Functional outcome in psychosis is better determined by negative symptoms than cognitive impairment

IntroductionCognitive impairment is considered the best predictor of functional outcome in psychosis. However, the nature of this relationship still remains to be determined.ObjectiveTo ascertain the relationship of negative symptoms and cognitive impairment with functional outcome in psychosis.MethodsNinety patients with a DSM-IV psychotic disorder diagnosis and 65 healthy controls were included in the study. We assessed the predominant negative symptoms over the course of illness with the Comprehensive Assessment of Symptoms and History (CASH). Functional outcome was assessed with the Specific Levels of Functioning (SLOF). Cognition was assessed with a set of neuropsychological tests, which were normalised to z-scores (regarding controls’ performance). Then, a Global Cognition Index (GCI) was obtained as a mean of the cognitive domains assessed: processing speed, attention, verbal and visual memory, executive functions, working memory and social cognition. We divided the sample in four groups, considering the presence/absence of negative symptoms (cut-off point of 2 in the CASH), and the presence/absence of cognitive impairment (considering a GCI z-score of–1 as cut-off point). We performed a MANOVA to compare the 4 groups’ functional outcome scores.ResultsFig. 1 shows the significant differences between groups regarding functional outcome.ConclusionsThe combination of negative symptoms and cognitive impairment has deleterious effects over functionality, but negative symptoms alone are related to functional outcome, independently of cognitive impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Effectiveness of Integrated Neurocognitive Therapy on Cognitive Impairment and Functional Outcome for Schizophrenia Outpatients

Schizophrenia Research and Treatment ◽

10.1155/2018/2360697 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Andreana De Mare ◽

Miriam Cantarella ◽

Giovanni Galeoto

Keyword(s):

Cognitive Impairment ◽

Functional Outcome ◽

Effect Size ◽

Negative Symptoms ◽

Social Cognitive ◽

Meta Analysis ◽

Positive Symptoms ◽

Global Functioning ◽

Cognitive Domains ◽

Treatment Research

Cognitive impairment is highly prevalent in patients with schizophrenia and schizoaffective disorder. Many interventions have been developed to treat cognitive deficit, since it has a strong impact on functional outcome; however, there are no integrated interventions targeting multiple neuro- and social-cognitive domains with a particular focus on the generalization of the effects of therapy on the functional outcome. Recently, a group of experts has developed a cognitive remediation group therapy approach called Integrated Neurocognitive Therapy (INT), which includes exercises to improve the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) neuro- and social-cognitive domains. This systematic review and meta-analysis aimed to assess the efficacy of this approach. We conducted a search of PubMed, Scopus, Web of Science, and PsycINFO to select primary studies evaluating INT in schizophrenic and schizoaffective patients. The primary outcomes of the meta-analysis included negative and positive symptoms and global functioning. Two randomized controlled trials met inclusion criteria. A total of 217 participants were included. Based on the results from the Positive and Negative Syndrome Scale (PANSS), a significant pooled effect size was observed for negative symptoms, which demonstrated not only an improvement in the patients treated immediately after therapy but also a permanence of positive results at a 9–12-month follow-up. On the other hand, no significant effect size was observed for positive symptoms. In addition, a significant pooled effect size was found for Global Assessment of Functioning (GAF), which shows how INT’s integrated approach has lasting positive implications on patients’ functional outcome. We concluded that INT might be an effective treatment for negative symptoms and global functioning in patients with schizophrenia, compared to treatment as usual (TAU).

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Longitudinal Trajectory and Characterization of Cancer-Related Cognitive Impairment in a Nationwide Cohort Study

Journal of Clinical Oncology ◽

10.1200/jco.2018.78.6624 ◽

2018 ◽

Vol 36 (32) ◽

pp. 3231-3239 ◽

Cited By ~ 21

Author(s):

Michelle C. Janelsins ◽

Charles E. Heckler ◽

Luke J. Peppone ◽

Tim A. Ahles ◽

Supriya G. Mohile ◽

...

