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Reading Deficits in Schizophrenia and Individuals at High Clinical Risk: Relationship to Sensory Function, Course of Illness, and Psychosocial Outcome
Nadine Revheim, Ph.D.; Cheryl M. Corcoran, M.D.; Elisa Dias, Ph.D.; Esther Hellmann, M.Phil.; Antigona Martinez, Ph.D.; Pamela D. Butler, Ph.D.; Jonathan M. Lehrfeld, M.A.; Joanna DiCostanzo, M.P.H.; Jennifer Albert, B.A.; Daniel C. Javitt, M.D., Ph.D.
Am J Psychiatry 2014;171:949-959. doi:10.1176/appi.ajp.2014.13091196
View Author and Article Information

Dr. Javitt has received honoraria from American Capital, Bristol-Myers Squibb, Clearpoint Communications, Clearview Healthcare, Consensus Medical Communications, Eli Lilly, Envivo, Guidepoint Global, Omeros, Otsuka, SK Biopharmaceuticals, Sunovion, Takeda, and Vindico Medical Communication; research support from Pfizer and Roche; equity in Glytech and AASI; and intellectual property rights for use of glycine, D-serine, and glycine transport inhibitors in schizophrenia and for serving on a scientific advisory board of Promentis. The other authors report no financial relationships with commercial interests.

Supported by NIH grants R01 MH49334, P50 MH086385, and P50 MH086385-S1 to Dr. Javitt.

From the Program in Cognitive Neuroscience and Schizophrenia, and the Departments of Psychiatry and Neuroscience, Nathan Kline Institute for Psychiatric Research, Orangeburg, N.Y.; the Division of Experimental Therapeutics, Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York.

Address correspondence to Dr. Revheim or Dr. Javitt (revheim@nki.rfmh.org or dcj2113@columbia.edu).

Copyright © 2014 by the American Psychiatric Association

Received September 09, 2013; Revised December 24, 2013; March 02, 2014; Accepted April 07, 2014.

Abstract

Objective  The ability to read passages of information fluently and with comprehension is a basic component of socioeconomic success. Reading ability depends on the integrity of underlying visual and auditory (phonological) systems. This study investigated the integrity of reading ability in schizophrenia relative to the integrity of underlying visual and auditory function.

Method  The participants were 45 schizophrenia patients, 19 clinical high-risk patients, and 65 comparison subjects. Reading was assessed using tests sensitive to visual or phonological reading dysfunction. Sensory, neuropsychological, and functional outcome measures were also obtained.

Results  Schizophrenia patients displayed reading deficits that were far more severe (effect size >2.0) than would be predicted based on general neurocognitive impairments (effect size 1.0–1.4). The deficits correlated highly with both visual and auditory sensory measures, including impaired mismatch negativity generation (r=0.62, N=51, p=0.0002). Patients with established schizophrenia displayed both visual and phonological impairments, whereas high-risk patients showed isolated visual impairments. More than 70% of schizophrenia patients met criteria for acquired dyslexia, with 50% reading below eighth grade level despite intact premorbid reading ability. Reading deficits also correlated significantly (rp=0.4, N=30, p=0.03) with failure to match parental socioeconomic achievement, over and above contributions of more general cognitive impairment.

Conclusions  Patients with schizophrenia display severe deficits in reading ability that represent a potentially remediable cause of impaired socioeconomic function. Such deficits are not presently captured during routine clinical assessment. Deficits most likely develop during the years immediately surrounding illness onset and may contribute to the reduced educational and occupational achievement associated with schizophrenia.

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FIGURE 1. Difference Between Present (Passage) and Estimated Premorbid Reading Ability in Schizophrenia Patients and Healthy Comparison Subjectsa

a Panel A depicts passage reading ability, as determined using the oral reading quotient of the Gray Oral Reading Test, and single-word reading ability, as assessed using the WRAT. Panel B depicts present grade-equivalent reading level assessed using the Nelson-Denny test compared with years of education completed. Bars represent standard deviations. Analyses of patients and comparison subjects are between-group t tests.

* p<0.05.

** p<0.001.

FIGURE 2. Relationship Between Sensory Deficits and Reading Impairments In Schizophreniaa

a Panel A depicts mismatch negativity scalp distributions in comparison subjects, reading-impaired patients, and nonimpaired patients, along with difference map between comparison subjects and reading-impaired patients. Panel B depicts the correlation between reduced mismatch negativity amplitude and impaired reading ability assessed using the Gray Oral Reading Test oral reading quotient. Correlations were significant across groups even when controlled for group status (rp=0.53, N=50, p=0.006), and in patients alone (r=0.62, N=31, p<0.0001). Panel C depicts the correlation between impaired sensory function, using a combined tone matching (TM) × contrast sensitivity (CS) sensory index, and scores on the oral reading quotient of Gray Oral Reading Test. Correlations were significant across groups even when controlled for group status (rp=0.43, N=47, p=0.003), and were independently significant in patients (r=0.42, N=33, p=0.016) and comparison groups (r=0.73, N=15, p=0.002) independently.

FIGURE 3. Relationship of Reading Deficits and Reduced Socioeconomic Status in Schizophreniaa

a Panel A depicts parental and participant socioeconomic status in schizophrenia patients and healthy comparison subjects. Panel B depicts the correlation of impaired reading ability to participant socioeconomic status across patients and comparison subjects (whole group: r=0.66, N=70, p<0.0001; patients alone: r=0.36, N=45, p=0.016). Analyses were conducted using between-group t tests.

* p<0.001.

FIGURE 4. Reading Scores of Clinical High-Risk Patients Relative to Comparison Subjectsa

a Panel A depicts scores of premorbid (single-word) reading ability assessed using the WRAT compared with present (passage) reading ability assessed using the Gray Oral Reading Test oral reading quotient. Panel B depicts subscale scores from the Gray Oral Reading Test. Panel C depicts scores on the Comprehensive Test of Phonological Processing showing discrepancy between visual reading reflected by mean rapid naming/alternative rapid naming scores compared with auditory (phonological) reading reflected by mean phonological awareness/alternate phonological awareness compared with phonological memory components in high-risk individuals. Analyses were conducted between clinical high-risk individuals and comparison subjects using between-group t tests

* p<0.05.

** p<0.001.

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TABLE 1.Demographic and Clinical Characteristics for Schizophrenia Patients and Comparison Subjects in a Study of Reading Deficits and Sensory Function
Table Footer Note

a N=26. Analyses conducted between patients and comparison subjects using between-group t tests.

Table Footer Note

*p<0.001; **p<0.00001.

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TABLE 2.Neurocognitive and Reading Test Measures for Schizophrenia Patients and Comparison Subjects in a Study of Reading Deficits and Sensory Function
Table Footer Note

a F=30.3, df=2, 66, p<0.001.

Table Footer Note

b Normed based on mean=10, SD=3.

Table Footer Note

c Included in brief battery.

Table Footer Note

d F=9.91, df=3, 43, p<0.001.

Table Footer Note

e F=20.3, df=5, 37, p<0.001.

Table Footer Note

f F=13.51, df=3, 39, p<0.001.

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TABLE 3.Sensory Measures for Schizophrenia Patients and Comparison Subjects
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