Neuropsychological Dysfunction in Schizotypal
Personality Disorder: A Profile Analysis
Martina M. Voglmaier, Larry J. Seidman, Dean Salisbury, and Robert W. McCarley
In order to examine the neuropsychological profile of schizotypal personality disorder (SPD),
we studied a wide array of cognitive functions in 10 right-handed men who met DSM-III-R
criteria for SPD and 10 matched normal controls. Cognitive functions included abstraction,
verbal and spatial intelligence, memory and learning, language, attention, and motor skills.
Neuropsychological profiles were constructed by standardizing test scores based on the means
and standard deviations of the normal control group. SPD subjects showed significant
decrements in performance on the California Verbal Learning Test, a word-list learning
measure which requires semantic clustering for more efficient performance, and on the
Wisconsin Card Sort Test, a measure requiring concept formation, abstraction, and mental
flexibility. These results suggest possible areas of specific neuropsychological dysfunction in
SPD, and are consistent with current hypotheses of left-temporal and prefrontal brain
dysfunction in schizophrenia.
© 1997 Society of Biological Psychiatry
Key Words: Schizotypal personality disorder, neuropsychological dysfunction, verbal learn-
ing, abstraction, temporal-limbic system, frontal networks
BIOL PSYCHIATRY 1997;41:530–540
A biological relationship between chronic schizophrenia
(SZ) and schizotypal personality disorder (SPD) is sug-
gested by genetic and family studies (e.g., Kendler et al
1993), by similarities in performance on measures of
attention and information processing (e.g., Kremen et al
1994), and by neurochemical similarities (e.g., Siever
1992). Neuropsychological deficits in SZ include impaired
abstraction, attention, language, and verbal learning and
memory, which are thought to reflect involvement of
frontal, left hemisphere, and temporal-limbic brain areas,
respectively (Gur et al 1991; Nestor et al 1993; Saykin et
al 1991; Seidman et al 1992a,b).
There have been very few studies of neuropsychological
function in individuals who meet DSM-III or DSM-III-R
diagnostic criteria for SPD (definite or probable). The few
extant studies have suggested deficit patterns similar to,
but less severe than, those seen in SZ. The findings
indicate trends for deficits on attentional tasks with a
perceptual-motor or “shift” component (Condray and
Steinhauer 1992; Thaker et al 1991), a reduction in verbal
recall (Thaker et al 1991) and language deficits which
include reduced comprehension of grammatical construc-
tions in adult male SPDs (Condray and Steinhauer 1992;
Condray et al 1992). In SPD children, communication
deficits (Caplan and Guthrie 1992) and thought disorder
From the Harvard Medical School, Department of Psychiatry at The Massachusetts
Mental Health Center, Boston, MA, and the Brockton/West Roxbury Veterans
Affairs Medical Center, Brockton, MA.
Address reprint requests to Dr. Robert W. McCarley, VA Medical Center,
Department of Psychiatry 116 A, 940 Belmont St., Brockton, MA 02401.
Received July 6, 1994; revised January 23, 1996.
© 1997 Society of Biological Psychiatry0006-3223/97/$17.00
(Caplan et al 1990) have been found. In these studies,
general intellect, visuospatial perception, and motor skills,
when examined, have been relatively preserved, however,
none of these studies have employed a full range of
More studies have assessed neuropsychological func-
tion in populations thought to be at higher risk for
developing SZ, in an attempt to elucidate markers of
vulnerability to the disease. These high-risk populations
include nonpsychotic first-degree relatives of schizo-
phrenic probands and the so-called “psychosis-prone”
populations, nonclinical groups with abnormally high
scores on one or more measures thought to assess schizo-
typal symptoms (e.g., the “Chapman Scales” [Chapman
and Chapman 1985]). While there is general agreement
that some neuropsychological and information-processing
deficits exist in the first-degree relatives of schizophrenics
(Neuchterlein and Dawson 1984), and that these may serve
as markers of vulnerability to schizophrenia, these indi-
viduals generally do not meet current diagnostic criteria
for SPD. Neuropsychological studies of psychosis-prone
individuals have also suggested cognitive deficits similar
to those found in SZ (Kremen et al 1994). The bulk of
these studies have suggested deficits in concept formation
and abstraction (Lenzenweger and Korfine 1991; Lyons et
al 1991; Raine et al 1992; Spaulding et al 1989; Tien et al
1992). Another area of deficit involves cerebral laterality,
with most studies suggesting left hemisphere overactiva-
tion and/or dysfunction (Overby 1992; Raine et al 1989)
and increased mixed- or left-hand preference (Chapman
and Chapman 1987; Kelley and Coursey 1992; Kim et al
1992). We emphasize, however, that “psychosis-prone”
individuals may differ phenomenologically from those
who meet diagnostic criteria for SPD. Further study of
neuropsychological function in clinically-defined SPD is
important for advancing our understanding of the cogni-
tive and clinical features of SPD and its relationship to SZ.