Keyword(s):

Breast Cancer ◽

Cognitive Impairment ◽

Visual Memory ◽

Mixed Model ◽

Clinical Problem ◽

Significant Group ◽

Cognitive Domains ◽

Match To Sample ◽

Oncology Research ◽

Sample Test

Purpose Cancer-related cognitive impairment (CRCI) is an important clinical problem in patients with breast cancer receiving chemotherapy. Nationwide longitudinal studies are needed to understand the trajectory and severity of CRCI in specific cognitive domains. Patients and Methods The overall objective of this nationwide, prospective, observational study conducted within the National Cancer Institute Community Clinical Oncology Research Program was to assess trajectories in specific cognitive domains in patients with breast cancer (stage I-IIIC) receiving chemotherapy, from pre- (A1) to postchemotherapy (A2) and from prechemotherapy to 6 months postchemotherapy (A3); controls were assessed at the same time-equivalent points. The primary aim assessed visual memory using the Cambridge Neuropsychological Test Automated Battery Delayed Match to Sample test by longitudinal mixed models including A1, A2, and A3 and adjusting for age, education, race, cognitive reserve score, and baseline anxiety and depressive symptoms. We also assessed trajectories of CRCI in other aspects of memory as well as in attention and executive function with computerized, paper-based, and telephone-based cognitive tests. Results In total, 580 patients with breast cancer (mean age, 53.4 years) and 363 controls (mean age, 52.6 years) were assessed. On the Delayed Match to Sample test, the longitudinal mixed model results revealed a significant group-by-time effect ( P < .005); patients declined over time from prechemotherapy (A1) to 6 months postchemotherapy (A3; P = .005), but controls did not change ( P = .426). The group difference between patients and controls was also significant, revealing declines in patients but not controls ( P = .017). Several other models of computerized, standard, and telephone tests indicated significantly worse performance by patients compared with controls from pre- to postchemotherapy and from prechemotherapy to 6 months postchemotherapy. Conclusion This nationwide study showed CRCI in patients with breast cancer affects multiple cognitive domains for at least 6 months postchemotherapy.

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Aerobic Capacity Is Not Associated with Most Cognitive Domains in Patients with Multiple Sclerosis—A Cross-Sectional Investigation

Journal of Clinical Medicine ◽

10.3390/jcm7090272 ◽

2018 ◽

Vol 7 (9) ◽

pp. 272 ◽

Cited By ~ 6

Author(s):

Martin Langeskov-Christensen ◽

Søren Eskildsen ◽

Egon Stenager ◽

Henrik Boye Jensen ◽

Helle Hvilsted Nielsen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Performance ◽

Aerobic Capacity ◽

Z Score ◽

Vo2 Max ◽

Cross Sectional ◽

Cognitive Domains ◽

Impaired Group ◽

Z Scores

(1) Background: Cognitive impairment is highly prevalent in multiple sclerosis (MS). Staying physically fit may be associated with preservation of cognitive performance in persons with MS (pwMS); (2) Objective: To investigate the association between aerobic capacity and the cognitive domains of information processing, learning and memory, and verbal fluency as well as single and composite z-scores of the Brief Repeatable Battery of Neuropsychological tests (BRBNT) in pwMS; (3) Methods: All subjects first performed the BRBNT and then a maximal oxygen consumption (VO2-max) test on a bicycle ergometer as a measure of aerobic capacity. Simple and multiple (adjusting for age, sex, and education level) regression analyses were performed to evaluate the relationship between aerobic capacity and cognitive performance in different domains. Published international norms were used to compute z-scores for each individual and composite BRBNT score. Furthermore, cognitive impairment was defined as one or more z-scores ≤−1.5 standard deviation (SD) of healthy controls; (4) Results: Eighty-four subjects were included (44.9 ± 9 years, 16.3 ± 2 education years, Expanded Disability Status Scale (EDSS): 2.6 ± 1.4, MS-type (relapsing-remitting, primary progressive, or secondary progressive): 73/6/5, disease duration: 9.9 ± 7 years, VO2-max: 28.4 ± 7.0 mL O2/min/kg). No significant associations between aerobic capacity and cognitive performance in the individual BRBNT tests were found, except that a weak relationship was found between aerobic capacity and the composite processing speed z-score (R2 = 0.06, p = 0.02). The average global BRBNT z-score (−0.2 ± 0.66) was not associated with aerobic capacity. Comparison of the cognitively impaired group (34.5%) with the nonimpaired group (65.5%) showed lower aerobic capacity in the impaired group (25.9 ± 1 vs. 29.7 ± 1 mLO2/min/kg, p = 0.02); (5) Conclusions: Limited support was found for an association between performance in most cognitive domains and aerobic capacity in the present MS group with a third of patients showing signs of cognitive impairments.

