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Selective deficits in semantic verbal fluency in patients with a first affective episode with psychotic symptoms and a positive history of mania

Authors

  • Eugenia Kravariti,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
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  • Abraham Reichenberg,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
    2. Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
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  • Kevin Morgan,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
    2. Department of Psychology, University of Westminster, London
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  • Paola Dazzan,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
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  • Craig Morgan,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
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  • Jolanta W Zanelli,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
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  • Julia M Lappin,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
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  • Gillian A Doody,

    1. Community Health Sciences, Queen’s Medical Centre, Institute of Clinical Research, University of Nottingham, Nottingham
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  • Glynn Harrison,

    1. Academic Unit of Psychiatry, Cotham House, University of Bristol, Bristol
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  • Peter B Jones,

    1. Department of Psychiatry, University of Cambridge, Cambridge, UK
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  • Robin M Murray,

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
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  • Paul Fearon

    1. Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King’s College London, London, UK
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  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

  • 1

    Although Raven’s Coloured Progressive Matrices are usually used in younger children and special groups, this nonverbal neurocognitive tool was included in the ÆSOP battery to assess visuospatial intellectual functioning in participants with English as a second language (all participants in the present analysis spoke English as a first language) and in patient groups with hypothesised deficits in visuospatial processing (i.e., including those with affective psychosis) (10, 36).

Eugenia Kravariti, PhD
Department of Psychiatry
NIHR Biomedical Research Centre, South London
Maudsley NHS Foundation Trust/Institute of Psychiatry (King’s College London)
Box 58, De Crespigny Park
London SE5 8AF, UK
Fax: 0044 207 701 9044
e-mail: e.kravariti@iop.kcl.ac.uk

Abstract

Objectives:  Neurocognitive dysfunction is likely to represent a trait characteristic of bipolar disorder, but the extent to which it comprises ‘core’ deficits as opposed to those secondary to longstanding illness or intellectual decline is unclear. We investigated neuropsychological performance in an epidemiologically derived sample of patients with a first affective episode with psychotic symptoms and a positive history of mania, compared to community controls.

Methods:  Using a nested case-control, population-based study, measures of episodic and working memory, executive function, processing speed, and visual-spatial perception were compared between 35 patients with a first affective episode with psychotic symptoms and a positive history of mania, and 274 community controls, as well as a subgroup of 105 controls matched on current IQ (‘good’ versus ‘poor’) and IQ trajectory (‘stable’, ‘declined’, or ‘improved’) with the patients (three controls per case).

Results:  Compared to the extended control sample, probands showed a suggestive deficit in short-term verbal recall, and a significant deficit in semantic fluency. Only the latter was detectable in the comparison with the IQ-matched controls. All other neurocognitive domains showed intact performance or nonsignificant deficits of small effect sizes compared to both control groups. Semantic fluency showed no association with symptoms or duration of untreated illness.

Conclusions:  Patients with a first affective episode with psychotic symptoms and a positive history of mania show an isolated, selective deficit in semantic verbal fluency, against a background of generally preserved neurocognitive function. This pattern seems to contrast with the more widespread neuropsychological dysfunction seen in schizophrenia.

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