Caracterización neuropsicológica de los déficits en las funciones ejecutivas cool y hot en pacientes con esquizofrenia con predominio de síntomas negativos o positivos

Resumen

Schizophrenia is one of the most serious and disabling mental disorders on the entire spectrum covered by psychiatry. It is characterized by a series of manifestations that are expressed at different levels, whether clinical, neuroanatomical, behavioral, or cognitive. All these levels are possibly related and operate together. From a clinical point of view, the symptoms of schizophrenia can be grouped according to the predominance of negative or positive symptoms that are present. Negative symptoms (NS)are characterized by a loss or decrease of normal mental and physical functions. While, in positive symptoms (PS), there are symptoms that were not present before, being generally characterized by a loss of contact with reality. Despite the shocking nature of these symptoms, the most devastating problem is the difficulties these patients present in their daily functioning (personal, family, work and social). These difficulties have been related to the cognitive impairment that occurs in schizophrenia. Specifically, it is the cognitive domain of executive functions (EEFF) that has been directly related to a higher incidence of problems in daily life. Executive functions refer to the set of higher order cognitive (cool) and socio-emotional (hot) processes, which allow us to carry out goal-directed actions and give adaptive responses to novel or complex situations. However, despite its importance, the evaluation of EEFF in schizophrenia has been accompanied over time by a series of important limitations. All this has contributed to the fact that, to date, it is difficult to establish both cognitive and socio-emotional executive deficits in this population. For this reason, with this Doctoral Thesis it was intended to carry out a neuropsychological evaluation that would allow to solve these difficulties. The objective, therefore, consisted in the neuropsychological characterization of the deficits in the cool and hot EEFF in patients with Schizophrenia with a predominance of negative symptoms and a predominance of positive symptoms with computerized evaluative instruments valid for the study of EEFF. Thus, in our first study with patients with a predominance of NS, we have found that these symptoms are related to dysexecutive behaviors associated with dorsolateral circuit involvement. Being those symptoms related to expressive deficits those that could benefit the most from psychosocial interventions. While those symptoms associated with disorderly relationships are the symptoms that present the greatest social and interpersonal difficulties. Regarding our second study, these patients with a predominance of NS show an impairment in the cool executive components of working memory and cognitive flexibility. And an impairment in hot executive functions, requiring a longer time to classify emotional facial expressions. and presenting an affectation of the theory of mind. Regarding our third study in patients with a predominance of PS, we found an impairment in the cool executive component of working memory, and an important impairment in hot executive functions, presenting an impairment in the recognition of basic and complex facial expressions and in theory of mind. Similarly, we found a relationship between EEFF and those symptoms related to disorganization, such as formal thought disorders and extravagant behavior, but not with the symptoms more related to the distortion of reality such as delusions and hallucinations. According to the results obtained, we can conclude that regardless of the symptomatology presented, the two groups of patients, both those with SN and SP predominance, present an important deterioration in the executive component of working memory, both in coding, as in maintenance and Information updating, being this ability the one that is most affected in comparison with the other executive processes. On the other hand, it is also concluded that patients with NS present a greater affectation of cool EEFF, and patients with PS present a greater affectation of hot EEFF. On the other hand, only the clinical symptoms related to disorganization, such as formal thought disorders, and extravagant behavior, are related to the performance of EEFF tasks. Finally, regarding the behavioral manifestations resulting from damage in the different fronto-subcortical circuits, we found that in general the symptoms of Schizophrenia occur with the three fronto-subcortical syndromes: dorsolateral (executive level involvement), orbitofrontal (disinhibition), and the Anterior cingulate (apathy), with dysexecutive and apathetic behaviors occurring to a greater extent, with a lower proportion of uninhibited behaviors. Finally, and considering the results of this Doctoral Thesis, it is evident the need to implement neuropsychological rehabilitation programs in Schizophrenia, which consider both the cognitive and socio-emotional components of the EEFF. In addition, these interventions must be followed by a prior systematic evaluation, based on experimental paradigms of cognitive neuroscience that helps to discriminate with greater precision the affectation that occurs in each executive domain, this, in order that the interventions are carried out in an individualized mode adapted to the specific deficits that each patient presents