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Vol. 3. Issue 2.
Pages 40-49 (January 2010)
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Vol. 3. Issue 2.
Pages 40-49 (January 2010)
DOI: 10.1016/S2173-5050(10)70008-X
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Attention Deficits and Response to Drug Therapy in Patients With Treatment-Resistant Schizophrenia: Results Through Confirmatory Factorial Analysis
Déficit atencionales y respuesta al tratamiento farmacológico en pacientes con esquizofrenia resistente al tratamiento: resultados mediante análisis factorial confirmatorio
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Pedro Sáncheza, Natalia Ojedaa,b,c,??
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jnojeda@fice.deusto.es

Corresponding author.
, Edorta Elizagáratea,c,d, Javier Peñab, Javier Ballesterosd,c, Ana B. Yollera, Miguel Gutiérrezc,d,e, Leonardo Casaisf, Jesús Ezcurraa
a Unidad de Psicosis Refractaria, Hospital Psiquiátrico de Álava, Vitoria, Álava, Spain
b Departamento de Psicología, Universidad de Deusto, Bilbao, Vizcaya, Spain
c Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
d Departamento de Neurociencias, Faculty of Medicine. Universidad del País Vasco, Leioa, Vizcaya, Spain
e Servicio de Psiquiatría, Hospital Santiago, Vitoria, Álava, Spain
f Departamento de Neurociencias, Universidad de Cádiz, Cádiz, Spain
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Abstract
Introduction

There are no experimental data that demonstrate whether patients with neuroleptic-resistant schizophrenia differ or not in their pattern of neuropsychological functioning from patients with adequate drug response.

Method

Fifty-two patients with drug-resistant psychosis (DRS) and 42 patients with schizophrenia not resistant to treatment (NDRS) were recruited following the criteria of Kane et al (1988). A sample of 45 healthy controls matched by age, sex and educational level was also recruited. The clinical evaluations used were the Positive and Negative Symptom (PANSS), functional disability (WHO-DAS) and Clinical Global Impression (CGI) scales.

Results

Through the use of confirmatory factorial analysis, we obtained a latent cognitive structure of six cognitive factors: attention, processing speed, verbal memory, working memory, verbal fluency and executive functions. As expected, the control group performed better than the two patient groups (both DRS and NDRS) in all neuropsychological domains. Additionally, the DRS group scored significantly worse in attention than the NDRS group even though no differences between these two groups were found in age of disease onset, number of hospitalisations or length of hospitalisation. From a clinical point of view, the DRS group showed greater severity of positive symptoms (P<0.01) and higher global deterioration (P<0.01), which did not translate into greater functional disability.

Conclusions

The results obtained do not allow us to conclude that there is a specific neuropsychological profile in neuroleptic-resistant patients. The only differential parameter was performance in the attention domain. Our findings better fit the hypothesis of a “clinical continuum” and differ from the categoric classification of this mental disorder.

Keywords:
Treatment-resistant schizophrenia
Confirmatory factorial analysis
Psychopathology
Cognitive performance
Resumen
Introducción

No hay datos experimentales que confirmen si, en cuanto al patrón de funcionamiento neuropsicológico, los pacientes con esquizofrenia resistente al tratamiento con neurolépticos difieren de los pacientes que muestran una respuesta farmacológica adecuada.

Método

Se reclutó a 52 pacientes con psicosis resistente a tratamiento farmacológico (ERT) y 42 pacientes con esquizofrenia no resistente a tratamiento (ENRT), siguiendo los criterios de Kane et al (1988). Además, se reclutó una muestra de 46 controles sanos (NC) apareados por edad, sexo y nivel educativo. Las medidas clínicas incluidas fueron las escalas PANSS (Escala de Síntomas Positivos y Negativos), de discapacidad funcional (WHO-DAS) y de Impresión Clínica Global (CGI).

Resultados

Mediante el empleo de análisis factorial confirmatorio, obtuvimos una estructura cognitiva latente de seis factores cognitivos: atención, velocidad de procesamiento, memoria verbal, memoria de trabajo, fluidez verbal y funciones ejecutivas. Como era esperable, el grupo control rindió mejor que los dos grupos de pacientes (tanto ERT como ENRT) en todos los dominios neuropsicológicos. Además, el grupo ERT rindió en tareas atencionales significativamente peor que el grupo ENRT, a pesar de que no diferían en edad de inicio de la enfermedad, número de hospitalisaciones y tiempo de hospitalisación. Desde el punto de vista clínico, el grupo ERT presentaba mayor severidad de síntomas positivos (P<0,01) y mayor deterioro general (P<0,01), lo que no se traducía en mayor discapacidad funcional.

Conclusiones

Los resultados obtenidos no permiten concluir la existencia de un perfil neuropsicológico específico en pacientes no respondedores al tratamiento con neurolépticos. El único parámetro diferencial fue el rendimiento en el dominio atencional. Nuestros hallazgos son más coherentes con la hipótesis del “fenómeno clínico continuo” y se distancian de la clasificación categórica de este trastorno mental.

Palabras clave:
Esquizofrenia resistente a tratamiento
Análisis factorial confirmatorio
Psicopatología
Rendimiento cognitivo
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