LVR-Klinikum Düsseldorf Hospital of the Heinrich-Heine University ...

Clinical symptom index More symptoms
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Neuropsychological vulnerability index
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Biological principles of the risk of illness
for psychotic disorders
Participation in the homonymous, multi-centre project
of the Competence Network on Schizophrenia (Principal
investigator: M. Wagner, University of Bonn)
W. Wölwer, M. Streit, J. Brinkmeyer, S. Stroth
Project period: 2000–2006
Financing: FMER funding 01 GI 9934, 01 GI 0234 to
Wagner, Bonn
This sub-project aims, amongst other things, to test
whether neuropsychological indicators of increased
vulnerability to psychosis can contribute to predicting the
actual development of a psychotic disorder in persons
who have been identified using clinical criteria as at-risk
groups (Figure 9). Known neuropsychological vulnerability
indicators were assessed in at-risk persons in the assumed
early and late prodromal stages of a psychotic development
both at inclusion into one of the early diagnosis and early
intervention projects of the Competence Network and after
twelve months. Compared with healthy controls the risk
group in the late prodromal stage demonstrated statistically
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Increased vulnerability
High-risk group
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ReseaRch
No clinical deterioration
Clinical deterioration within one year
Figure 9: Prediction of the clinical
deterioration of patients with
schizophrenia within one year of
illness onset: the risk of a clinically
poor disease course is particularly
high in patients with incompletely
remitted acute symptoms at the
start of long-term treatment and
a high degree of vulnerability to
illness (after Wölwer et al. 2008,
Neuropsychological impairments
predict the clinical course in
schizophrenia. Eur Arch Psychiat
Clin Neurosc 258: 28–34)
significant cognitive impairments in all cognitive functions
under investigation, including facial affect decoding. These
impairments were qualitatively similar but quantitatively
less marked than those found in patients with manifest
schizophrenia. The risk group in the early prodromal stage
demonstrated on average only mild cognitive impairments,
which differed significantly from the cognitive functions of
healthy controls only in terms of executive functions and
facial affect decoding. However, in the early prodromal
group as opposed to the late prodromal group, cognitive
impairments in verbal memory and executive functions were
found to be predictive of a later transition into a psychotic
episode. This is confirmed by findings in the recent literature
describing a predictive validity of cognitive impairment
for the development of a psychosis. The fact that this was
detectable in our own study only in at-risk persons in the
early prodromal stage could suggest that, in later stages,
the effect of vulnerability factors is superimposed by
further (supposedly psychosocial stress) factors and only
contributes together with these factors to the accumulation
of a higher risk at this later stage of psychosis development.
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