Abstract : Schizophrenia is a complex, chronic mental health disorder

characterized by an array of symptoms, including delusions, hallucinations,

disorganized speech or behavior, and impaired cognitive ability. Current thinking
about schizophrenia acknowledges that the illness is fundamentally a disease of
the brain.Deficit in cognition is one of the manifestations of the neuropathology
of the illness. Changes in the Cognitive domains result in the inability to: 1.Pay
attention 2.Process information quickly 3.Remember and recall of information
4.Respond to information quickly 5.Think critically, plan, organize and solve
problems 6.Initiation of speech. These cognitive deficits contribute to poor
functional outcome of the patient.
Early detection and effective management of cognitive dysfunction will have
better outcome and improves quality of life. So the present study aims to
investigate Cognitive Dysfunctions among the Schizophrenia patients in
comparison with healthy subjects in Indian setting
Methods : People who are being diagnosed schizophrenia by ICD 10 in psychiatry
outpatient were included as cases. 50 controls were selected from Healthy
volunteers from tertiary hospital who are willing to participate in the study by
using General health questionnaire and who scores < 23.
cognitive functions of both cases and controls were assessed using Standardized
mini mental status examination (SMMSE), Digit Symbol Substitution Test (DSST),
Trial Making Test - A and Trail 24 Making Test – B. Further they are compared
among cases and with to that of controls.
Results :Healthy Controls performed better on SMMSE, DSST, than Schizophrenia
group. TMT- A ,TMT – B. shows that as duration of illness increases cognitive
deficits increases
Introduction :
Schizophrenia is a complex, chronic mental health disorder ciharacterized by an
array of symptoms, including delusions, hallucinations, disorganized speech or
behavior, and impaired cognitive ability. The early onset of the disease, along with
its chronic course, make it a disabling disorder for many patients and their
families
Since the 1980s, cognitive impairment has come to be seen as a core feature of
the disorder, reliably present in the majority of patients, independent of such
positive symptoms as delusions and hallucinations, and a major cause of poor
social and vocational outcome.
Changes in the Cognitive domains result in the inability to: 1.Pay attention
2.Process information quickly 3.Remember and recall of information 4.Respond to
information quickly 5.Think critically, plan, organize and solve problems
6.Initiation of speech
MATERIALS AND METHODS:
The sample of the study comprised of 100 participants.50 patients who were
diagnosed as schizophrenia according to ICD 10 and 50 controls who were healthy
volunteers from tertiary care hospital who are willing to participate in the study
are selected as controls.The clearance from Institutional Ethics committee was
obtained before the study was started .All the cases and controls were obtained
an informed ,bilingual and written consent before they were included in to the
study
INCLUSION CRITERIA FOR CASES:
1. Age = 18-60 years,both male and female
2. Patients diagnosed as schizophrenia according to ICD 10.
INCLUSION CRITERIA FOR CONTROLS :
1. Age 18-60 years, both male and female.
2. People who are healthy.
EXCLUSION CRITERIA FOR CASES and CONTROLS :
1. Age < 18 or > 60 years
2. Patients with any history of neurodegenerative disorders.
3. Patients with any history of neurological disorders.
4 .Patients who are treated with ECT within 6 months prior to the study.
5. Patients diagnosed with any other psychiatric disorder
STUDY TYPE: Case control study
INSTRUMENTS USED: 1.Standardized mini mental status examination (SMMSE) 2.
Brief cognitive rating scale (BCRS) 3. Digital symbol substitution test (DSST) 4. Trail
making –A test 5. Trail making –B test 6.General health questionnaire – 28

Results :
Distribution of the study groups according to SMMSE scores.

The mean (± SD) SMMSE score among the cases was (21.34 +4.265) and among
the controls (28.74 + 1.084).This mean difference was statistically significant
between the cases and controls with a p – value < 0.001. This shows clearly that
Healthy Controls performed better on SMMSE than Schizophrenia group.

Distribution of the study groups according to DSST scores

Distribution of the study groups according to DSST scores. and TMT _ A errors.

Distribution of the study groups according to TMT _ B scores. and TMT _ B errors.

Comparision of duration of illness with SMMSE, DSST

Table 8.shows the comparision of duration of illness with SMMSE and DSST.This
was statiscally significant at P value < 0.0001 and 0.005 for SMMSE and DSST
respectively.This shows that as duration of illness increases cognitive deficits
increases

Comparision of duration of illness with TMT- A, TMT- A errors ,TMT – B, TMT – B

errors.

Table 9. shows Comparision of duration of illness with TMT- A, TMT- A

errors ,TMT – B, TMT – B errors with a p – value > 0.05.
Discussion :
In the present study the mean Standardized Mini Mental Status Examination
(SMMSE) score among the cases was (21.34 +4.265) and (28.74 + 1.084)among
the controls. This was statistically significant with p – value < 0.0001.When
compared to previous studies, the present study had low Standardized Mini
Mental Status Examination (SMMSE) scores among the schizophrenia patients .
In a study done by Ahmed Mubarak et al. where 30 patients and 15 healthy
controls participated results showed that patients showed lower scores in MMSE
than controls and there was statistically significant differences noted in MMSE
scores in schizophrenia cases when compared to controls at P value 0.002
In the present study , The mean (± SD) of DSST scores among the cases was 70.02
(+ 19.670) and 95.64 (+ 7.708 ) among the controls and was statistically significant
with a p – value < 0.0001. It reflects that schizophrenia patients (Cases)
performed poorer than the Healthy controls in giving the correct responses with
in a time period of 120 seconds on Digit symbol substitution test (DSST).
The present study results were similar with previous studies in relation to DSST
scores among the schizophrenia patients. Most of the previous studies suggested
that schizoprenia patients give less correct responses while performing DSST -
B.J.M. Jogems-Kosterman et al, C. Hughes et al.
In the present study, the mean Trail making – A (TMT _A) scores among the cases
was 36.62 (+ 15.674 ) and 20.86 (+ 5.784) among the controls. This was
statistically significant with p – value < 0.0001. This shows schizophrenia patients
are taking more time in performing the task when compared to healthy controls.
In the present study, the mean Trail making – B (TMT – B) scores among the cases
was 115.04 (+68.211) among the cases and 59.42 (+ 22.847) among the controls.
This was statistically significant with a p – value < 0.0001. This show Schizophrenia
patients are taking more time to complete the task when compared to healthy
controls. The present study results were similar to the previous studies -
Krishnadas et al., C. Hughes et al., Mosiołek et al. in relation to trail making tests.
In the present study on comparision of duration of illness with SMMSE,
DSST,TMT-A,TMT-A errors , TMT-B , TMT-B errors .This was statiscally significant
with P value for SMMSE - < 0.0001 , DSST - 0.005 .This indicates that as duration
of illness increases the cognitive deficits increases.
Davidson et al. conducted a study Severity of symptoms in chronically
institutionalized geriatric schizophrenic patients and found that a decline of two
to three points per decade in a global measure of cognitive functioning
However some studies Krishnadas et al. show that cognitive dysfunction is stable
over the course of illness.