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Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study

  • Emre Bora (a1), Murat Yucel (a2) and Christos Pantelis (a3)



Cognitive functioning in affective psychosis and schizoaffective disorder is much less studied compared with schizophrenia.


To quantitatively undertake a meta-analysis of the available data that directly compares cognitive functioning across schizophrenia, schizoaffective disorder and affective psychosis.


Following a thorough literature review, 31 studies that compared the performances of people with schizophrenia (1979 participants) with that of those with affective psychosis or schizoaffective disorder (1314 participants) were included. To determine the effect of demographic and clinical confounders, meta-regression and subgroup analyses were conducted.


In 6 of 12 cognitive domains, people with schizophrenia performed worse than people with schizoaffective disorder or affective psychosis. However, the between-group differences were small and the distribution of effect sizes showed substantial heterogeneity. The between-group differences were driven by a higher percentage of males, more severe negative symptoms and younger age at onset of illness in the schizophrenia samples.


Neuropsychological data do not provide evidence for categorical differences between schizophrenia and other groups. However, a subgroup of individuals with schizophrenia who have more severe negative symptoms may be cognitively more impaired than those with affective psychosis/schizoaffective disorder.

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Corresponding author

Emre Bora, Melbourne Neuropsychiatry Centre, Alan Gilbert Building, National Neuroscience Facility, Level 3, Victoria 3053, Australia. Email:


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1 Owen, MJ, Craddock, N, Jablensky, A. The genetic deconstruction of psychosis. Schizophr Bull 2007; 33: 905–11.
2 Angst, J. Psychiatric diagnoses: the weak component of modern research. World Psychiatry 2007; 6: 30–1.
3 Craddock, N, Owen, MJ. Rethinking psychosis: the disadvantages of a dichotomous classification now outweight the advantages. World Psychiatry 2007; 6: 8491.
4 Bora, E, Yucel, M, Fornito, A, Berk, M, Pantelis, C. Major psychoses with mixed psychotic and mood symptoms: are mixed psychoses are associated with different neurobiological markers? Acta Psychiatr Scand 2008; 118: 172–87.
5 Robinson, LJ, Thompson, JM, Gallagher, P, Goswami, U, Young, AH, Ferrier, IN, et al. A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 2006; 93: 105–15.
6 Torres, IJ, Boudreau, VG, Yatham, LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl 2007; 434: 1726.
7 Bora, E, Yucel, M, Pantelis, C. Cognitive endophenotpes of bipolar disorder: A meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord 2009; 113: 120.
8 Krabbendam, L, Arts, B, Van Os, J, Aleman, A. Cognitive functioning in patients with schizophrenia and bipolar disorder: a quantitative review. Schizophr Res 2005; 80: 137–49.
9 Pantelis, C, Stuart, GW, Nelson, HE, Robbins, TW, Barnes, TRE. Spatial working memory deficits in schizophrenia: relationship with tardive dyskinesia and negative symptoms. Am J Psychiatry 2001; 158: 1276–85.
10 Gruzelier, J, Seymour, K, Wilson, L, Jolley, A, Hirsch, S. Impairments on neuropsychological tests of temporohippocampal and frontohippocampal functions and word fluency in remitting schizophrenia and affective disorders. Arch Gen Psychiatry 1988; 45: 623–9.
11 Bornstein, RA, Nasrallah, HA, Olson, SC, Coffman, JA, Torello, M, Schwarzkopf, SB. Neuropsychological deficit in schizophrenic subtypes: paranoid, nonparanoid, and schizoaffective subgroups. Psychiatry Res 1990; 31: 1524.
12 Morice, R. Cognitive inflexibility and pre-frontal dysfunction in schizophrenia and mania. Br J Psychiatry 1990; 157: 50–4.
13 Beatty, WW, Jocic, Z, Monson, N, Staton, RD. Memory and frontal lobe dysfunction in schizophrenia and schizoaffective disorder. J Nerv Ment Dis 1993; 181: 448–53.
14 Jeste, DV, Heaton, SC, Paulsen, SJ, Ercoli, L, Harris, MJ, Heaton, RK. Clinical and neuropsychological comparison of psychotic depression with nonpsychotic depression and schizophrenia. Am J Psychiatry 1996; 153: 490–6.
15 Miller, LS, Swanson-Green, T, Moses, JA, Faustman, WO. Comparison of cognitive performance in RDC diagnosed schizoaffective and schizophrenic patients with the Luria-Nebraska neuropsychological battery. J Psychiatr Res 1996; 30: 277–82.
16 Manschreck, TC, Maher, BA, Beaudette, SM, Redmond, DA. Context memory in schizoaffective and schizophrenic disorders. Schizophr Res 1997; 26: 153–61.
17 Evans, JD, Heaton, RK, Paulsen, JS, McAdams, LA, Heaton, SC, Jeste, DV. Schizoaffective disorder: a form of schizophrenia or affective disorder? J Clin Psychiatry 1999; 60: 874–82.
18 Mojtabai, R, Bromet, EJ, Harvey, PD, Carlson, GA, Craig, TJ, Fennig, S. Neuropsychological differences between first-admission schizophrenia and psychotic affective disorders. Am J Psychiatry 2000; 157: 1453–60.
19 Rossi, A, Arduini, L, Daneluzzo, E, Bustini, M, Prosperini, P, Stratta, P. J Psychiatr Res 2000; 34: 333–9.
20 Verdoux, H, Liraud, F. Neuropsychological function in subjects with psychotic and affective disorders. Relationship to diagnostic category and duration of illness. Eur Psychiatry 2000; 15: 236–43.
21 Gilvarry, CM, Russell, A, Jones, P, Sham, P. Hemsley, P, Murray, RM. Verbal fluency in patients with schizophrenia and affective psychoses and their first degree relatives. Psychol Med 2001; 31: 695704.
22 Gooding, DC, Tallent, KA. Spatial working memory performance in patients with schizoaffective psychosis versus schizophrenia: a tale of two disorders? Schizophr Res 2002; 53: 209–18.