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Abstract TMP45: Predicting Long-term Body Function, Activity & Participation After Stroke: The Prevailing Role of Cognition in Determining Functional Outcome

Stroke ◽

10.1161/str.48.suppl_1.tmp45 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Arunima Kapoor ◽

Krista Lanctot ◽

Mark Bayley ◽

Alex Kiss ◽

Richard Swartz

Keyword(s):

Cognitive Impairment ◽

Functional Outcome ◽

Stroke Severity ◽

Post Stroke ◽

Body Function ◽

Multiple Levels ◽

Multiple Domains ◽

Levels Of Functioning ◽

The Impact

Background: Stroke can impact multiple levels of function and result in complex disability. Few studies have examined limitations across the range of functions from body function to social participation, or explored the impact of post-stroke comorbidities, such as depression, obstructive sleep apnea (OSA) and cognition, on function, especially in the long-term. We aimed to determine post-stroke predictors of multiple levels of functioning approximately 2 years after a stroke, and to specifically evaluate the impact of depressive symptoms, OSA and cognitive impairment on outcome. Hypothesis: We hypothesized that in addition to traditional predictors of outcome–age and stroke severity–depression, OSA and cognitive impairment will predict functional outcome in multiple domains. Methods: Baseline assessment of depression, apnea and cognitive impairment with 2-year follow-up assessment of functional outcome to evaluate each of the three levels of functioning as stated in the WHO International Classification of Functioning: Body Function (Montreal Cognitive Assessment), Activity (modified Rankin) and Participation (Reintegration to Normal Living Index). Results: A total of 162 patients were enrolled at approximately 2 years and 5 months post-stroke. Forty one percent had activity limitations, 58% were cognitively impaired and 68% had restrictions in participation. Long-term activity limitation was predicted by greater age (OR = 0.95), stroke severity (OR = 1.69) and cognitive impairment (OR = 1.28) at baseline. Body function impairment was predicted by greater age (OR = 0.96), and cognitive impairment (OR = 1.49). Participation restriction was predicted by cognitive impairment (OR = 1.26). Conclusion: Baseline cognition predicts long-term function in multiple domains and is a better predictor of long-term participation than age or baseline stroke severity. In view of the widespread impact of post-stroke cognitive impairment on every level of functioning, routine post-stroke cognitive screening and target interventions are warranted. Greater attention to functional domains beyond activity could further optimize recovery and enhance outcome after stroke.

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Nonlinguistic Cognitive Impairment in Poststroke Aphasia

Neurorehabilitation and Neural Repair ◽

10.1177/1545968313508467 ◽

2013 ◽

Vol 28 (3) ◽

pp. 273-281 ◽

Cited By ~ 36

Author(s):

Hanane El Hachioui ◽

Evy G. Visch-Brink ◽

Hester F. Lingsma ◽

Mieke W. M. E. van de Sandt-Koenderman ◽

Diederik W. J. Dippel ◽

...

