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Memory and attention performance in psychiatric patients: Lack of correspondence between clinician-rated and patient-rated functioning with neuropsychological test results


In the present study, the correspondence between clinician-assessed and self-reported neurocognitive performance was contrasted with scores obtained from psychometric neuropsychological tests in 148 psychiatric in-patients. Results revealed that self-reported cognitive functioning was strongly associated with depressive symptomatology but was only poorly related to psychometric neurocognitive performance, particularly in schizophrenia. After illness denial was controlled for, the overall association between subjective and objective test performance was slightly increased but still failed to reach significance in six out of eight analyses. In approximately 20% to 40% of all cases, clinicians judged memory performance to be normal despite substantial impairment revealed by neuropsychological test results (attention parameters: 7–51%). Since (ecological) validity and reliability have been demonstrated for many neurocognitive paradigms, the present results question the validity of non-psychometric neurocognitive assessment and call for a complementation of clinical judgment with neurocognitive assessment. Reasons for decreased sensitivity of self-reported and clinician-assessed neurocognitive functioning are discussed. (JINS, 2004, 10, 623–633.)

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Reprint requests to: Steffen Moritz: University Hospital Hamburg-Eppendorf, Department for Psychiatry and Psychotherapy, Martinistraße 52; D-20246 Hamburg, Germany. E-mail:
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Antikainen, R., Hanninen, T., Honkalampi, K., Hintikka, J., Koivumaa-Honkanen, H., Tanskanen, A., & Viinamaki, H. (2001). Mood improvement reduces memory complaints in depressed patients. European Archives of Psychiatry and Clinical Neuroscience, 251, 611.
Austin, M.P., Mitchell, P., & Goodwin, G.M. (2001). Cognitive deficits in depression: Possible implications for functional neuropathology. British Journal of Psychiatry, 178, 200206.
Bates, M.E., Bowden, S.C., & Barry, D. (2002). Neurocognitive impairment associated with alcohol use disorders: Implications for treatment. Experimental and Clinical Psychopharmacology, 10, 193212.
Brekke, J.S., Raine, A., Ansel, M., Lencz, T., & Bird, L. (1997). Neuropsychological and psychophysiological correlates of psychosocial functioning in schizophrenia. Schizophrenia Bulletin, 23, 1928.
Brickenkamp, R. (1978). Test d2. Handanweisung [Test d2. Manual]. Göttingen, Germany: Hogrefe.
Chen, E.Y., Kwok, C.L., Chen, R.Y., & Kwong, P.P. (2001). Insight changes in acute psychotic episodes: a prospective study of Hong Kong Chinese patients. Journal of Nervous and Mental Disease, 189, 2430.
Cuesta, M.J., Peralta, V., & Juan, J.A. (1996). Abnormal subjective experiences in schizophrenia: Its relationships with neuropsychological disturbances and frontal signs. European Archives of Psychiatry and Clinical Neuroscience, 246, 101105.
Donohoe, G., Owens, N., O'Donnell, C., Burke, T., Moore, L., Tobin, A., & O'Callaghan, E. (2001). Predictors of compliance with neuroleptic medication among inpatients with schizophrenia: a discriminant function analysis. European Psychiatry, 16, 293298.
Giovagnoli, A.R., Mascheroni, S., & Avanzini, G. (1997). Self-reporting of everyday memory in patients with epilepsy: relation to neuropsychological, clinical, pathological and treatment factors. Epilepsy Research, 28, 119128.
Gold, J.M., Goldberg, R.W., McNary, S.W., Dixon, L.B., & Lehman, A.F. (2002). Cognitive correlates of job tenure among patients with severe mental illness. American Journal of Psychiatry, 159, 13951402.
Green, M.F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153, 321330.
Green, M.F., Kern, R.S., Braff, D.L., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the “right stuff”? Schizophrenia Bulletin, 26, 119136.
Harvey, P.D., Serper, M.R., White, L., Parrella, M.J., McGurk, S.R., Moriarty, P.J., Bowie, C., Vadhan, N., Friedman, J., & Davis, K.L. (2001). The convergence of neuropsychological testing and clinical ratings of cognitive impairment in patients with schizophrenia. Comprehensive Psychiatry, 42, 306313.
