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Most of the authors use a dimensional approach to describe relationships between schizophrenic symptoms and cognitive variables (Liddle 1991). But, because symptomatic dimensions may overlap, distinguishable cognitive impairments may be difficult to identify (Norman 1997).The Aim: of the study was to characterize the cognitive functioning in homogeneous symptomatic subgroups of schizophrenic patients. We have tested the hypothesis that subtypes suffering from specific cognitive impairments may be individualized.Methods: The Schedule of Deficit Syndrome (Kirkpatrick 1989) and the item "Conceptual Disorganization" of the Positive And Negative Syndrome Scale (Kay 1987) were used to categorize 53 DSM IV patients into deficit (Det) (N = 12), disorganized (Dis) (N = 9) and non deficit non disorganized residual patients (Res) (N = 32). They were evaluated with frontal cognitive tests.Results: Patients performed more poorly than healthy controls (N = 27) for all the tests (p < 0.05). (Det) patients were more impaired on the Wisconsin Card Sorting Test perseverations than (Res) patients (6.7 ± 4.5 vs 3 ± 3.6; p < 0.05), whereas (Dis) patients were more impaired on the Trail Making Test B than (Res) patients (176.3 seconds ± 51 vs 129.3 ± 68.4; p < 0.05).This study argues for categorical approach to isolate distinct patterns of cognitive impairments in schizophrenic subgroups.

Deinstitutionalization (DI) of most of the chronic long-stay patients has taken place in the last decades in Germany. However, a "residual" group of patients often remains in psychiatric hospitals, with an ongoing controversy on an appropriate type of their care (community based vs. hospital). Clinical, functional and social characteristics of such schizophrenic patients still residing in the long-stay wards in the German state of Hesse after decades of DI are presented. The n = 266 patients investigated displayed a marked degree of negative symptoms and moderate positive symptoms but, however, severe social disabilities. In addition, the patients were very dependent in daily living, had an extremely impoverished social network and leisure activities. The findings contribute to the research on "difficult-to-place" patients described in the literature.

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