Keyword(s):

Cognitive Impairment ◽

Visual Perception ◽

Functional Outcome ◽

Visual Memory ◽

Rating Scale ◽

Cognitive Impairments ◽

Cognitive Domain ◽

First Year ◽

Abstract Reasoning ◽

Severity Rating

Background and objectives. Information on cognitive impairment in aphasic patients is limited. Our aim was to investigate the prevalence and course of nonlinguistic cognitive impairments in the first year after stroke and their association with aphasia and functional outcome. Methods. We included 147 patients with acute aphasia. At 3 months and 1 year, we assessed cognition with a nonlinguistic cognitive examination including abstract reasoning, visual memory, visual perception and construction, and executive functioning. We assessed language with a verbal communication rating (Aphasia Severity Rating Scale), the ScreeLing (a linguistic-level screening test), and the Token Test. We evaluated functional outcome with the modified Rankin scale and registered the use of antidepressants. Results. In total, 107 (88%) patients had impairments in at least one nonlinguistic cognitive domain at 3 months and 91 (80%) at 1 year. The most frequently observed impairment concerned visual memory (83% at 3 months; 78% at 1 year) and the least frequent visual perception and construction (19% at 3 months; 14% at 1 year). There was improvement on all cognitive domains including language, except for abstract reasoning. Patients with persisting aphasia had lower cognitive domain scores, worse functional outcome, and were more often depressed than patients who had recovered from aphasia. Conclusions. Standard nonlinguistic cognitive examination is recommended in aphasic stroke patients. Nonlinguistic cognitive impairments are common and associated with poor functional outcome and depression, especially in patients with persisting aphasia.

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Cognitive impairment in COPD: a systematic review

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132015000004424 ◽

2015 ◽

Vol 41 (2) ◽

pp. 182-190 ◽

Cited By ~ 32

Author(s):

Irene Torres-Sánchez ◽

Elisabeth Rodríguez-Alzueta ◽

Irene Cabrera-Martos ◽

Isabel López-Torres ◽

Maria Paz Moreno-Ramírez ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Verbal Memory ◽

Visual Memory ◽

Cognitive Domain ◽

Disease Stage ◽

Cognitive Domains ◽

Future Studies ◽

Memory And Attention ◽

Copd Patients

The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD.

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Sex Differences in Verbal Memory Predict Functioning Through Negative Symptoms in Early Psychosis

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa054 ◽

2020 ◽

Vol 46 (6) ◽

pp. 1587-1595 ◽

Cited By ~ 2

Author(s):

Gabriella Buck ◽

Katie M Lavigne ◽

Carolina Makowski ◽

Ridha Joober ◽

Ashok Malla ◽

...

Keyword(s):

Sex Differences ◽

Verbal Memory ◽

Visual Memory ◽

Parental Education ◽

Negative Symptoms ◽

Early Psychosis ◽

First Episode ◽

Severe Illness ◽

Cognitive Domains

Abstract Verbal memory (VM) is one of the most affected cognitive domains in first-episode psychosis (FEP) and is a robust predictor of functioning. Given that healthy females demonstrate superior VM relative to males and that female patients show less-severe illness courses than male patients, this study examined whether normative sex differences in VM extend to FEP and influence functioning. Four hundred and thirty-five patients (299 males, 136 females) with affective or nonaffective psychosis were recruited from a catchment-based specialized FEP intervention service and 138 nonclinical controls (96 males, 42 females) were recruited from the same community. One of the two neurocognitive batteries comprising six cognitive domains (VM, visual memory, working memory, attention, executive function, processing speed) were administered at baseline. In patients, positive and negative symptoms were evaluated at baseline and functioning was assessed at 1-year follow-up. Patients were more impaired than controls on all cognitive domains, but only VM showed sex differences (both patient and control males performed worse than females), and these results were consistent across batteries. In patients, better baseline VM in females was related to better functioning after 1 year, mediated through fewer baseline negative symptoms. Supplemental analyses revealed these results were not driven by affective psychosis nor by age and parental education. Thus, normative sex differences in VM are preserved in FEP and mediate functioning at 1-year follow-up via negative symptoms. This study highlights the importance of investigating sex effects for understanding VM deficits in early psychosis and suggests that sex may be a disease-modifying variable with important treatment implications.