Helmstaedter, C., Hauff, M., & Elger, C.E. (1998). Ecological validity of list-learning tests and self-reported memory in healthy individuals and those with temporal lobe epilepsy. Journal of Clinical and Experimental Neuropsychology, 20, 365375.
Helmstaedter, C., Lendt, M., & Lux, S. (2001). Verbaler Lern- und Merkfähigkeitstest [Verbal Learning and Memory Test]. Göttingen, Germany: Beltz.
Heubrock, D. (1992). Der Auditiv-Verbale Lerntest (AVLT) in der klinischen und experimentellen Neuropsychologie. Durchführung, Auswertung und Forschungsergebnisse [The Auditory-Verbal Learning Test (AVLT) in clinical and experimental neuropsychology. Administration, evaluation, and research findings]. Zeitschrift für Differentielle und Diagnostische Psychologie, 3, 161174.
Horner, M.D., Harvey, R.T., & Denier, C.A. (1999). Self-report and objective measures of cognitive deficit in patients entering substance abuse treatment. Psychiatry Research, 86, 155161.
Kopelman, M.D., Stanhope, N., & Guinan, E. (1998). Subjective memory evaluations in patients with focal frontal diencephalic and temporal lobe lesion. Cortex, 34, 191207.
Krausz, M., Moritz, S., Lambert, M., & Naber, D. (2000). Dosage of conventional neuroleptic medication and subjective cognitive functioning in schizophrenia. International Clinical Psychopharmacology, 15, 7781.
Kurtz, M.M., Moberg, P.J., Gur, R.C., & Gur, R.E. (2001). Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: A review and meta-analysis. Neuropsychology Review, 11, 197210.
Lannoo, E., Colardyn, F., Vandekerckhove, T., Deyne, C. de, Soete, G. de, & Jannes, C. (1998). Subjective complaints versus neuropsychological test performance after moderate to severe head injury. Acta Neurochirugica, 140, 245253.
Le Fevre, P.D. (2001). Improving the physical health of patients with schizophrenia: Therapeutic nihilism or realism? Scottish Medical Journal, 46, 1113.
Lezak, M.D. (1995). Neuropsychological assessment. (3rd ed.). Oxford, UK: Oxford University Press.
Meehl, P.E. (1997). Credentialed persons, credentialed knowledge. Clinical Psychology: Science and Practice, 4, 9198.
Moore, L.H., van Gorp, W.G., Hinkin, C.H., Stern, M.J., Swales, T., & Satz, P. (1997). Subjective complaints versus actual cognitive deficits in predominantly symptomatic HIV-1 seropositive individuals. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 3744.
Moritz, S., Iverson, G., & Woodward, T.S. (2003). Reliable change indexes for memory performance in schizophrenia as a means to determine drug-induced cognitive decline. Applied Neuropsychology, 10, 115120.
Moritz, S., Kloss, M., Jahn, H., Hand, I., Haasen, C., & Krausz, M. (2002a). Executive functioning in obsessive-compulsive disorder, unipolar depression and schizophrenia. Archives of Clinical Neuropsychology, 17, 477483.
Moritz, S., Krausz, M., Gottwalz, E., Lambert, M., Perro, C., Ganzer, S., & Naber, D. (2000). Cognitive dysfunction at baseline predicts symptomatic one-year outcome in first-episode schizophrenics. Psychopathology, 33, 4851.
Moritz, S., Perro, C., Woodward, T.S., & Krausz, M. (2002b). Subjective cognitive dysfunction in first-episode patients predicts symptomatic outcome: A replication. Psychopathology, 35, 367368.
Moritz, S., Woodward, T.S., PERSIST Study Group, Krausz, M., & Naber, D. (2002c). Relationship between neuroleptic dosage and subjective cognitive dysfunction in schizophrenic patients treated with either conventional or atypical neuroleptic medication. International Clinical Psychopharmacology, 17, 4144.
Newman, S., Klinger, L., Venn, G., Smith, P., Harrison, M., & Treasure, T. (1989). Subjective reports of cognition in relation to assessed cognitive performance following coronary artery bypass surgery. Journal of Psychosomatic Research, 33, 227233.
Nishiyama, K., Sugishita, M., Kurisaki, H., & Sakuta, M. (1998). Reversible memory disturbance and intelligence impairment induced by long-term anticholinergic therapy. Internal Medicine, 37, 514518.
Nixon, S.J. & Phillips, J.A. (1999). Neurocognitive deficits and recovery in chronic alcohol abuse. CNS Spectrums, 4, 95102.
