Immediate and delayed memory performance in schizophrenia spectrum patients: use of matched tasks.

Rapid forgetting has been observed in long-term schizophrenic patients in the past. In this study, the rate of forgetting was assessed in short-term schizophrenic, schizophreniform and schizoaffective patients who had positive symptoms in the past, and in schizophreniform patients who never had positive symptoms. Four groups of patients representing these distinctions and a group of normal controls were assessed using immediate and delayed recall tasks, while controlling for effects of discriminating power of tasks, using matched-task methodology. The results showed that all schizophrenia spectrum patients with positive symptoms showed rapid forgetting as compared to schizophreniform patients with negative symptoms and normal controls. It is concluded that better immediate than delayed recall characterizes schizophrenia spectrum patients who have had positive symptoms. However, schizophrenia spectrum patients with negative symptoms may be qualitatively different from patients with positive symptoms in showing a slower rate of forgetting. The results support the hypothesis that there is at least one and possibly two brain dysfunctions affecting memory in schizophrenia.

Cost and benefit in the choice of ECT schedule. Twice versus three times weekly ECT.

BACKGROUND: We compared the antidepressant and cognitive effects of up to eight sessions of bilateral, brief pulse electroconvulsive therapy (ECT) administered twice (ECT x 2) or three times weekly (ECT x 3), to confirm that ECT x 3 acts more rapidly although the two schedules are equivalent in antidepressant outcome, and to establish whether ECT x 3 is indeed associated with more severe memory impairment. METHOD: Patients with major depression, endogenous subtype were randomly assigned to ECT x 3 or ECT x 2 plus one simulated ECT per week, both up to a maximum of eight real ECT. Depression was evaluated by the Hamilton Depression Scale the day after each treatment and cognitive function by a test battery administered before and after the ECT series and at one month follow-up. RESULTS: Assessed categorically or parametrically, there was no significant difference in antidepressant outcome between the two schedules. Rate of response was significantly more rapid with ECT x 3 but was associated with more severe memory impairment. CONCLUSIONS: Twice weekly administration is an optimum schedule for bilateral ECT unless clinical indications require the more rapid antidepressant effect of three times weekly treatment.

Developmental disorder, Tourette disorder and schizophrenia: a case study.

We present a unique case of an 18-year-old male who had a classic picture of schizophrenia preceded by a well documented history of Tourette Disorder and a developmental disorder. The subject, a member of an ongoing study on first-admission psychosis, has been systematically evaluated and followed up for two years, and the interesting neuropsychological findings are presented and compared to those of the rest of the sample with a diagnosis of schizophrenia. The triad of schizophrenia, Tourette Disorder and developmental disorder is described for the first time in a subject with an adult type schizophrenia. Possible neurodevelopmental impairments explaining the clinical picture are discussed in view of the recent literature.

Affect and memory in depression: evidence of better delayed recall of positive than negative affect words.

It is widely accepted that depressives focus on negative memories, and forget or repress positive memories (showing a mood-congruent affective tendency). Normals have an opposite positive bias in memory ('Pollyanna tendency'). Research evidence for depressives' negative bias in memory comes mainly from studies of retrieval of personal experiences during depression, or from studies of such retrieval during induced mood. In the present study, the hypothesis that depressives encode and remember negative emotion materials better than other materials was tested. Contrary to the hypothesis, the results showed that severely depressed patients remembered more positive affect than negative affect words, after a 2-day delay. Depressives' overall memory performance and rate of forgetting were poor, similar to schizophrenics', and worse than normals'. The results suggest that, while memory performance during a depressive episode is poor, the memory consolidation process for affective information is normal. Unlike in schizophrenia, it does not select negative emotion materials. This conclusion is not incongruent with the finding that depressives show mood-congruent retrieval for previously learnt personal (experiential) information. The consolidation of non-personal (nonexperiential) positive affect materials during depression may provide a clue as to the mechanism of recovery in depression, and the lack of such recovery in schizophrenia.

ECT and non-memory cognition: a review.

The literature on the effects of electroconvulsive therapy (ECT) on non-memory cognitive functions is reviewed. It is concluded that with early methods of ECT administration (sine wave, high dose), these effects are larger than those of depression. They are less pronounced, and usually do not exceed the effects of depression, when modern methods of ECT administration (brief pulse, moderate or low dose) are used. Following ECT, these functions progressively improve. At one week to seven months after ECT, performance is better than before ECT, probably because of the alleviation of both the effects of depression and of ECT. The time course to full recovery of the non-memory effects resembles that of the recovery of amnesic effects, although the latter are more pronounced. With bilateral ECT, as with right unilateral ECT, there is evidence that right hemisphere effects are more pronounced. The results of this review argue that clinicians should take the non-memory cognitive effects of ECT into account, and patients should be informed of their existence before they sign consent for ECT.

Antidepressant and cognitive effects of twice- versus three-times-weekly ECT.