23 Seidman, LJ, Kremen, WS, Koren, D, Faraone, SV, Goldstein, JM, Tsuang, MT. A comparative profike analysis of neuropsychological functioning in patients with schizophrenia and bipolar psychoses. Schizophr Res 2002; 53: 3144.
24 Arduini, L, Kalyvoka, A, Stratta, P, Rinaldi, O, Daneluzzo, E, Rossi, A. Insight and neuropsychological function in patients with schizophrenia and bipolar disorder with psychotic features. Can J Psychiatry 2003; 48: 338–41.
25 Fitzgerald, D, Lucas, S, Redoblado, MA, Winter, V, Brennan, J, Anderson, J, et al. Cognitive functioning in young people with first-episode psychosis: relationship to diagnosis and clinical characteristics. Aus N Z J Psychiatry 2004; 38: 501–10.
26 Wiegand, LC, Warfield, SK, Levitt, JJ, Hirayasu, Y, Salisbury, DF, Heckers, S, et al. Prefrontal cortical thickness in first-episode psychosis: a magnetic resonance imaging study. Biol Psychiatry 2004; 5: 131–40.
27 Badcock, JC, Michie, PT, Rock, D. Spatial working memory and planning ability: contrasts between schizophrenia and bipolar I disorder. Cortex 2005; 41: 753–63.
28 Goldstein, G, Shemansky, WJ, Allen, DN. Cognitive function in schizoaffective disorder and clinical subtypes of schizophrenia. Arch Clin Neuropsychol 2005: 20; 153–9.
29 Stip, E, Sepehry, AA, Prouteau, A, Briand, C, Nicole, L, Lalolende, P, et al. Cognitive discernible factors between schizophrenia and schizoaffective disorder. Brain Cogn 2005; 59: 292–5.
30 Glahn, DC, Bearden, CE, Cakir, S, Barrett, JA, Najt, P, Monkul, ES, et al. Differential working memory impairment in bipolar disorder and schizophrenia: effects of life time history of psychosis. Bipolar Disord 2006; 8: 117–23.
31 Gruber, O, Gruber, E, Falkai, P. Articulatory rehearsal in verbal working memory: a possible neurocognitive endophenotype that differentiates between schizophrenia and schizoaffective disorder. Neurosci Let 2006; 405: 24–8.
32 Fiszdon, JM, Richardson, R, Greig, T, Bell, MD. A comparison of basic and social cognition between schizophrenia and schizoaffective disorder. Schizophr Res 2007; 91: 117–21.
33 Selva, G, Salazar, J, Balanza-Martinez, V, Martinez-Aran, A, Rubio, C, Daban, C, et al. Bipolar patients with and without a history of psychotic symptoms: do they differ in cognitive functioning? J Psychiatr Res 2007; 41: 265–72.
34 Szoke, A, Meary, A, Trandafir, A, Bellivier, F, Roy, I, Schurhoff, F, et al. Executive deficits in psychotic and bipolar disorders. Implications for our understanding of schizoaffective disorder. Eur Psychiatry 2008; 23: 20–5.
35 Heinrichs, RW, Ammari, N, Vaz, SM, Miles, AA. Are schizophrenia and schizoaffective disorder are distinguishable? Schizophr Res 2008; 99: 149–54.
36 Ayres, MA, Busatto, GF, Menezes, PR, Schaufelberger, MS, Coutinho, L, Murray, RM, et al. Cognitive deficits in first episode psychosis: a population based study in Sao Paulo, Brazil. Schizophr Res 2007; 90: 338–43.
37 Gilvarry, CM, Barber, JS, Van Os, J, Murray, RM. Neuropsychological performance of psychotic patients in community care: results from the UK700 study. Acta Psychiatr Scand Suppl 2001; 104: 8191.
38 Metz, JT, Johnson, MD, Pliskin, NH, Luchins, DJ. Maintenance of training effects of the Wisconsin Card Sorting Test by patients with schizophrenia or affective disorders. Am J Psychiatry 1994; 151: 120–2.
39 Savage, RM, Jackson, WT, Sourathathone, CM. A brief neuropsychological testing battery for evaluating patients with schizophrenia. Community Ment Health J 2003; 39: 253–62.
40 Taiminen, T, Jaaskelainen, S, Ilonen, T, Meyer, H, Karlsson, H, Lauerma, H, et al. Habituation of the blink reflex in first-episode schizophrenia, psychotic depression and non-psychotic depression. Schizophr Res 2000; 44: 6979.
41 Reitan, RM. Validity of Trail Making Test as an indication of organic brain disease. Percept Mot Skills 1958; 8: 271–6.
42 Wechsler, D. WAIS–III. Wechsler Adult Intelligence Scale, Administration and Scoring Manual (3rd edn). Psychological Corporation, 1997.
43 Heaton, RK. Wisconsin Card Sorting Test Manual. Psychological Assessment Resources, 1981.