The purpose of the current study was to establish a
neuropsychological profile of SPD by examining a broad
range of neuropsychological functions in individuals who
meet DSM-III-R criteria for SPD. We predicted that SPDs
would show relative deficits on measures of verbal learn-
ing and memory, and abstraction, in accord with hypoth-
eses of left-temporal (McCarley et al 1989, 1993a, b;
Shenton et al 1989, 1992) and prefrontal (Seidman 1983;
Seidman et al 1992b; Weinberger et al 1986; Weinberger
1987) brain dysfunction in SZ, respectively.
Subjects were 10 unmedicated right-handed men who met
DSM-III-R criteria for SPD, and 10 right-handed male
controls, who were matched for age, ethnicity, and paren-
tal socioeconomic status (SES) (Hollingshead 1975).
Seven SPD subjects were recruited from the general
population, and answered advertisements in local newspa-
pers asking for men who a) “believe they have ESP,
clairvoyance, telepathy, or a ‘sixth-sense’; sense the pres-
ence of others when alone; think others can feel your
emotions” (Lyons et al 1991), and b) “are shy or uncom-
fortable around unfamiliar people or in close relation-
ships.” Two SPD subjects were referred by their primary
clinician at the Massachusetts Mental Health Center, and
one SPD subject was recruited at a local “psychic fair.”
Normal control subjects answered newspaper advertise-
ments recruiting healthy, right-handed men for a “brain
imaging study” (all subjects had auditory event-related
potentials measured; these results will be reported in
Salisbury et al in press). All subjects had English as their
first language, normal or corrected-to-normal vision, nor-
mal hearing, and normal upper limb function as the basic
requirements for optimal performance on the neuropsy-
chological test battery. Informed consent was obtained
before all data collection procedures. All subjects were
paid for their participation in the study.
Demographic characteristics of the subject groups are
summarized in Table 1. The groups did not differ signif-
icantly in age, parental SES, or years of education,
although the SPD group showed a trend for lower esti-
mated IQ (Brooker and Cyr 1986). Because this measure
is heavily weighted by verbal ability and education (indi-
Table 1. Subject Characteristics for SPD (n ? 10) and Normal
Control (n ? 10) Groups
aBased on t test (two-tailed).
bBased on WAIS-R Vocabulary and Block Design Subtests (Brooker and Cyr
cBased on WAIS-R Block Design Subtest.
ces that might be reduced in SPDs as a result of the
disorder), an estimate of nonverbal intelligence (NVIQ)
was calculated, based on performance on the WAIS-R
Block Design subtest. There were no differences between
groups on this measure. The SPD group had significantly
lower personal SES compared to controls. Because it was
thought likely that depression and anxiety might be higher
in the SPD group, the Beck Depression Inventory (BDI)
(Beck 1978) and the State-Trait Anxiety Inventory (STAI)
(Spielberger 1983) were administered to assess the effect
of these variables on neuropsychological performance. As
expected, SPDs reported significantly greater state and
trait levels of anxiety, and there was a strong trend for the
SPD group to report more depressive symptoms (mild/
moderate levels) on the BDI. Control subjects were within
normal limits on all clinical measures.
than ninth grade or estimated IQ less than 80, a history of
head injury (with loss of consciousness and/or cognitive
sequelae), neurological disorder, systemic illness, or cur-
rent medication with cognitive effects were excluded from
the study. SPD subjects were excluded if they had a
history of bipolar disorder, psychotic disorder, substance
abuse within the past year, or a current depressive disor-
der. Normal controls with any personal history of DSM-
III-R Axis I or Axis II disorder, learning disability or
developmental disorder, or with a family history (first- or
second-degree relatives) of Axis I disorder were excluded
from the study.
