Superior Intellectual Ability in Schizophrenia: Neuropsychological Characteristics James H. MacCabe King’s College London Gildas Bre ´bion Sant Joan de De ´u – Serveis de Salut Mental y CIBERSAM, Barcelona, Spain Abraham Reichenberg and Taposhri Ganguly King’s College London Peter J. McKenna Germanes Hospitala `ries del Sagrat Cor de Jesu ´s, Barcelona, Spain Robin M. Murray and Anthony S. David King’s College London Objective: It has been suggested that neurocognitive impairment is a core deficit in schizophrenia. However, it appears that some patients with schizophrenia have intelligence quotients (IQs) in the superior range. In this study, we sought out schizophrenia patients with an estimated premorbid Intelligence Quotient (IQ) of at least 115 and studied their neuropsychological profile. Method: Thirty-four patients meeting diagnostic criteria for schizophrenia or schizoaffective disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV), with mean estimated premorbid IQ of 120, were recruited and divided into two subgroups, according to whether or not their IQ had declined by at least 10 points from their premorbid estimate. Their performance on an extensive neuropsychological battery was compared with that of 19 IQ-matched healthy controls and a group of 16 “typical” schizophrenia patients with estimated premorbid IQ 110, using one way ANOVAs and profile analysis using MANOVAs. Results: Schizophrenia patients whose estimated premorbid and current IQ both lay in the superior range were statistically indistinguishable from IQ-matched healthy controls on all neurocognitive tests. However, their profile of relative performance in subtests was similar to that of typical schizophrenia patients. Patients with superior premorbid IQ and evidence of intellectual deterioration had intermediate scores. Conclusions: Our results confirm the existence of patients meeting DSM–IV diagnostic criteria for schizophrenia who have markedly superior premorbid intellectual level and appear to be free of gross neuropsychological deficits. We discuss the implications of these findings for the primacy of cognitive deficits in schizophrenia. Keywords: schizophrenia, psychosis, neuropsychology, intelligence, neuropsychologically normal Schizophrenia is associated with global cognitive impairment over a wide variety of domains, which is present in both first-episode and chronic patients, and is often as severe as that seen in some neurological disorders (Heinrichs & Zakzanis, 1998). Some deficits are detectable prior to the onset of clinical symptoms (David, Malmberg, Brandt, Allebeck, & Lewis, 1997; Reichenberg et al., 2002; MacCabe, 2008; MacCabe et al., 2008). This has led many researchers to conclude that cognitive deficits are a universal feature of schizophrenia (Weinberger & Gallhofer, 1997) and/or that they are a conse- quence of abnormal neurodevelopment (Marenco & Wein- berger, 2000; MacCabe & Murray, 2004). In apparent contradiction to this view, some patients with schizophrenia have been documented to have an overall IQ in the normal range, and a few have above-average performance, at least in some neuropsychological domains (Palmer et al., 1997; David, This article was published Online First December 26, 2011. James H. MacCabe, Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, United Kingdom; Gildas Bre ´bion, Unit of Research and Development, Sant Joan de De ´u - Serveis de Salut Mental y CIBERSAM, Barcelona, Spain; Abraham Reichenberg and Taposhri Ganguly, Department of Psychosis Studies, Institute of Psychiatry, King’s College London; Peter J. McKenna, Benito Menni CASM y CIBERSAM, Germanes Hospitala `ries del Sa- grat Cor de Jesu ´s, Barcelona, Spain; Robin M. Murray and Anthony S. David, Department of Psychosis Studies, Institute of Psychiatry, King’s College London. J. H. M. has received support for this project from the Stanley Founda- tion, the Psychiatry Research Trust, the United Kingdom Medical Research Council, and the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London. P. J. M. was supported by the Instituto de Salud Carlos III, Centro deInvestigacio ´n en Red de Salud Mental, CIBERSAM. G. B. was supported by CIBERSAM and Lundbeck. Correspondence concerning this article should be addressed to James H. MacCabe, Department of Psychosis Studies, Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom. E-mail: james.maccabe@kcl.ac.uk Neuropsychology © 2011 American Psychological Association 2012, Vol. 26, No. 2, 181–190 0894-4105/12/$12.00 DOI: 10.1037/a0026376 181