Comparison of executive functions in patients with schizophrenia without psychotic symptoms, major depression without psychotic symptoms and normal people in Shiraz (2011).

Dissertation for Master's degree (M.A.)

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Comparison of executive functions in patients with schizophrenia without psychotic symptoms, major depression without psychotic symptoms and normal people in Shiraz (2013)

Abstract

Different researches have identified cognitive deficits as one of the have raised important aspects of schizophrenia. In addition, the presence of psychosis in these patients can affect the level of executive function impairment. The aim of the current research is to compare the executive functions in schizophrenia patients without psychotic symptoms and major depression without psychotic symptoms and normal people. This research is causal-comparative. For this purpose, 30 schizophrenic patients without psychotic symptoms (15 women, 15 men) and 30 major depressive patients without psychotic symptoms (15 women, 15 men) and 40 normal subjects (20 women, 20 men) were selected from the available sampling method from Dr. Moharri Neurological and Psychiatric Hospital in Shiraz, and they were matched based on the variables of age, sex, and education. Executive functions of the subjects were evaluated by means of Wisconsin classification tests, Stroop word and color test, general health questionnaire and Mehek test. The data were analyzed using multivariate analysis of variance, one-way F test, and Ben Feroni's post hoc test. The results showed that there was no significant difference in the Wisconsin test between schizophrenia patients with psychotic symptoms and major depression without psychotic symptoms and normal subjects, but in the Strobe word and color test, there was a difference in reaction time between the performance of schizophrenia patients without psychotic symptoms and major depression without psychotic symptoms and normal subjects. Also, there was no significant difference between male and female subjects in the Stroop and Wisconsin tests, and the results of the multivariate analysis of variance showed that the education factor and age did not have an effect on the scale of executive function, but the results showed that the factor of changes in morbid intelligence has an effect on the performance of the groups, but it alone cannot be a predictor.

Conclusion: In general, more impairment of executive functions in the Wisconsin Card Sorting Test and the Stroop word and color test is related to psychotic aptitude, and also gender has an effect on the executive function of schizophrenia patients without psychotic symptoms and major depression without psychotic symptoms and normal people. Keywords: executive functions, schizophrenia without psychotic symptoms, depression without psychotic symptoms, Wisconsin card matching test, Stroop word and color test

"There is considerable evidence from postmortem studies of patients' brains, which confirms the anatomical abnormality of the prefrontal cortex in schizophrenia. Functional brain imaging methods have also shown functional defects in the frontal area. It has been known for a long time that such schizophrenic symptoms are similar to the symptoms seen in prefrontal lobotomy or frontal lobe syndromes." (Reza'i, 2015, p. 19).

The prefrontal communication area is capable of recalling information from wide areas of the brain and then using it in deep thinking patterns to achieve to the desired patterns. A defect in the prefrontal area causes a disturbance in executive actions, i.e. neuro-psychological processes that are necessary to adapt to the environment. Executive actions include abilities such as planning, initiative, flexibility, maintaining motivation, the ability to recognize and change sequences, the ability to use cues and feedback to perform targeted behavior, the ability to think abstractly (increasing the depth and connection of thoughts), and simultaneously maintaining a large number of units of information and then recalling this information to perform subsequent actions (Klan [1], Kenan [2], 2000).

Studies related to regional brain blood flow (RCBF) [3] using positron emission thermography (SPEST_PET) [4] has shown that the disturbance in responding to the Wisconsin test was observed with frontal lobe dysfunction (Strata and Danilo [5], 2000).

Research has shown that patients with schizophrenia have more cognitive defects compared to normal people. In the definition of executive performance, Lezak [6], 1995 said: Executive performance requires a person's ability to regulate and direct his behavior.This role can be divided into sub-sections including intention and will, planning, purposeful action and effective performance (quoted by Pasha Sharifi, 2016).

Unlike the importance of executive abilities, this is ignored in the psychological evaluation situation. One of the reasons for this is that the executive function is disturbed, while other cognitive functions seem to be healthy. Grath-Marnat (2003, translated by Pasha Sharifi and Niko, 2016). There is some evidence that shows that the patient's intelligence increases after a frontal lobe lesion, but their executive abilities are impaired (same source).

Executive functions are defined as complex processes that are used in solving new problems. This process includes awareness of existing problems and their evaluation, analysis of problem conditions and the formulation of specific goals, creating a set of plans and maps in order to specify the actions needed to solve the problem. Changing ineffective plans and changing to implement more effective plans, comparing the results obtained with the previous results (if a new plan suitable for the situation of the problem is used), finishing the plan when the results are satisfactory, and finally maintaining the plan and recovering it for dealing with a similar problem or problem in the future is Grath-Marnat (2003, translated by Pasha Sharifi and Nikkho, 2016). (Golden [8], 1987) and the Wisconsin Card Sorting Test [9] (Grant and Weberg [10], 1993) are measured by Heben [11], Milberg [12] (2002, translated by Haqshanas, 2017).

Actually, the purpose of the research is to investigate the executive function of patients with schizophrenia without psychotic symptoms, major depression without psychotic symptoms and normal people. By means of two Stroop color and word tests and the Wisconsin card sorting test.

1-2- Statement of the problem

Schizophrenia (psychosis) is a clinical syndrome that includes variable but deeply destructive psychological pathology that includes cognition, emotion, perception and other aspects of behavior. The lifetime prevalence of schizophrenia in the United States is 1%, which means that approximately one in 100 people will develop schizophrenia, and there is also considerable evidence from postmortem brain studies of patients that supports anatomical abnormalities of the prefrontal cortex in schizophrenia patients, and it is estimated that the economic and social cultural factors of the financial losses caused by schizophrenia in the United States are greater than the losses caused by all cancers combined, Kaplan Vesaduk [13] (2007, Reza'i translation, 2013)

According to the revised text of the fourth edition (DSM-IV-TR)[14], major depressive disorder occurs without a history of mania, mixed, or hypomania. A major depressive episode must last at least two weeks and also have four symptoms from a list including changes in appetite and weight, changes in sleep and activity, lack of energy, feelings of guilt, difficulty thinking and making decisions, and recurrent thoughts of death or suicide. Depressive disorder has the highest prevalence (17%) among psychiatric disorders (same source).

Given the high prevalence of major depression as well as the financial problems and losses of schizophrenia, this research is useful, as well as research in the field of comparing the executive functions of patients with schizophrenia, major depression without psychosis and normal people using the Wisconsin cards so far, but the research that measures the executive functions of these groups with word and color Stroop tests has so far been conducted. It has not been done, therefore, the present research in this regard is under the title of comparing the executive functions of patients with schizophrenia without psychotic symptoms, major depression without psychotic symptoms and normal people. Perception and other aspects involve behavior. The occurrence of these manifestations varies in different people and over time, but the impact of the disease is always severe and usually long-lasting. Kaplan and Sadok [15] (2007, Reza'i translation, 1390). 1-3-2 Major depression Depression is a very broad and somewhat vague term. For a normal person, it evokes a certain state of sadness, cramping and impatience, and for a doctor, it evokes a wide group of mood disorders with many sub-branches (Porafkari, 2016).