Cognition of Schizophrenic Inpatients and Healthy Individuals: Casual-Comparative Study

Introduction: Aim of current study is to compare cognitive condition of schizophrenic inpatients of psychiatric hospital and healthy individuals. Materials and Methods: This study is a practical research and with respect to nature and method is casual-comparative research. Statistical Society of this society consisted of 73 inpatients schizophrenic patients, who were admitted to Zare psychiatric hospital between 2015-2016. Sample Size Determination was done via Krejcie and Morgan Table and sample size reduced to 60 patients. In order to choose sample, random sampling method was used. Field data collection and library were used regarding obtaining data; GHQ28 and Wechsler Adult Intelligence Scale were used. Reliability of the test was 0.77 according to Cronbach’s alpha. We assessed hypotheses of this study via SPSS software and univariate t-analysis. Results and Conclusion: A result of the study is demonstrative of meaningful difference between similarities, picture completion and information between case group and control group. However, no meaningful difference was noticed in aforementioned subtests with respect to duration of this disorder.


Introduction
Among psychiatric disorders, psychosis and more specifically schizophrenia maintain significant importance among mental health professionals. Schizophrenia contains wide spectrum of cognitive, social and emotional deficiencies and lead to major malfunctioning in afflicted individuals [1].
Emil Kraepelin was one of the pioneers who categorized schizophrenia as specific disorder; due to early onset of this disorder Kraepelin called it youth psychosis. The term schizophrenia was firstly coined by Bleuler [2].
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
Signs and Symptoms Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too. The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.
Positive symptoms: "Positive" symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may "lose touch" with some aspects of reality. Symptoms include: Hallucinations Delusions Thought disorders (unusual or dysfunctional ways of thinking) Movement disorders (agitated body movements) Negative symptoms: "Negative" symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include: "Flat affect" (reduced expression of emotions via facial expression or voice tone) Reduced feelings of pleasure in everyday life Difficulty beginning and sustaining activities Reduced speaking Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include: Poor "executive functioning" (the ability to understand information and use it to make decisions), Trouble focusing or paying attention, Problems with "working memory" (the ability to use information immediately after learning it) In recent years reviews have yield a reconsideration of some widely cited, but poorly supported by evidence, aspects of schizophrenia epidemiology. The first is the notion that schizophrenia has universal incidence across cultures and countries. The second is the belief that schizophrenia distributes itself equality in males and females. Taken together these beliefs could be conceptualized as schizophrenia is an equalitarian disorder, and schizophrenia is an exceptional disorder. It is puzzling that these two interrelated beliefs are usually cited as evidence for a biological origin of the disease, when most diseases in medicine do vary across cultures, countries, and gender [3].

Cognitive Dysfunction among Schizophrenic Patients:
Cognitive dysfunction is a core feature of schizophrenia. Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits pre-date the onset of frank psychosis and are stable throughout the course of the illness in most patients. Over the past decade, the focus on these deficits has increased dramatically with the recognition that they are consistently the best predictor of functional outcomes across outcome domains and patient samples. Recent treatment studies, both pharmacological and behavioral, suggest that cognitive deficits are malleable. Other research calls into question the meaningfulness of cognitive change in schizophrenia [4]. According to recent meta-analysis on cognitive deficits of patients with schizophrenia evidenced by the comparison with normal control cases, has confirmed the stability of the results found in the previous work. These findings show a generalized presence of cognitive impairment among the patients with schizophrenia. These results cannot be considered free of the potential bias that only controlled studies with positive results are available in the published evidence, while all those with negative results are not traceable. The real possibility of such a bias, should make us consider that the results obtained in this meta-analysis might be, in some degree, inflated by an underrepresentation of negative results [5].
It is clear that it is not possible to assess all detrimental aspects of schizophrenia in one study. Thus, in current study we mainly focused on cognitive problems of this group of patients. Screening and identifying cognitive problems related to this malady may assist clinicians in order to approach this disorder with more insight about its detrimental consequences.

Materials and Methods
This study is a practical research and with respect to nature and method is casual-comparative research. Statistical Society of this society consisted of 73 inpatients schizophrenic patients, who were admitted to Zare psychiatric hospital between 2015-2016. Sample Size Determination was done via Krejcie and Morgan Table and sample size reduced to 60 patients. In order to choose sample, random sampling method was used. Field data collection and library were used regarding obtaining data; GHQ28 and Wechsler Adult Intelligence Scale were used. Reliability of the test was 0.77 according to Cronbach's alpha. We assessed hypotheses of this study via SPSS software and univariate t-analysis  Malakouti and Colleagues (2007), GHQ-28 was an internally consistent measure. Cronbach's alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Four factors were extracted using factor analysis: "depression," "psychosocial activity," "anxiety," and "somatic." Using receiver operating curve (ROC) analysis, the optimum cutoff score for the GHQ-28 in this group was 19/20 (sensitivity 0.83, specificity 0.76). Using a loading of 0.6 or greater, a short form of the instrument (GHQ-15) (alpha=0.9) was derived and correlated well with the longer form of the scale (r=0.97). Using ROC analysis, the optimum cutoff score was 10/11 (sensitivity 0.83, specificity 0.69) [8].

Results
Data regarding gender distribution can be noticed in Table 1. Data regarding educational status can be noticed in Table 2. Data regarding marital status can be noticed in Table 3.  Regarding assessment of normal distribution of data we used Kolmogorov-Smirnov test. Data can be noticed in Table 5.

Group
Variables z Error p-value value is lower than 0.05 and there is meaningful difference between score of Information subtest between case group and control group; score of Information subtest is higher in control group. According to Table 6, p-value is lower than 0.05 and there is meaningful difference between score of Block Design subtest between case group and control group; score of Block Design subtest is higher in control group. According to Table 6, p-value is lower than 0.05 and there is meaningful difference between score of Picture Arrangement subtest between case group and control group; score of Picture Arrangement subtest is higher in control group. According to Table 6, p-value is lower than 0.05 and there is meaningful difference between score of IQ subtest between case group and control group; score of IQ subtest is higher in control group.