OBJECTIVE: The purpose of this study was to determine which of the two commonly used schedules of ECT administration, twice or three times weekly, is clinically optimal in terms of antidepressant efficacy and cognitive effects. METHOD: In this double-blind study, 52 consenting, medication-free patients with major depressive disorder, endogenous subtype (Research Diagnostic Criteria), were randomly assigned to bilateral, brief-pulse, constant-current ECT administered over 4 weeks at a rate of three times weekly or twice weekly with the addition of one simulated ECT (anesthesia and muscle relaxant only) per week. Outcome measures were the Hamilton Depression Rating Scale, Acute Cognitive Effects Battery, and Chronic Cognitive Effects Battery. RESULTS: Hamilton depression scale scores were significantly improved by both schedules, with no difference in outcome either 1 week or 1 month after the end of the ECT series. However, the rate of response to ECT three times a week was significantly faster and was related to the rate of real ECT administration. Cognitive effects were more prominent with ECT three times a week. CONCLUSIONS: ECT twice a week is an effective schedule for clinical practice and is potentially advantageous in view of a therapeutic outcome identical to that of ECT three times a week and less severe cognitive effects. ECT three times a week may be specifically indicated when early onset of clinical effect is of primary importance.

Neuropsychology and ECT: past and future research trends.

Past research focused on characterizing the cognitive deficits caused by ECT, understanding their causes, and defining ways of ameliorating the deficits. Future research includes the following recommendations. IN CHARACTERIZING THE DEFICITS: more accurately defining the time course to recovery; finding out whether specific memory tasks and specific patients show long-lasting effects; and defining specific components of memory and non-memory deficits (e.g., associative memory, incidental everyday memory, inattention). IN UNDERSTANDING THE CAUSES: determining whether seizure activity in certain brain structures is associated with specific cognitive deficits; finding out in which ways electric dose, electrode placement, seizure duration, and seizure threshold interact in causing the deficits; evaluating the effects of mediating variables such as blood pressure rise; and assessing the influence of background variables such as age, sex, and brain abnormality. IN AMELIORATING THE DEFICITS: continuing the search for effective medication; defining ways of reducing the number of treatments (twice weekly ECT, caffeine or thyroxine modified treatment); and manipulating dose in relation to electrode placement.

Factor analysis of schizophrenic symptoms and comparison of different rating scales.

This study examines the factor structure of persistent schizophrenic symptoms and compares factors derived from different rating scales. Forty stable chronic schizophrenic patients were assessed for positive and negative symptoms. In factor analysis, 3 factors could be detected: a negative factor which correlated with low drug dose and increased involuntary movements, a thought disturbance/paranoid factor which correlated negatively with extrapyramidal side effects and a delusion/hallucination factor which correlated negatively with involuntary movements. These findings support the existence of a negative factor but only partly the trichotomous division of schizophrenic symptoms. Positive symptom organisation is heterogeneous but thought disorder marks one clear dimension and non-paranoid delusions and hallucinations may mark another. The type of scale used has very significant effects on the findings.

Affect and memory in schizophrenia: negative emotion words are forgotten less rapidly than other words by long-hospitalized schizophrenics.

The objective of this study was to investigate the effect of emotion on the rate of forgetting by long-hospitalized schizophrenics. Neutral, positive and negative emotion word lists were read by long-hospitalized schizophrenic and normal control subjects. Subjects were tested for recall immediately and after a delay of about 48 h. The results showed that long-hospitalized schizophrenics: (1) remembered less information; (2) forgot rapidly over time and (3) the negative emotion list was forgotten less rapidly by schizophrenics than the positive emotion list. These findings cannot be explained by differences in discriminating power of tasks, primacy and recency effects in recall, drug status, age, sex or intelligence. The conclusions drawn were that long-hospitalized schizophrenics are characterized by the rapid forgetting of verbal materials, and negative emotion materials are forgotten less rapidly by schizophrenics than other materials. Organic and psychological factors may interact in producing these effects in long-stay but not in short-stay patients.

Enhanced serotonergic responsivity following electroconvulsive therapy in patients with major depression.

Prolactin release in response to fenfluramine hydrochloride (60 mg orally) and placebo was evaluated in 18 medication-free patients with RDC major depressive disorder, endogenous subtype, before and after a series of bilateral treatments with ECT. Before ECT, fenfluramine induced a twofold increase in plasma prolactin levels. This response was significantly enhanced after the ECT series, while baseline prolactin levels and response to the placebo challenge were not altered. There was no significant difference in plasma fenfluramine and norfenfluramine levels during the pre- and post-ECT challenges. These findings suggest that ECT enhances central serotonergic responsivity and extend to depressed patients pre-clinical observations regarding the effect of electroconvulsive shock on serotonergic function.

Effect of fenfluramine on mood: a double-blind placebo-controlled trial.

Depressed patients (n = 10), schizophrenics (n = 6), and normal control subjects was (n = 9) were administered fenfluramine hydrochloride (FF) (60 mg/os) or placebo in the context of a randomized, double-blind crossover trial. No effect of FF on mood or activation was detected over a 6-hr period. A previous report claiming acute antidepressant effects of FF in depressed subjects was not confirmed.