Subjects with education less
using the Structured Clinical Interview for DSM-III-R for
Axis I (SCID) and Axis II (SCID-II) disorders (Spitzer et
al 1990). One of the authors (MMV) administered the
SCID and SCID-II to all SPD and normal control subjects.
Interrater reliability for SPD was 0.84 (kappa statistic), as
assessed by two independent raters on the clinical inter-
views of 24 subjects (i.e., the 10 SPD individuals included
in this study, and 14 additional subjects who answered the
“ESP” advertisement and were excluded). Twenty-two of
the 24 interviews were administered by one examiner
(MMV), and videotaped. The videotaped interview was
then reevaluated by a second examiner (LJS or DS). The
remaining two interviews were administered conjointly by
two examiners. There was considerable diagnostic overlap
with other Axis II personality disorders, in accord with
other reports (Oldham et al 1992). Six SPD subjects (60%)
reported a family history of psychopathology, including
schizophrenia, mood disorders, and substance use disor-
ders; seven (70%) reported some difficulty in early school-
Subjects were diagnosed
ing. By selection criteria, normal control subjects had no
personal or family history of psychopathology and no
history of learning, attentional, or developmental disorder.
logical functions assessed included abstraction, verbal and
spatial intelligence, memory and learning, language, atten-
tion, and motor skills. The organization of tests, indicated
in Table 2, is supported by factor-analytic studies in
normal, neurological, and psychiatric populations (Ernst et
al 1988; Goldstein and Shelley 1972; Shelley and Gold-
stein 1982; Swiercinsky and Howard 1983). Given our
hypotheses of left-temporal and prefrontal brain dysfunc-
tion in SPD, it was predicted that the functions of verbal
learning, verbal memory, and abstraction would be partic-
ularly deficient in this group. Measures of these selected
functions are described below.
was made up of the total words learned over five trials of
the California Verbal Learning Test (CVLT) (Delis et al
1987), a word-list learning measure which requires seman-
tic clustering for more efficient performance. The CVLT
involves five presentations of a list of 16 “shopping
items,” which can be grouped into four semantic clusters
for more efficient learning (fruits, spices, clothing, and
tools). Free recall of the list is measured after a short delay
(SD) interposed by an interference list, and again after a
long (20’) delay (LD). Immediately after the SD and LD
free recall trials, subjects are cued with the semantic
category names to assess the effect of supplying external
semantic structure on recall performance. The percent of
correct information-retained scores was calculated as fol-
lows—1) at SD: (SD/Trial 5) ? 100; 2) at LD: (LD/SD) ?
100. CVLT semantic clustering scores were tabulated
using the standard method of scoring one point for every
pair of successively recalled words from any of the four
semantic categories (Delis et al 1987). Because the amount
of clustering was limited by the number of words recalled,
the raw scores were converted to percentages by dividing
the cluster score for any given trial by the number of
correctly recalled word-list items for that trial. This
procedure was used as an initial method for examining
clustering performance between groups.
The verbal learning function score
was made up of the number of story items recalled from
both the immediate and delayed recall portions of the
Wechsler Memory Scale-Revised (WMS-R) Logical
Memory task (Wechsler 1987). This test consists of two
aurally presented paragraph stories. Subjects’ verbal recall
is measured immediately after each story is presented and
after a 30-minute delay.
The verbal memory function score
532M.M. Voglmaier et al
the total number of categories completed and number of
perseverative responses made on the Wisconsin Card Sort
Test [WCST] (Heaton 1981), a measure requiring concept
formation, abstraction, and mental flexibility. The WCST
requires subjects to sort cards according to one of three
principles determined by the examiner, who gives limited
feedback about the subject’s response.
