Scholar
Garmezy, N., Masten, A. S., & Tellegen, A. (1984). The study of stress and competence in children: A building block for developmental psychopathology. Child Development, 55, 97–111.CrossRefGoogle Scholar
Garmezy, N., & Rodnick, E. H. (1959). Premorbid adjustment and performance in schizophrenia: Implications for interpreting heterogeneity in schizophrenia. Journal of Nervous and Mental Disease, 129, 450–466.CrossRefGoogle ScholarPubMed
Garmezy, N., & Streitman, S. (1974). Children at risk: The search for the antecedents of schizophrenia: Part I. Conceptual models and research methods. Schizophrenia Bulletin, 1, 14–90.CrossRefGoogle Scholar
Gottesman, I. I. (1991). Schizophrenia genesis: The origins of madness. New York: W. H. Freeman.Google Scholar
Gottesman, I. I., & Gould, T. D. (2003). The endophenotype concept in psychiatry: Etymology and strategic intentions. American Journal of Psychiatry, 160, 636–645.CrossRefGoogle ScholarPubMed
Gottesman, I. I., & Shields, J. A. (1982). Schizophrenia: The epigenetic puzzle. Cambridge: Cambridge University Press.Google Scholar
Green, M. F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153, 321–330.Google ScholarPubMed
Green, M. F., Kern, R. S., Braff, D. L., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the “right stuff”? Schizophrenia Bulletin, 26, 119–136.CrossRefGoogle ScholarPubMed
Green, M. F., Kern, R. S., & Heaton, R. K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: Implications for MATRICS. Schizophrenia Research, 72, 41–51.CrossRefGoogle ScholarPubMed
Green, M. F., Nuechterlein, K. H., Gold, J. M., Barch, D. M., Cohen, J., Essock, S., et al. (2004). Approaching a consensus cognitive battery for clinical trials in schizophrenia: The NIMH-MATRICS conference to select cognitive domains and test criteria. Biological Psychiatry, 56, 301–307.CrossRefGoogle ScholarPubMed
Kendler, K. S., & Diehl, S. R. (1993). The genetics of schizophrenia: A current, genetic epidemiologic perspective. Schizophrenia Bulletin, 19, 261–284.CrossRefGoogle ScholarPubMed
Kendler, K. S., & Gruenberg, A. M. (1984). An independent analysis of the Danish Adoption Study of Schizophrenia. VI. The relationship between psychiatric disorders as defined by DSM-III in the relatives and adoptees. Archives of General Psychiatry, 41, 555–564.CrossRefGoogle ScholarPubMed
Kern, R. S., Nuechterlein, K. H., Green, M. F., Baade, L. E., Fenton, W. S., Gold, J. M., et al. (2008). The MATRICS Consensus Cognitive Battery: Part 2. Co-norming and standardization. American Journal of Psychiatry, 165, 214–220.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1919). Dementia praecox and paraphrenia. Edinburgh, Scotland: E. & S. Livingstone.Google Scholar
MacDonald, A. W., & Schulz, S. C. (2009). What we know: Findings that every theory of schizophrenia should explain. Schizophrenia Research, 35, 493–508.Google ScholarPubMed
Marcus, L. M. (1973). Studies of attention in children vulnerable to psychopathology. Dissertation Abstracts International, 33, 5023B.Google Scholar
Marder, S. R., & Fenton, W. (2004). Measurement and treatment research to improve cognition in schizophrenia: NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia. Schizophrenia Research, 72, 5–9.CrossRefGoogle ScholarPubMed
Mednick, S. A., & Schulsinger, F. (1968). Some premorbid characteristics related to breakdown in children with schizophrenic mothers. In Rosenthal, D. & Kety, S. S. (Eds.), Transmission of schizophrenia (pp. 267–291). New York: Pergamon Press.Google Scholar
Nuechterlein, K. H. (1977). Reaction time and attention in schizophrenia: A critical evaluation of the data and theories. Schizophrenia Bulletin, 3, 373–428.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H. (1983). Signal detection in vigilance tasks and behavioral attributes among offspring of schizophrenic mothers and among hyperactive children. Journal of Abnormal Psychology, 92, 4–28.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Asarnow, R. F., Subotnik, K. L., Fogelson, D. L., Payne, D. L., Kendler, K. S., et al. (2002). The structure of schizotypy: Relationships between neurocognitive and personality disorder features in relatives of schizophrenic patients in the UCLA Family Study. Schizophrenia Research, 54, 121–130.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Asarnow, R. F., Subotnik, K. L., Fogelson, D. L., Ventura, J., Torquato, R., et al. (1998). Neurocognitive vulnerability factors for schizophrenia: Convergence across genetic risk studies and longitudinal trait/state studies. In Lenzenweger, M. F. & Dworkin, R. H. (Eds.), Origins and development of schizophrenia: Advances in experimental psychopathology (pp. 299–327). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Nuechterlein, K. H., Barch, D. M., Gold, J. M., Goldberg, T. E., Green, M. F., & Heaton, R. K. (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research, 72, 29–39.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., & Dawson, M. E. (1984). A heuristic vulnerability/stress model of schizophrenic episodes. Schizophrenia Bulletin, 10, 300–312.