[Psychopathologic and cognitive investigations in schizophrenia].

UNLABELLED: The topics of the thesis are: analysing the long-term course of delusions and hallucinations in patients with psychotic disorders, in particular in the highlight of schizophrenia patients, according to the "Budapest 2000" project; and studying the feedback-guided associative learning and acquired equivalence in two groups of schizophrenia patients and matched controls.

AIMS: I. 1. To study the severity, the changeability, and likelihood of appearance of delusions and hallucinations in each identified clinical group over time; 2. to differentiate the courses of illnesses along the two psychopathological symptoms. II. To investigate the cognitive dimension in schizophrenia patients regarding feedback-guided associative learning and acquired equivalence: distinguishing the deficit/non-deficit schizophrenia subtypes from each other and controls.

METHODS: 221 female patients were evaluated in the first study. Originally, the subjects were classified according to Leonhardian nosological system into affective, cycloid and schizophrenia groups (at the endpoint of the study they were re-diagnosed according to DSM-IV) and were assessed at three different times (index, and 5, and 21-33-year follow-up). The Rockland-Pollin Rating Scale and "List of Specific Symptoms" were obtained at each time point in the study. In the second study 49 male and female schizophrenia patients and 20 matched controls were evaluated. They were assessed by Rutgers Acquired Equivalence Test, some frontal neuropsychological tests, and Positive and Negative Symptom Scale.

RESULTS: 1. The main positive symptoms with some fluctuations persist through the illness courses. Each symptom of positive dimension shows reduction, but the severity of hallucinations shows a significant worsening after 5 years, while the severity of delusions shows mild, but not significant reduction. Affective, cycloid and schizophrenia groups were distinguished in view of the observed symptoms and social functioning, and certain schizophrenia subgroups were distinguishable based on the correlation of the two symptoms. 2. The acquired equivalence learning was similarly impaired in deficit and non-deficit patients, whereas feedback-guided associative learning was impaired only in deficit patients. Associative learning and acquired equivalence were not related to frontal lobe tests.

CONCLUSIONS: 1. The two subgroups (deficit/non-deficit) of schizophrenia may be distinguished based on the observed phenomenon of cognitive dimension. 2. The classical schizophrenic subtypes (catatonic, hebephrenic, paranoid) may be differentiated based on the changes of positive dimension through the long-term follow-up investigation.