The abstraction function was made up of
cognitive function in schizophrenic patients, methodolog-
ical problems have been identified in the establishment of
a selective deficit in any neuropsychological domain (e.g.,
Goldberg et al 1990; Saykin et al 1991). Because a
background of global impairment (e.g., a “generalized
deficit”) might be expected in such patient populations, a
specific cognitive deficit must be demonstrated as separate
from any general reduction in performance. Controlling
for general ability (e.g., a ‘g’-factor) is warranted to guard
against the possibility that any apparent specific cognitive
deficit is only a reflection of a more generalized deficit in
A related concern involves differences in the psycho-
metric characteristics of various neuropsychological test
measures. For example, if tests are not matched for levels
of difficulty and reliability, what appears to be a selective
deficit in a patient group may simply reflect the difference
in psychometric properties between tests (Chapman and
Chapman 1978). Yet matching psychometric properties
across tests as a method of controlling for this would be an
arduous undertaking. Instead, the use of standardized
scores has been recommended as a more efficient alterna-
tive to laborious matching procedures (Chapman and
In the current study, SPD subjects’ test scores were
standardized based on the means and standard deviations
of the normal control group to help control for differences
in psychometric properties of the neuropsychological tests
across domains. In addition, estimated IQ (Brooker and
Cyr 1986) was entered as a covariate in most analyses to
control for differences in general ability. Because this
measure is weighted by vocabulary level and education,
indices that might be reduced in the SPD group as a result
of the disorder, we considered it an appropriate factor to
covary in order to equate groups on these indices and
thereby detect domains of relatively specific cognitive
deficit. On the other hand, verbal learning and memory
were areas of predicted deficiency, and we were concerned
that covarying a verbally weighted measure of ability
might artificially dilute the extent of the deficit in these
areas (e.g., the “matching fallacy” [Meehl 1970]). Because
of this, comparison analyses were conducted which used
NVIQ, the estimate of nonverbal general ability, as the
In prior studies of
constructed by standardizing SPD subjects’ test scores
based on the means and standard deviations (SDs) of
normal control (NC) subjects. For the purpose of compar-
ison, means and SDs for the two subject groups are listed
in Table 2. Multivariate analyses of variance (MANO-
VAs) with neuropsychological functions or test scores as
Neuropsychological profiles were
Table 2. Neuropsychological Test Scoresaof SPD and Normal
(n ? 10)
(n ? 10)
WCST perseverative responses
Verbal intelligence (VIN)
Spatial organization (SPA)
WAIS-R block design
WAIS-R picture arrangement
Judgment of line orientation
Semantic memory (SEM)
WMS-R logical memory
Visual memory (VIS)
WMS-R visual reproductions
Verbal learning (CVL)
CVLT total correct, trials 1–5
Visual learning (CVM)
CVMT total correct
MAE controlled oral word
BDAE animal naming
MAE sentence repetition
Auditory and visual attention (AVT)
HRB trail making test
WAIS-R digit symbol
WAIS-R digit span
Motor skills (MOT)
Finger tapping test
56.1 (7.4)41.3 (9.3)
78.9 (7.1)77.6 (2.7)
53.8 (8.9)40.2 (13.6)
aWCST indicates Wisconsin Card Sorting Test (Heaton 1981); WAIS-R,
Wechsler Adult Intelligence Scale-Revised (Wechsler 1981); WRAT-R, Wide
Range Achievement Test-Revised (Jastak and Wilkinson 1984); WMS-R, Wechsler
Memory Scale-Revised (Wechsler 1987); CVLT, California Verbal Learning Test
(Delis et al 1987); CVMT, Continuous Visual Memory Test (Trahan and Larrabee
1988); MAE, Multilingual Aphasia Examination (Benton et al 1976); BDAE,
Boston Diagnostic Aphasia Examination (Goodglass and Kaplan 1983); HRB,
Halstead-Reitan Battery (Reitan and Wolfson 1985). Total correct scores are listed
unless otherwise indicated. WAIS-R lists age-corrected scaled scores. WRAT-R
lists age-corrected standard scores.
the dependent variables and subject group (SPD vs NC) as
the independent variable were used to assess differences
between groups and profile shapes. This was followed by
within-subject contrasts on each function. For each con-
trast, the score for a particular function was contrasted
with the mean of all functions (SPSS/PC?  contrast
procedure, deviation option). This allowed for determina-
tion of areas of selective deficit, as opposed to general
impairment equally affecting all functions.
