Schizophrenic symptoms and frontal lobe performance

Royal Postgraduate Medical School, Hammersmith Hospital, London.
The British Journal of Psychiatry (Impact Factor: 7.99). 04/1991; 158(3):340-5. DOI: 10.1192/bjp.158.3.340
Source: PubMed


A battery of neuropsychological tests sensitive to frontal lobe impairment was administered to 43 chronic schizophrenic patients to delineate the abnormality of mental processing associated with the syndromes of psychomotor poverty and disorganisation, which had been identified in a previous study of the segregation of schizophrenic symptoms. Psychomotor poverty was found to be associated with slowness of mental activity, including slowness of generating words. The disorganisation syndrome was associated with impairment in tests in which the subject is required to inhibit an established but inappropriate response.

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    • "Both in clinical practice and research with this patient group, many different tests are used as measures of frontal dysfunction. Deficits in the WCST (e.g., Egan et al., 2011; Banno et al., 2012; Sánchez-Torres et al., 2013), Verbal Fluency (e.g., Liddle and Morris, 1991; Frith et al., 1992; Cochrane et al., 2012), and TMTB (e.g., Chan et al., 2006; Erol et al., 2012; Sánchez-Torres et al., 2013) have been consistently reported. Impairments in such tasks are often interpreted with close reference to specific test content. "
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    ABSTRACT: An enduring question is unity vs. separability of executive deficits resulting from impaired frontal lobe function. In previous studies, we have asked how executive deficits link to a conventional measure of fluid intelligence, obtained either by standard tests of novel problem-solving, or by averaging performance in a battery of novel tasks. For some classical executive tasks, such as the Wisconsin Card Sorting Test (WCST), Verbal Fluency, and Trail Making Test B (TMTB), frontal deficits are entirely explained by fluid intelligence. However, on a second set of executive tasks, including tests of multitasking and decision making, deficits exceed those predicted by fluid intelligence loss. In this paper we discuss how these results shed light on the diverse clinical phenomenology observed in frontal dysfunction, and present new data on a group of 15 schizophrenic patients and 14 controls. Subjects were assessed with a range of executive tests and with a general cognitive battery used to derive a measure of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate. In line with our previous results, significant patient-control differences in classical executive tests were removed when fluid intelligence was introduced as a covariate. However, for tests of multitasking and decision making, deficits remained. We relate our findings to those of previous factor analytic studies describing a single principal component, which accounts for much of the variance of schizophrenic patients' cognitive performance. We propose that this general factor reflects low fluid intelligence capacity, which accounts for much but not all cognitive impairment in this patient group. Partialling out the general effects of fluid intelligence, we propose, may clarify the role of additional, more specific cognitive impairments in conditions such as schizophrenia.
    Frontiers in Behavioral Neuroscience 02/2014; 8:46. DOI:10.3389/fnbeh.2014.00046 · 3.27 Impact Factor
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    • "Although some decision-making deficits associated with OCD are similar to those seen in schizophrenia and following OFC lesions, such as impairment in inhibitory control over behavior (26–28), the affective phenotype of obsessions and anxiety distinguish OCD from these disorders in other ways. Obsessive-compulsive disorder patients have an inflated sense of personal responsibility (29), thought to exacerbate the experience of regret (30). "
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    ABSTRACT: Background Obsessive-compulsive disorder (OCD) is a disorder of automatic, uncontrollable behaviors and obsessive rumination. There is evidence that OCD patients have difficulties performing goal-directed actions, instead exhibiting repetitive stimulus-response habit behaviors. This might result from the excessive formation of stimulus-response habit associations or from an impairment in the ability to use outcome value to guide behavior. We investigated the latter by examining counterfactual decision making, which is the ability to use comparisons of prospective action-outcome scenarios to guide economic choice. Methods We tested decision making (forward counterfactual) and affective responses (backward counterfactual) in 20 OCD patients and 20 matched healthy control subjects using an economic choice paradigm that previously revealed attenuation of both the experience and avoidance of counterfactual emotion in schizophrenia patients and patients with orbitofrontal cortex lesions. Results The use of counterfactual comparison to guide decision making was diminished in OCD patients, who relied primarily on expected value. Unlike the apathetic affective responses previously shown to accompany this decision style, OCD patients reported increased emotional responsivity to the outcomes of their choices and to the counterfactual comparisons that typify regret and relief. Conclusions Obsessive-compulsive disorder patients exhibit a pattern of decision making consistent with a disruption in goal-directed forward modeling, basing decisions instead on the temporally present (and more rational) calculation of expected value. In contrast to this style of decision making, emotional responses in OCD were more extreme and reactive than control subjects. These results are in line with an account of disrupted goal-directed cognitive control in OCD.
    Biological psychiatry 02/2013; 75(8). DOI:10.1016/j.biopsych.2013.01.018 · 10.26 Impact Factor
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    • "Verbal fluency is a common test of response generation, in which participants are asked to generate, in a one-minute interval, as many words as possible that begin with each of three letters. Patients with schizophrenia typically generate fewer words than controls on VF tasks and negative symptoms are associated with these deficits (Liddle and Morris, 1991; Frith, 1992). Negative symptom ratings are also correlated with impaired VF in patients with schizotypal personality disorder (Diforio et al., 2000), and negative schizotypy is positively associated with VF deficits in the healthy siblings of schizophrenic patients (Franke et al., 1993). "
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