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Cognition in schizophrenia: Selective impairment and factors that influence it

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2127 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S193-S193 ◽

Cited By ~ 3

Author(s):

N. Petrova ◽

M. Dorofeikova

Keyword(s):

Cognitive Impairment ◽

Cognitive Functioning ◽

Clinical Features ◽

Visual Memory ◽

Memory Impairment ◽

Paranoid Schizophrenia ◽

Disease Onset ◽

Complex Figure ◽

Competing Interest ◽

Problem Solving Behavior

Currently it is well known that schizophrenia is associated with cognitive impairment. Still there are many unresolved questions, such as whether cognitive deficit is total, what are the relationships of cognitive impairment with clinical features, demographic characteristics and different biomarkers, which could shed light on its pathogenesis. The aim of our study was to characterize cognitive impairment in schizophrenia and to find factors that may contribute to it. Sixty patients with paranoid schizophrenia were examined. BACS, Rey-Osterreith complex figure and correction task were used to assess cognitive functioning. Only 14.3% of patients had BACS score in the normal range. The vast majority of them showed impaired motor function, verbal and visual memory. Cognitive functioning did not worsen with time. Working memory impairment was influenced by genetic predisposition to schizophrenia and age of disease onset. Residual positive symptoms led to a decrease in the speed of skill development. Symptoms of anxiety and depression contributed to the impairment of accuracy. Hypomania was associated with impaired planning. Planning and problem-solving behavior did not correlate with other cognitive functions, which makes them isolated domains. Higher levels of NSE had been found in patients with more severe memory impairment. S100B level was associated with safer constructive abilities. In general, cognitive impairment in schizophrenia, although present in the majority of patients, varies a lot and appears selective and dependent on certain clinical features.The study was supported by RSCF 14-50-00069 grant.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Association of neuropsychiatric symptoms and sub-syndromes with cognitive impairment in community-dwelling Asian elderly

International Psychogeriatrics ◽

10.1017/s1041610215000976 ◽

2015 ◽

Vol 27 (11) ◽

pp. 1839-1847 ◽

Cited By ~ 8

Author(s):

Xin Xu ◽

Seow Li Ang ◽

Saima Hilal ◽

Qun Lin Chan ◽

Tien Yin Wong ◽

...

Keyword(s):

Cognitive Impairment ◽

Verbal Memory ◽

Visual Memory ◽

Neuropsychiatric Symptoms ◽

Neuropsychological Testing ◽

Executive Dysfunction ◽

Community Dwelling ◽

Cognitive Domains ◽

Epidemiology Of Dementia ◽

Cognitive Impairment No Dementia

ABSTRACTObjectives:To investigate the presence of neuropsychiatric symptoms (NPS) and sub-syndromes in elderly community-dwelling Asians with varying severity of cognitive impairment.Methods:Chinese and Malay participants (n = 613) from the Epidemiology of Dementia in Singapore (EDIS) Study aged ≥ 60 years underwent clinical examination, neuropsychological testing, and NPS assessment using the Neuropsychiatric Inventory (NPI). Diagnosis of no cognitive impairment (NCI), cognitive impairment-no dementia (CIND), including CIND-mild and CIND-moderate, and dementia were made using established criteria.Results:A significant increase in the numbers of NPS was observed accompanying with increasing severity of cognitive impairment (p < 0.001). Compared to those with NCI/CIND-mild, participants with CIND-moderate [Odds ratio (OR): 4.2, 95% confidence interval (CI): 1.8–10.0] or dementia [OR: 9.2, 95% CI: 2.3–36.0] were more likely to have two or more neuropsychiatric sub-syndromes. Participants with CIND-moderate were more likely to have hyperactivity [OR: 2.0, 95% CI: 1.0–3.8] and apathy [OR: 2.9, 95% CI: 1.0–8.4] sub-syndromes, whereas patients with dementia were more likely to have psychosis [OR: 6.9, 95% CI: 2.4–20.1], affective (OR: 8.7, 95% CI: 1.8–42.9), and hyperactivity (OR: 5.4, 95% CI: 1.8–16.1). Furthermore, executive dysfunction and visual memory impairment were associated with the presence of three neuropsychiatric sub-syndromes; whist language and visuomotor speed impairment were related to the presence of two sub-syndromes. By contrast, impairment in attention, verbal memory, and visuoconstruction were not associated with any of the sub-syndromes.Conclusions:The presence of NPS and sub-syndromes increase with increasing severities of cognitive impairment, and different neuropsychiatric syndromes are associated with specific impairment on cognitive domains in community-dwelling Asian elderly.

