Executive function in schizophrenia: is it linked to psychosis and poor life functioning?

The authors examined the relationship of major aspects of executive function to acute psychosis and long-term outcome in patients enrolled in a 15-year study of the natural history of psychosis. They evaluated 157 patients, including 42 schizophrenic, 42 other psychotic, and 73 nonpsychotic psychiatric patients 15 years after index hospitalization. Patients were administered the Wisconsin Card Sorting Test (WCST) and measures of psychosis and posthospital adjustment. Schizophrenia patients performed significantly worse than both nonschizophrenic psychiatric control groups on WCST indices, regardless of psychosis. Aspects of executive function were impaired in schizophrenia patients with severe deficits in their level of overall functioning and outcome and also in many with only moderate impairment in overall functioning; however, these deficits were seen to a greater degree in schizophrenia patients with very poor overall functioning. Executive function deficits appear to be a core component of schizophrenia rather than an effect of acute psychotic disorganization, and are associated with long-term outcome.

Neuropsychological functioning in a cohort of HIV infected women: importance of antiretroviral therapy.

We evaluated neurocognitive function in 149 HIV-seropositive and 82 seronegative women enrolled in the Women's Interagency HIV Study (WIHS), a large multi-center study of disease progression in women living with HIV/AIDS. We evaluated the prevalence of abnormal neuropsychological (NP) test findings in HIV-seropositive and seronegative women and factors associated with increased risk of abnormal NP test performance. Risk of NP impairment was no higher for HIV positive women receiving antiretroviral therapy at testing than for HIV-negative women (OR = 1.00). However, the risk of abnormal NP performance increased significantly for seropositive women not receiving antiretroviral therapy (OR = 2.43). Further, treatment status was a significant predictor of NP impairment in a multivariate analysis that included viral load (OR = 1.48) and CD4 count (OR = 1.08) which were not significant. The multivariate analyses controlled for substance use, age, education, head injury, ethnicity, estimated IQ, and psychological distress. This study emphasizes the critical association of antiretroviral therapy with the risk of neurocognitive impairment in women living with HIV/AIDS.