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A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders.

ABSTRACT: Psychotic disorders are characterized by a generalized neurocognitive deficit (i.e., performance 1.5 SD below controls across neuropsychological domains with no specific profile of differential deficits). A motivational account of the generalized neurocognitive deficit has been proposed, which attributes poor neuropsychological testing performance to low effort. However, findings are inconsistent regarding effort test failure rate in individuals with psychotic disorders across studies (0-72%), and moderators are unclear, making it difficult to know whether the motivational explanation is viable. To address these issues, a meta-analysis was performed on data from 2205 individuals with psychotic disorders across 19 studies with 24 independent effects. Effort failure rate was examined along with moderators of effort test type, forensic status, IQ, positive symptoms, negative symptoms, diagnosis, age, gender, education, and antipsychotic use. The pooled weighted effort test failure rate was 18% across studies and there was a moderate pooled association between effort failure rate and global neurocognitive performance (r = .57). IQ and education significantly moderated failure rate. Collectively, these findings suggest that a nontrivial proportion of individuals with a psychotic disorder fail effort testing, and failure rate is associated with global neuropsychological impairment. However, given that effort tests are not immune to the effects of IQ in psychotic disorders, these results cannot attest to the viability of the motivational account of the generalized neurocognitive deficit. Furthermore, the significant moderating effect of IQ and education on effort test performance suggests that effort tests have questionable validity in this population and should be interpreted with caution.

SUBMITTER: Ruiz I

PROVIDER: S-EPMC7447112 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerized tool used to measure cognitive function in diverse populations and is sensitive for assessing developmental changes in children. Although CANTAB has been used in several countries, its applicability in a Mexican child population is unknown. This study examined developmental trends on CANTAB in a large sample of urban Mexico City youth and tested the hypothesis that their performance would be similar to a large US normative sample. METHOD:As part of a birth cohort, Early Life Exposures in Mexico to Environmental Toxicants, 826 children, ages 5-15 years, completed CANTAB. Subtests measured planning (Stockings of Cambridge; SOC), short-term memory (Delayed Matching to Sample; DMS), sustained attention (Rapid Visual Information Processing; RVP), ability to match visual stimuli (Match to Sample Visual Search; MTS), flexibility (Intra-extra Dimensional Set Shift; IED), and response inhibition (Stop Signal Task; SST). Determinants of performance on the CANTAB, including age, maternal/child IQ, and sex, were analyzed using Spearman correlation and Welch t tests. Equivalence testing compared performance with existing norms. RESULTS:Performance improved with age on all measures. Child IQ was mildly associated with measures of memory and attention but not executive functioning, consistent with US norms. Maternal IQ was not associated with any outcomes, and males performed better on IED. Mexican norms were comparable to US norms on almost all outcomes, with the exception of a short-term visual recognition memory task (DMS). CONCLUSIONS:This study provides the largest normative data for CANTAB performance in a community sample of Mexican youth. Findings demonstrate the expected maturational effects of executive function, specifically in cognitive shifting and inhibition. Levels of executive function performance demonstrated by a Mexican sample were consistent with normative values reported in US youth. These findings, as well as expected associations with child IQ, indicate high applicability of CANTAB for Mexican youth in neurobehavioral studies.

Project description:BackgroundThe last comprehensive systematic review of the incidence of psychotic disorders was published in 2004. New epidemiological data from different settings now permit a broader understanding of global variation. We examined the variation in psychosis by demographic characteristics and study method.MethodsFor this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, PsycINFO, and bibliographies, and directly contacted first authors. We sought to obtain citations of original research published between Jan 1, 2002, and Dec 31, 2017, on incidence of non-organic adult-onset psychotic disorder. We included papers that were published or in grey literature and had no language restrictions. Data were extracted from published reports, where possible, by sex, age, and ethnic group. Quality of yield was assessed. Data were assessed using univariable random-effects meta-analysis and meta-regression. We registered our systematic review on PROSPERO, number CRD42018086800.FindingsFrom 56 721 records identified, 177 met inclusion criteria. The pooled incidence of all psychotic disorders was 26·6 per 100 000 person-years (95% CI 22·0-31·7). Heterogeneity was high (I2≥98·5%). Men were at higher risk of all psychotic disorders (incidence rate ratio 1·44 [1·27-1·62]) and non-affective disorders (1·60 [1·44-1·77]) than women, but not affective psychotic disorders (0·87 [0·75-1·00]). Ethnic minorities were also at excess risk of all psychotic disorders (1·75 [1·53-2·00]), including non-affective disorders (1·71 [1·40-2·09]). Meta-regression revealed that population registers reported higher rates of non-affective disorders (9·64 [2·72-31·82]), schizophrenia (2·51 [1·24-5·21]), and bipolar disorder (4·53 [2·41-8·51]) than first contact study designs.InterpretationWe found marked variation in incidence of psychotic disorders by personal characteristics and place. Some geographical variation could be partially explained by differences in case ascertainment methods.FundingNone.

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A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders.

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