A series of analyses indicated that estimated IQ, BDI,
and STAI scores correlated significantly with performance
on some neuropsychological tests. As mentioned above,
estimated IQ was entered as a covariate in selected
analyses to control for “g”; NVIQ was used as the
covariate in comparison analyses as a measure of general
ability. Because of the differences between groups on the
BDI and STAI measures, these scores were entered as
additional covariates in selected analyses to correct for
Repeated measures and univariate analyses of variance
(ANOVAs) were used to examine differences in individ-
ual functions and test scores between the groups, and
changes in performance over successive presentations of
The z-score profile for SPD subjects is presented in Figure
1. The MANOVA revealed a function ? group interaction
(F[1,19], ? 3.44, p ? 0.05), indicating a nonflat profile
shape in the SPD group. When estimated IQ, BDI, and
STAI scores were added as covariates, profile contrasts
revealed that SPD subjects showed significant decrements
in the functions of verbal learning (2.0 SD below the
normative mean; p ? 0.05) and abstraction (1.92 SD
below the normative mean; p ? 0.05). Differences be-
Figure 1. Neuropsychological profile for SPD subjects (n ? 10) relative to mean values of controls (n ? 10), which are set to 0 (?
1 SD). Mean values have been adjusted for estimated IQ, BDI, and STAI scores. Standard error bars are indicated.
534M.M. Voglmaier et al
tween the groups in other neuropsychological functions
were not significant, although visual inspection of Figure
1 suggests a mild reduction in a number of cognitive
domains. When NVIQ was covaried as the measure of
general ability, additional areas of significant deficit in-
cluded verbal and spatial intelligence and language. This
pattern suggests that when verbal ability and education are
corrected for in SPD subjects, the domains of verbal
learning and abstraction remain areas of relatively severe
A repeated measures ANOVA of CVLT performance over
five learning trials and two free recall trials indicated a
significant difference between groups (F[1,16] ? 6.76;
p ? 0.05), with the SPD group learning fewer words over
all trials compared to controls (see Figure 2). Both groups
showed similar increments in learning over time, F(6,108)
? 18.17, p ? 0.0001. Both groups retained similar
amounts of information after interference (89.1% vs
93.2%) and after a 20-minute delay (96.6% vs 97.0%).
There were no differences between groups in degree of
proactive or retroactive inhibition.
ANOVA of percent clustering scores (Figure 3) indicated
that SPDs used significantly less semantic clustering
overall compared to normal controls, F(1,18) ? 6.93; p ?
0.02. Both groups made similar increments in clustering
over successive trials, F(6,108) ? 12.46; p ? 0.0001.
When cued with the semantic categories by the examiner,
SPD subjects made significantly more intrusion errors
than controls, F(1,18) ? 4.75, p ? 0.05. The groups did
not differ in number of intrusion errors during free recall
trials or in number of perseverative errors.
Figure 2. Learning curves of SPD (n ? 10) and control (n ? 10) groups on the California Verbal Learning Test. Standard error bars
Selected measures from the WCST were examined more
closely. Significantly more SPD subjects (70%) “lost set”
(e.g., failed to maintain a category in progress for the
required 10 trials [Heaton 1981]) as compared to control
subjects (20%), Fisher’s Exact Test ? 5.05; p ? 0.05.
SPDs formed fewer categories than controls (M ? 4.5 vs
M ? 5.8), and made perseverative responses at a rate
comparable to SZ populations (M ? 23.7 for SPD; M ?
11.5 for controls). When estimated IQ was entered as the
covariate, the reduction in categories remained significant
(p ? 0.05), but the number of perseverative responses did
not (p ? 0.10). Both measures remained significantly
different when NVIQ was entered as the covariate.
To our knowledge, this is the first study to examine the
wide-range neuropsychological profile of DSM-III-R-de-
fined schizotypal personality disorder. The current results
indicate that SPD subjects recruited primarily from the
general population show significant cognitive deficits in
verbal learning and abstraction. This study involved a
small group of subjects and thus must be interpreted
cautiously. There is evidence of a milder reduction in
performance in other cognitive domains, and, in this
context, the current results suggest areas of relatively more
severe neuropsychological dysfunction in SPD, i.e., the
deficits in verbal learning and abstraction are seen against
a background of relatively less impaired cognitive func-
tioning. These cognitive deficits are consistent with cur-
rent hypotheses of left-temporal (McCarley et al 1989,
1993a, b; Shenton et al 1989, 1992) and prefrontal
(Seidman 1983; Seidman et al 1992a, b; Weinberger et al
1986; Weinberger 1987) brain dysfunction in SZ, and may
implicate similar areas of brain dysfunction in SPD.