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Cognitive Impairment in Tramadol & Synthetic Cannabinoids Use Disorder Patients

QJM ◽

10.1093/qjmed/hcab102.006 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Yasser Abdelrazik Mohamed ◽

Hanan Hany Elrassas ◽

Zeinab Mohamed Ahmed ◽

Aya Taha Mohamed

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Personality Disorder ◽

Personality Disorders ◽

Visual Memory ◽

Borderline Personality ◽

Synthetic Cannabinoid ◽

Trail Making Test ◽

Cognitive Domains ◽

Trail Making

Abstract Background Studies have suggested that Patients with polysubstance abuse (n = 76) and tramadol alone abuse (n = 24) were more likely to have cognitive impairment (CI) (81% and 66.7%, respectively) than the control subjects (28%) as reflected by the total Montreal cognitive assessment (MoCA) scores. All cognitive domains were significantly impaired among tramadol-abuse patients, whereas tramadol-alone patients had significant impairment in all cognitive domains except attention, visuoconstructional (cube), and trail-making test. The most affected cognitive domains were memory, visuospatial skills, and verbal fluency. Reliable estimates of tramadol and synthetic cannabinoids addiction prevalence are important to prevent, treat, and identify causes of addiction, especially in light of recent work revealing a high prevalence of cognitive impairment among drug abusers. Aim of the Work to assess the cognitive function among tramadol & synthetic cannabinoid use disorder patients in addiction clinic of Ain shams university hospitals, as well as comparing the cognitive function between them and healthy adults. Patients and Methods This is a Cross sectional case-control observational study conducted in Ain Shams University hospitals. This present study aimed at analyzing the data of 30 tramadol dependent, 30 synthetic cannabinoid dependent patients & 30 healthy controls, diagnosed by DSM-4 and then they will undergo SCIDI (to exclude any psychiatric comorbidity), SCIDII (for personality disorders), addiction severity index, Wechsler memory scale (for different memory functions), trail making test (for visual attention and task switching) and Benton visual retention test (for visual perception and visual memory), over a period from October 2018 to August 2019. Results A total of 30 tramadol dependent patients, 14 (46.67) were diagnosed as major depressive disorder, 14 (46.67%) as antisocial personality disorder, 23 (76.67) as borderline personality disorder. 26 (86.67 %) patients showed impairment in Benton visual test, 10 (33.33%) patients showed impairment in trail making test. 29 (96.69%) out of 30 patients showed impairment in verbal paired association I & II and visual memory span scales, 30 (100%) out of 30 patients showed impairment in visual paired association I&II and digit span scales. A total 30 synthetic cannabinoid patients, 9 (30%) were diagnosed as psychotic disorder, 7 (23.33%) as bipolar disorder, 1 (3.33%) as major depressive disorder, 19 (63.33%) as antisocial personality disorder, 27 (90%) as borderline personality disorder. 29 (96.67%) patients showed impairment in Benton visual test, 22 (73.33%) patients showed impairment in trail making test. 30 (100%) out of 30 patients showed impairment in visual paired association I&II, verbal paired association I&II, visual memory span and digit span. Conclusion This study provides observation of impaired cognitive function in chronic tramadol and SC users. Tramadol and SC users have shown impairments in visual, auditory, working, immediate, delayed memory and task shifting, as well as an elevation of comorbid psychiatric and personality disorders as psychotic, bipolar and depressive disorders. Also, there was comorbid antisocial and borderline personality disorders. Further research is required to examine the effects of acute and chronic SC consumption on cognitive function with comprehensive explorations of demographic background and objective measurements of substance use.

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