Elsevier

Psychiatry Research

Volume 79, Issue 2, 15 June 1998, Pages 139-149
Psychiatry Research

Article
Executive-frontal lobe cognitive dysfunction in schizophrenia: A symptom subtype analysis

https://doi.org/10.1016/S0165-1781(98)00031-6Get rights and content

Abstract

Impairment of executive-frontal lobe functioning, affecting the planning, initiation and regulation of goal-directed behavior, is a common cognitive deficit in schizophrenia. However, it is unclear if deficits in these frontal-lobe-mediated abilities are differentially expressed across clinical subgroups. We analyzed executive-frontal abilities in relation to symptom expression in 53 hospitalized schizophrenic patients. Patients were assigned to one of three subgroups based on rank order analysis of Brief Psychiatric Rating Scale factors: Withdrawal-Retardation, Reality Distortion and Conceptual Disorganization. Executive-frontal tests included Visual Search, Verbal Fluency, Verbal Series Attention, Trail Making — Part B, Symbol Digit, Hopkins Verbal Learning, Digit Span, Wisconsin Card Sorting, Stroop Color-Word and Attentional Capacity. The schizophrenia group showed significant deficits relative to healthy control subjects (n = 20) on all tests. Exploratory factor analysis of test scores revealed three factors: (i) Verbal Processing/Memory; (ii) Cognitive Flexibility/Attention; and (iii) Psychomotor Speed/Visual Scanning. The three symptom subgroups were differentially impaired on executive-frontal abilities: Withdrawal-Retardation on psychomotor speed, verbal fluency, working memory, visual search and cognitive flexibility; Conceptual Disorganization on attention; Reality Distortion on verbal memory. The results have implications for syndrome definition, pharmacological intervention and prediction of outcome in schizophrenia.

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      Additionally, if working memory is counted as an executive task, then there is evidence that even when immediate memory span is intact (digits forwards), it is only the higher level working memory component of the same task that differentiates schizophrenia from control groups (digits backwards) (Stone et al., 1998). Deviating somewhat, but not contradicting this model, are the findings that disproportionate EF occurs only in those individuals with a predominantly negative symptom profile (Mahurin et al., 1998; Bryson et al., 2001; Donohoe et al., 2006b). Meta analytic results have been used to support the general deficit proposition (Laws, 1999).

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