As a group, SPDs showed significant impairment in
learning and remembering aurally presented, unstructured
Figure 3. Semantic clustering performance of SPD (n ? 10) and control (n ? 10) groups. Standard error bars are indicated.
536M.M. Voglmaier et al
word-list items on the CVLT. They learned significantly
fewer words and used significantly less semantic cluster-
ing. Moreover, when the semantic cues were provided for
them, SPDs made significantly more intrusion errors. In
contrast, SPDs learned information at the same rate as
controls over time, and they had similar rates of retention.
This suggests that the deficit in performance on the CVLT
results from reduced encoding (e.g., entering of informa-
tion prior to memory consolidation) or to reduced re-
trieval, rather than to rapid memory loss. Similar encoding
deficits have been found in schizophrenic patients, espe-
cially those with milder, less chronic illness, while post-
encoding deficits (e.g., retrieval, retention) are found in
more chronic SZ patients (Calev et al 1983). Difficulty in
verbal recall was found previously in a very small sample
of SPD subjects (Thaker et al 1991). More recently, Lyons
et al (submitted) found similar CVLT deficits in a sample
of first-degree relatives of schizophrenic patients, provid-
ing some additional support for our findings.
The clustering performance of these SPD subjects
suggests a deficit in the use of basic semantic categorical
structures to organize aurally-presented list information,
and/or a deficit in employing the category to encode
information or to cue memory. It is unclear whether this
performance deficit represents either a general organiza-
tional problem stemming from prefrontal lobe dysfunction
or a problem in accessing the semantic lexicon, implicat-
ing left posterior temporal lobe structures (Luria 1976), or
both. In this sample, SPDs had no difficulty recalling
aurally-presented stories (WMS-R Logical Memory) in
which information is already semantically structured.
Thus, their deficient learning of word-list items on the
CVLT could suggest frontal lobe dysfunction, i.e., an
inability to impose organization onto unstructured infor-
mation, a hypothesis which has been suggested to explain
similar difficulty in schizophrenic populations (Koh et al
1974; Koh et al 1973). On the other hand, given their
reduced performance when cued with a semantic category,
the SPD group also appears to have a deficit in utilizing
basic semantic systems for encoding and/or for cuing
SPD subjects also showed significant impairment in ab-
straction. On the WCST, more SPDs “lost set” as com-
pared to controls, indicating a deficit in maintaining
formed concepts. In addition, the number of categories
achieved by SPDs was intermediate to that of SZ and
control groups examined in the literature, whereas perse-
verative responses were comparable to some SZ samples
(Heaton 1981; Seidman et al 1991). These findings are in
accord with studies of “psychosis-prone” individuals who
have shown deficits on the WCST and other measures of
abstraction (Kremen et al 1994; Lenzenweger and Korfine
1991; Lyons et al 1991; Raine et al 1992; Spaulding et al
1989; Tien et al 1992). Poor performance on the WCST
has been related to dorsolateral prefrontal lobe dysfunction
(Seidman et al 1994; Weinberger 1987, 1991; Weinberger
et al 1992), and to MRI measures of temporal lobe volume
(Nestor et al 1993).
The current results are consistent with the hypothesis
that neuropsychological deficits in schizophrenia may
reflect dysfunction in an interconnected neural system
involving both temporal lobe and dorsolateral prefrontal
brain structures (Nestor et al 1993; Weinberger 1991;
Weinberger et al 1992). Such a position might predict a
relationship between deficits in verbal learning, memory,
abstraction, and/or categorization and dysfunction at any
point along this system. Consistent with this interpretation,
recent results from our laboratory showed a relationship
between bilateral temporal lobe MRI volume reduction
and both verbal memory and abstraction deficits in schizo-
phrenic patients (Nestor et al 1993).
Although areas of significant deficit were apparent in the
current study, the results must be tempered by the small
sample size and resultant reduction in power. We can
attempt to place the results in context by discussing the
differences in domains in terms of effect size, and relating
them to the performance of other relevant groups which
use larger sample sizes. For the purpose of comparison, in
Table 3, the neuropsychological performance of the cur-
rent SPD group is contrasted with performance in extant
studies of first-degree relatives and schizophrenic patients
(Nestor et al 1993; Cannon et al 1994; Faraone et al 1995).
