Cognitive Impairment in Schizophrenia and Affective Psychoses: Implications for DSM-V Criteria and Beyond
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TLDR
The overall results of this inquiry suggest that inclusion of cognitive impairment criteria in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-V) would not provide a major advancement in discriminating schizophrenia from bipolar disorder and affective psychoses.Abstract:
It has recently been suggested that the diagnostic criteria of schizophrenia should include specific reference to cognitive impairments characterizing the disorder. Arguments in support of this assertion contend that such inclusion would not only serve to increase the awareness of cognitive deficits in affected patients, among both clinicians and researchers alike, but also increase the "point of rarity" between schizophrenia and mood disorders. The aim of the current article is to examine this latter assertion in light of the recent opinion piece provided by Keefe and Fenton (Keefe RSE, Fenton WS. How should DSM-V criteria for schizophrenia include cognitive impairment? Schizophr Bull. 2007;33:912-920). Through literature review, we explore the issue of whether cognitive deficits do in fact differentiate the major psychoses. The overall results of this inquiry suggest that inclusion of cognitive impairment criteria in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-V) would not provide a major advancement in discriminating schizophrenia from bipolar disorder and affective psychoses. Therefore, while cognitive impairment should be included in DSM-V, it should not dictate diagnostic specificity--at least not until more comprehensive evidence-based reviews of the current diagnostic system have been undertaken. Based on this evidence, we consider several alternatives for the DSM-V definition of cognitive impairment in schizophrenia, including (1) the inclusion of cognitive impairment as a specifier and (2) the definition of cognitive impairment as a dimension within a hybrid categorical-dimensional system. Given the state of current evidence, these possibilities appear to represent the most parsimonious approaches to the inclusion of cognitive deficits in the diagnostic criteria of schizophrenia and, potentially, of mood disorders.read more
Citations
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Meta-analysis of Cognitive Deficits in Ultra-high Risk to Psychosis and First-Episode Psychosis: Do the Cognitive Deficits Progress Over, or After, the Onset of Psychosis?
Emre Bora,Robin M. Murray +1 more
TL;DR: The findings suggest that cognitive deficits are already established before the prodromal phases of psychosis, and support the neurodevelopmental model rather than neurodegenerative and related staging models of schizophrenia.
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Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity—Implications for Diagnosis and Ultra–High Risk Research
Johanna T. W. Wigman,Martine van Nierop,Wilma A. M. Vollebergh,Roselind Lieb,Roselind Lieb,Katja Beesdo-Baum,H.-U. Wittchen,H.-U. Wittchen,Jim van Os,Jim van Os +9 more
TL;DR: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.
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Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity - Implications for diagnosis and ultra-high risk research
Johanna T. W. Wigman,M. van Nierop,W.A.M. Vollebergh,Roselind Lieb,K. Beesdo-Baum,Hans-Ulrich Wittchen,J. van Os +6 more
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Theory of mind impairments in first-episode psychosis, individuals at ultra-high risk for psychosis and in first-degree relatives of schizophrenia: systematic review and meta-analysis
Emre Bora,Christos Pantelis +1 more
TL;DR: ToM was substantially impaired in first-episode psychosis and this deficit was comparable to findings in chronic patients and Severity of ToM deficits in unaffected relatives and UHR subjects was similar to other cognitive deficits observed in these groups.
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Meta-analysis of Cognitive Impairment in First-Episode Bipolar Disorder: Comparison With First-Episode Schizophrenia and Healthy Controls
Emre Bora,Christos Pantelis +1 more
TL;DR: Cognitive functions in FEBP lie intermediate between FES and healthy controls and neurodevelopmental factors are likely to play a significant role not only in schizophrenia but also in BP.
References
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Neurocognitive Deficits and Functional Outcome in Schizophrenia: Are We Measuring the “Right Stuff”?
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