Marielle Gorissen1, Juan Carlos Sanz, Ben Schmand. 1. Psychiatric hospital Meerkanten, Veldwijk Research Institute, PO box 1000, 3850 BA Ermelo, The Netherlands. mariellegorissen@aol.com
Abstract
OBJECTIVE: The aim of this study was to determine whether low cognitive test scores in schizophrenia patients are due to insufficient effort and, if so, to what extent. METHOD: Mental effort was measured with the Word Memory Test (WMT), an effort test that has been extensively validated. Schizophrenic patients (n=64), non-psychotic psychiatric patients (n=63), neurological controls (n=20), and normal controls (n=44) were tested with a neuropsychological test battery measuring memory, attention and executive functioning. RESULTS: The majority of the schizophrenia patients and a quarter of the psychiatric patients scored below the cut-offs for normal effort on the WMT. Scores on the effort test explained a significant amount of variance in the neuropsychological test performance of schizophrenic patients. This lends support to the notion that cognitive functioning in schizophrenia is compromised by insufficient effort. Furthermore, poor mental effort was related to negative symptoms. CONCLUSIONS: Poor mental effort might be considered a core symptom of schizophrenia, representing an executive, monitoring or motivational problem. Mental effort should be taken into consideration in the neuropsychological assessment of schizophrenic patients and of psychiatric patients in general. Controlling for this variable may have a considerable impact on research, assessment and treatment of cognitive disorders in schizophrenic patients.
OBJECTIVE: The aim of this study was to determine whether low cognitive test scores in schizophreniapatients are due to insufficient effort and, if so, to what extent. METHOD: Mental effort was measured with the Word Memory Test (WMT), an effort test that has been extensively validated. Schizophrenicpatients (n=64), non-psychotic psychiatricpatients (n=63), neurological controls (n=20), and normal controls (n=44) were tested with a neuropsychological test battery measuring memory, attention and executive functioning. RESULTS: The majority of the schizophreniapatients and a quarter of the psychiatricpatients scored below the cut-offs for normal effort on the WMT. Scores on the effort test explained a significant amount of variance in the neuropsychological test performance of schizophrenicpatients. This lends support to the notion that cognitive functioning in schizophrenia is compromised by insufficient effort. Furthermore, poor mental effort was related to negative symptoms. CONCLUSIONS: Poor mental effort might be considered a core symptom of schizophrenia, representing an executive, monitoring or motivational problem. Mental effort should be taken into consideration in the neuropsychological assessment of schizophrenicpatients and of psychiatricpatients in general. Controlling for this variable may have a considerable impact on research, assessment and treatment of cognitive disorders in schizophrenicpatients.
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