In many domains the current SPD group appears similar to
schizophrenic family members, who perform at a level
intermediate to that of schizophrenic and control subjects;
however, it is also clear that in our SPD subjects, the
domains of abstraction and verbal learning are areas of
relatively greater deficit where performance appears more
comparable to that of schizophrenic subjects. Verbal and
spatial intelligence and language are other areas which
appear more comparable to schizophrenic subjects. Sig-
nificant deficits were apparent in these domains when the
nonverbal measure of “g” (NVIQ) was entered as the
covariate. Power analyses revealed that approximately 22
subjects would be required for the domains of spatial
organization and visual memory to be significant, 32
subjects would be required for semantic memory to be
significant, and 196 subjects would be required for the
domains of attention and motor skills to be significant.
Such a comparison also raises the issue of potential
heterogeneity among schizotypal individuals. For exam-
ple, there is some evidence that schizotypes with a family
history of schizophrenia differ from those without schizo-
phrenic relatives in symptomatology as well as in their
relationship to the schizophrenia spectrum (e.g., Torgersen
1985; Lyons et al 1994). Because the SPD subjects in this
study were not selected for a family history of schizophre-
nia (although two subjects did report a family history of
the disease), one might question how the neuropsycholog-
ical profiles of these individuals would compare to those
of familial SPDs. This is a difficult question to answer,
given that family studies often mix relatives with and
without schizotypal symptoms, and a full range of cogni-
tive functions is rarely examined. Although comparison of
the performance of current SPDs to extant results of
family members of schizophrenic probands suggests dif-
ferences in some domains (Table 3), it cannot be deter-
mined if this is related to differences in symptomatology
or to genetic background. One study has compared famil-
ial and non-familial SPDs on a brief neuropsychological
battery (Condray and Steinhauer 1992), and found only a
difference in comprehension of complex grammatical
structures. Until further research is completed, it remains
unclear how familial SPDs who meet full diagnostic
criteria would perform if given the current battery of tests.
In conclusion, these results underscore the cognitive
deficits and treatment needs of SPD individuals. Although
speculative, it appears that both the SPD and NC groups
began with the same potential for success, e.g., middle
class parental SES and college level of education, yet the
SPD group has experienced a “downward drift” in SES
(lower middle class). Behaviorally, the cognitive limita-
tions apparent in the SPD group can result in deficits in
efficient verbal learning (e.g., oral instructions), and re-
duced executive functioning, such as poor planning, rea-
soning, organization, and goal formulation. Selected pri-
marily from the general population, this group has at least
average intelligence, yet each subject experienced some
impairment in both social and occupational functioning,
difficulties that may stem from both characterological
features and cognitive deficits. Further study of the behav-
ioral, functional, and structural correlates of brain function
in SPD populations is warranted to examine the cognitive
and clinical features of this disorder, as well as to help
shape our understanding of the pathophysiology of SZ.
Research supported by the Medical Research Service of the Department
of Veterans Affairs (RWM), NIMH 5-T32-MH16259 (MMV), NIMH
R01 40, 779 (RWM), Peter Livingston Research Fellowship (MMV) and
Research and Education Fund Fellowship (MMV) from the Department
of Psychiatry, Harvard Medical School, Massachusetts Mental Health
Center, Senior Investigator Award from National Alliance for Research
in Schizophrenia and Affective Disorder (RWM). RWM is a Medical
Investigator, Department of Veterans Affairs.
The authors thank Geoffrey Schnirman, Stephen Smith, Jonathan
Sollinger and Carol Katz for assistance with this study.
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aUnadjusted Z-scores for 10 SPD subjects in the current study.
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cZ-scores for 16 non-schizophrenic co-twins from Goldberg et al 1990, 16 non-schizophrenic siblings from Cannon et al 1994, and 15 non-schizophrenic relatives from
Faraone et al 1995, respectively.
dZ-scores for 16 schizophrenic co-twins from Goldberg et al 1990 and 15 schizophrenic subjects from Cannon et al 1994, respectively.
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