Optimal use of electroconvulsive therapy: choosing a treatment schedule.

Choice of treatment schedule is an important component of the ongoing efforts to optimize electroconvulsive therapy (ECT) administration and thereby maximize therapeutic benefit while reducing cognitive adverse effects. Frequency of ECT administration (that is, the spacing between treatments) and the total number of treatments in a series are the two factors that define the ECT schedule. Available evidence supports the view that a schedule of twice weekly ECT with a total of six to eight treatments is an effective therapeutic regiment that potentially reduces cognitive morbidity associated with more frequent administration and a larger number of treatments. More frequent administration, however, may accelerate antidepressant response and may be indicated in cases in which rapidity of therapeutic effect is a significant clinical consideration. This consideration may be at the cost of greater cognitive impairment, which could be reduced by limiting the number of treatments administered. Aside from their clinical relevance, these issues have important implications for understanding the mechanisms of action of ECT.

Early and long-term effects of electroconvulsive therapy and depression on memory and other cognitive functions.

Twenty-seven medication-free, depressed patients (Research Diagnostic Criteria, endogenous subtype) were administered a comprehensive battery testing memory and other cognitive functions before and after a series of bilateral, brief-pulse electroconvulsive therapy (ECT) administered according to a dosage-titration procedure (8.9 +/- 1.981 treatments). A subset of patients (N = 14) were reexamined at 1 month and 6 months after the conclusion of the treatment. Anterograde (verbal and visuospatial tasks), as well as retrograde (famous and personal events), memory function was significantly impaired at the end of the ECT series. By 1 month follow-up, performance had improved to pre-ECT (depression) levels on both anterograde and retrograde tasks and exceeded these by 6 months. The memory deficits induced by ECT were not a consequence of generalized cognitive impairment. Furthermore, depression and ECT were shown to independently affect memory, and recovery from depression was not a consequence of the amnestic action of the treatment. The results generally confirm previous reports regarding the nature of ECT-induced memory impairment, in a different language and culture. They suggest that long-term effects of the treatment on memory are even less prominent than previously observed.

Performance of long-stay schizophrenics after drug withdrawal on matched immediate and delayed recall tasks.

Both anticholinergic and neuroleptic drugs were withdrawn from eight long-stay hospitalized chronic schizophrenics. These patients and normal controls were then tested on Calev, Venables & Monk's (1983) immediate and delayed matched recall tasks to evaluate their rate of forgetting of verbal well-encoded materials. The results showed rapid forgetting in schizophrenics. This finding suggests that a post-encoding deficit characterizes long-stay schizophrenics after drug withdrawal. Cognitive and brain pathologies that may explain these results are discussed.

Performance of long-stay schizophrenics on matched verbal and visuospatial recall tasks.

A verbal and a visuospatial recall task were compared for discriminating power, using the matched-tasks methodology. These tasks were administered to long-hospitalized schizophrenics. No evidence of a differential deficit, that is, better recall of either the verbal or the visuospatial materials, emerged in the patients. The results replicate a former finding showing no difference between verbal and visuospatial recall in schizophrenics, using memory tasks which were less sensitive as left- and right-hemisphere measures and a non-verbal task less affected by verbal mediation. This replication questions the assumption that the hemispheric differences observed in schizophrenics affect such memory tasks.

Verbal and visuospatial recall by younger and older subjects: use of matched tasks.

In this study, 18 older (over age 65, M = 75.61 years) and 18 younger (below age 40 and over age 17, M = 26.44 years) healthy volunteers were tested on verbal and visuospatial recall. Tasks were matched on discriminating power. Older Ss performed worse than younger Ss on both tasks. The older Ss also showed a larger deficit in visuospatial than in verbal recall, relative to the younger Ss. These results are consistent with the theory of aging according to which verbal tasks are more resistant to deterioration than are nonverbal tasks. A psychological explanation based on lifetime experience with verbal material is preferred over the physiological explanation advocating faster aging of the right hemisphere.

Distinct memory impairments following electroconvulsive therapy and imipramine.

Memory functioning was assessed in 26 unmedicated patients with major depressive disorder (DSM-III) who were then administered either bilateral electroconvulsive therapy (ECT) (N = 16) or imipramine 200 mg per day (N = 10). The subjects were retested following seven ECT administrations or 21 days of imipramine treatment respectively. The retrograde memory tasks included recall of public and autobiographic events. The anterograde memory tasks included an immediate memory task, a verbal paired-associates recall task, and a non-verbal figure reproduction task. Depression was significantly improved in the ECT-treated subjects but not in those administered imipramine. Both ECT- and imipramine-treated patients showed a deficit in recent anterograde memory relative to their pretreatment performance, but no deficit in immediate memory. ECT-treated patients also had a significant and well-characterized impairment in retrograde remote memory. By contrast, imipramine-treated patients did not show a retrograde memory impairment which could be explained by treatment. The results suggest qualitatively different memory deficits produced by ECT and imipramine.