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Dawson, M. E., Gitlin, M. J., Ventura, J., Goldstein, M. J., Snyder, K. S., et al. (1992). Developmental processes in schizophrenic disorders: Longitudinal studies of vulnerability and stress. Schizophrenia Bulletin, 18, 387–425.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Green, M. F., Kern, R. S., Baade, L. E., Barch, D. M., Cohen, J. D., et al. (2008). The MATRICS Consensus Cognitive Battery: Part 1. Test selection, reliability, and validity. American Journal of Psychiatry, 165, 203–213.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Pashler, H. E., & Subotnik, K. L. (2006). Translating basic attentional paradigms to schizophrenia research: Reconsidering the nature of the deficits. Development and Psychopathology, 18, 831–851.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Phipps-Yonas, S., Driscoll, R. M., & Garmezy, N. (1982). The role of different components of attention in children vulnerable to schizophrenia. In Goldstein, M. J. (Ed.), Preventive intervention in schizophrenia: Are we ready? (pp. 54–77). Washington, DC: US Government Printing Office.Google Scholar
Nuechterlein, K. H., Subotnik, K. L., Green, M. F., Ventura, J., Asarnow, R. F., Gitlin, M. J., et al. (2011). Neurocognitive predictors of work outcome in recent-onset schizophrenia. Schizophrenia Bulletin, 37(Suppl. 2), S33–S40.CrossRefGoogle ScholarPubMed
Orzack, M. H., & Kornetsky, C. (1966). Attention dysfunction in chronic schizophrenia. Archives of General Psychiatry, 14, 323–326.CrossRefGoogle ScholarPubMed
Pashler, H. (1994). Dual-task interference in simple tasks: Data and theory. Psychological Bulletin, 116, 220–244.CrossRefGoogle ScholarPubMed
Phillips, L. (1953). Case history data and prognosis in schizophrenia. Journal of Nervous and Mental Disease, 117, 515–525.CrossRefGoogle ScholarPubMed
Phipps-Yonas, S. (1984). Visual and auditory reaction time in children vulnerable to psychopathology. In Watt, N. F., Anthony, E. J., Wynne, L. C., & Rolf, J. E. (Eds.), Children at risk for schizophrenia: A longitudinal perspective (pp. 312–319). New York: Cambridge University Press.Google Scholar
Reitan, R. M. (1958). Validity of the trail making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276.CrossRefGoogle Scholar
Rodnick, E. H., & Garmezy, N. (1957). An experimental approach to the study of motivation in schizophrenia. Nebraska Symposium on Motivation (pp. 107–184). Lincoln, NE: University of Nebraska Press.Google Scholar
Rodnick, E. H., & Shakow, D. (1940). Set in the schizophrenic as measured by a composite reaction time index. American Journal of Psychiatry, 97, 214–225.CrossRefGoogle Scholar
Rosvold, H. E., Mirsky, A. F., Sarason, I., Bransome, E. D. Jr., & Beck, L. H. (1956). A continuous performance test of brain damage. Journal of Consulting Psychology, 20, 343–350.CrossRefGoogle Scholar
Rutschmann, J., Cornblatt, B., & Erlenmeyer-Kimling, L. (1977). Sustained attention in children at risk for schizophrenia. Archives of General Psychiatry, 34, 571–575.CrossRefGoogle ScholarPubMed
Sergi, M. J., Rassovsky, Y., Nuechterlein, K. H., & Green, M. F. (2006). Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. American Journal of Psychiatry, 163, 448–454.CrossRefGoogle ScholarPubMed
Shakow, D. (1962). Segmental set: A theory of the formal psychological deficit in schizophrenia. Archives of General Psychiatry, 6, 1–17.CrossRefGoogle Scholar
Ventura, J., Subotnik, K. L., Guzik, L. H., Hellemann, G. S., Gitlin, M. J., Wood, R. C., et al. (2011). Remission and recovery during the first outpatient year of the early course of schizophrenia. Schizophrenia Research, 132, 18–23.CrossRefGoogle ScholarPubMed
Wohlberg, G. W., & Kornetsky, C. (1973). Sustained attention in remitted schizophrenics. Archives of General Psychiatry, 28, 533–537.CrossRefGoogle ScholarPubMed
Wu, E. Q., Birnbaum, H. G., Shi, L., Ball, D. E., Kessler, R. C., Moulis, M., et al. (2005). The economic burden of schizophrenia in the United States in 2002. Journal of Clinical Psychiatry, 66, 1122–1129.CrossRefGoogle ScholarPubMed
Wykes, T., Huddy, H., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. American Journal of Psychiatry, 168, 472–485.CrossRefGoogle ScholarPubMed
Zahn, T. P., & Rosenthal, D. (1965). Preparatory set in acute schizophrenia. Journal of Nervous and Mental Disease, 141, 352–358.CrossRefGoogle ScholarPubMed
Zahn, T. P., Rosenthal, D., & Shakow, D. (1963). Effects of irregular preparatory intervals on reaction time in schizophrenia. Journal of Abnormal and Social Psychology, 67, 44–52.CrossRefGoogle ScholarPubMed
Zahn, T. P., Shakow, D., & Rosenthal, D. (1961). Reaction time in schizophrenic and normal subjects as a function of preparatory and intertrial intervals. Journal of Nervous and Mental Disease, 133, 283–287.CrossRefGoogle ScholarPubMed
Zubin, J., & Spring, B. (1977). Vulnerability—A new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126.CrossRefGoogle ScholarPubMed