Perez, M. & Godoy, J. (1998). Comparison between a “traditional” memory test and a “behavioral” memory battery in Spanish patients. Journal of Clinical and Experimental Neuropsychology, 20, 496502.
Rammsayer, T.H., Rodewald, S., & Groh, D. (2000). Dopamine-antagonistic, anticholinergic, and GABAergic effects on declarative and procedural memory functions. Brain Research, 9, 6171.
Reitan, R.M. (1992). Trail Making Test. Manual of administration and scoring. Tuscon, AZ: Reitan Neuropsychology Laboratory.
Rossell, S.L., Coakes, J., Shapleske, J., Woodruff, P.W.R., & David, A.S. (2003). Insight: Its relationship with cognitive function, brain volume and symptoms in schizophrenia. Psychological Medicine, 33, 111119.
Smith, G.E., Petersen, R.C., Ivnik, R.J., Malec, J.F., & Tangalos, E.G. (1996). Subjective memory complaints, psychological distress, and longitudinal change in objective memory performance. Psychology and Aging, 11, 272279.
Strome, T.M. (1989). Schizophrenia in the elderly: What nurses need to know. Archives of Psychiatric Nursing, 3, 4752.
Theml, T. & Romero, B. (1991). Selbstbeurteilung von Aufmerksamkeitsdefiziten bei Alzheimer-Kranken mit sehr leichter Demenz. Eine explorative Studie [Self-reported attention deficits in patients with mild dementia of the Alzheimer type. A preliminary study]. Zeitschrift für Neuropsychologie, 12, 151159.
Tonne, U., Hiltunen, A.J., Vikander, B., Engelbrektsson, K., Bergman, H., Bergman, I., Leifman, H., & Borg, S. (1995). Neuropsychological changes during steady-state drug use, withdrawal and abstinence in primary benzodiazepine-dependent patients. Acta Psychiatrica Scandinavica, 91, 299304.
Vadhan, N.P., Serper, M.R., Harvey, P.D., Chou, J.C.-Y., & Cancro, R. (2001). Convergent validity and neuropsychological correlates of the schedule for the assessment of negative symptoms (SANS) attention subscale. Journal of Nervous and Mental Disease, 189, 637641.
van den Bosch, R.J. & Rombouts, R.P. (1998). Causal mechanisms of subjective cognitive dysfunction in schizophrenic and depressed patients. Journal of Nervous and Mental Disease, 186, 364368.
Velligan, D.I., Bow-Thomas, C.C., Mahurin, R.K., Miller, A.L., & Halgunseth, L.C. (2000). Do specific neurocognitive deficits predict specific domains of community function in schizophrenia? Journal of Nervous and Mental Disease, 188, 518524.
von Zerssen, D. & Koeller, D.M. (1976). Paranoid-Depressivitäts Skala (PDS) [Paranoid-Depression Scale]. Göttingen, Germany: Hogrefe.
Wagle, A.C., Berrios, G.E., & Ho, L. (1999). The cognitive failures questionnaire in psychiatry. Comprehensive Psychiatry, 40, 478484.
Wilder-Willis, K.E., Shear, P.K., Steffen, J.J., & Borkin, J. (2002). The relationship between cognitive dysfunction and coping abilities in schizophrenia. Schizophrenia Research, 55, 259267.
Wilson, B., Cockburn, J., & Baddeley, A. (1992). Rivermead Behavioural Memory Test. German translation. Bury St. Edmunds, UK: Thames Valley Test Company.
World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Primary health care classification. Geneva: WHO.
Zimmerman, M. & Mattia, J.I. (1999). Psychiatric diagnosis in clinical practice: is comorbidity being missed? Comprehensive Psychiatry, 40, 182191.
Zimmermann, P. & Fimm, B. (1994). Testbatterie zur Aufmerksamkeitsprüfung (TAP) [Test Battery for the Assessment of Attentional Dysfunction]. Herzogenrath, Germany: Psytest.
Zimmermann, P., Messner, C., Poser, U., & Sedelmeier, P. (1991). Ein Fragebogen erlebter Defizite der Aufmerksamkeit (FEDA) [a questionnaire measuring self-experienced deficits of attention]. Freiburg, Germany: Psychologisches Institut der Universität Freiburg.
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Journal of the International Neuropsychological Society
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