44 Lezak, MD, Howieson, DB, Loring, DW. Neuropsychological Assessment, (4th edn). Oxford University Press, 2004.
45 Gold, JM, Carpenter, C, Randolph, C, Goldberg, TE, Weinberger, DR. Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Arch Gen Psychiatry 1997; 54: 159–65.
46 Robbins, TW, James, M, Owen, AM, Sahakian, BJ, McInnes, L, Rabbitt, P. Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytical study of large sample of normal elderly volunteers. Dementia 1994; 5: 266–81.
47 Rey, A. L'examen Clinique en Psychologie. Presses Universitaires de France, 1964.
48 Delis, DC, Kramer, JH, Kaplan, E, Ober, BA. California Verbal Learning Test: Adult Version. Psychological Corporation, 1987.
49 Signoret, JL. BEM-84, Batterie d'Efficience Mnesique Reduite (Abbreviated battery of memory efficiency). Editions Elsevier, 1991.
50 Brandt, J, Benedict, RHB. The Hopkins Verbal Learning Test-Revised: Professional Manual. Psychological Assessment Resources, 2001.
51 Miller, G, Selfridge, J. Verbal context and recall of meaningful material. Am J Psychol 1950; 63: 176–85.
52 Wechsler, D. Wechsler Memory Scale – Revised Manual. Psychological Corporation, 1987.
53 Rey, A. Psychological examination of traumatic encephalopathy. Archives de Psychologie 1941; 28: 286340.
54 Benton, A. Benton Visual Retention Test, (4th edn). Psychological Corporation, 1974.
55 Van Beilen, M, Pijnenborg, M, van Zomeren, EH, van den Bosch, RJ, Withaar, FK, Bouma, A. What is measured by verbal fluency tests in schizophrenia? Schizophr Res 2004; 69: 267–76.
56 Bax, L, Yu, LM, Ikeda, N, Tsuruta, H, Moons, KGM. Development and validation of MIX: comprehensive free software for meta-analysis of causal research data. BMC Med Res Methodol 2006; 6: 50.
57 Leung, A, Chue, P. Sex differences in schizophrenia, a review of the literature. Acta Psychiatr Scand Suppl 2000; 401: 338.
58 Roy, MA, Maziade, M, Labbe, A, Merette, C. Male gender is associated with deficit schizophrenia: a meta-analysis. Schizophr Res 2001; 47: 141–7.
59 Cohen, AS, Saperstein, AM, Gold, JM, Kirkpatrick, B, Carpenter, WT Jr, Buchanan, RW. Neuropsychology of the deficit syndrome: new data and meta-analysis of findings to date. Schizophr Bull 2007; 33: 1201–12.
60 Kempf, L, Hussain, N, Potash, JB. Mood disorders with psychotic featurs, schizoaffective disorder, and schizophrenia with mood features: trouble at the borders. Int Rev Psychiatry 2005; 17: 919.
61 Kirckpatrick, B, Buchanan, RW, Breier, A, Carpenter, WT. Depressive symptoms and the deficit syndrome of schizophrenia. J Nerv Ment Dis 1994; 182: 452–5.
62 Fleming, SK, Blasey, C, Schatzberg, AF. Neuropsychological correlates of psychotic features in major depressive disorders: a review and meta-analysis. J Psychiatr Res 2004: 38: 2735.
63 Bora, E, Vahip, S, Akdeniz, F, Gonul, AS, Eryavuz, A, Ogut, M, et al. The effect of previous psychotic mood episodes on cognitive impairment in euthymic bipolar patients. Bipolar Disord 2007: 9: 468–77.
64 Glahn, DC, Bearden, CE, Barguil, M, Barrett, J, Reichenberg, A, Bowden, CL, et al. The neurocognitive signature of psychotic bipolar disorder. Biol Psychiatry 2007; 62: 910–6.
65 Crow, T. Nature of the genetic contribution to psychotic illness – a continuum view point. Acta Psychiatr Scand 1990; 81: 401–8.
66 Lake, CR, Hurwitz, N. Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease – there is no schizoaffective disorder. Curr Opin Psychiatry 2007; 20: 365–79.
67 Hallmayer, JF, Kalaydjeiva, L, Badcock, J, Dragovic, M, Howell, S, Michie, PT, et al. Genetic evidence for distinct subtype of schizophrenia characterized by pervasive cognitive deficit. Am J Hum Genet 2005; 77: 468–76.
68 Keefe, RSE, Fenton, WS. How should DSM-V criteria for schizophrenia include cognitive impairment? Schizophr Bull 2007; 33: 912–20.

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Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study

  • Emre Bora (a1), Murat Yucel (a2) and Christos Pantelis (a3)


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