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Lateral ventricle size, smooth pursuit eye tracking and neuropsychological test performance in chronic… Tallman, Karen Shepard 1986

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LATERAL VENTRICLE S I Z E , SMOOTH PURSUIT EYE TRACKING AND NEUROPSYCHOLOGICAL T E S T PERFORMANCE IN CHRONIC SCHIZOPHRENIA By Karen Shepard B.Sc,  University  Tallman  of British  Columbia,  1976  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE  REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in  THE  FACULTY OF GRADUATE STUDIES (Department o f P s y c h o l o g y )  We a c c e p t t h i s to  THE  thesis  the required  as conforming standard  UNIVERSITY OF BRITISH COLUMBIA August © Karen  1986  S h e p a r d T a l l m a n , 1986  In p r e s e n t i n g  this thesis  r e q u i r e m e n t s f o r an of  British  it  freely available  agree t h a t  in partial  advanced degree a t  Columbia,  Library  shall  for reference  and  study.  I  for extensive copying of  understood for  that  h i s or  be  her  g r a n t e d by  f i n a n c i a l gain  s h a l l not  be  of  The U n i v e r s i t y o f B r i t i s h 1956 Main Mall V a n c o u v e r , Canada V6T 1Y3  Date  -6 n/flin  DA  1 IK<Q  of  Columbia  make  further this  thesis  head o f  this  my  It is thesis  a l l o w e d w i t h o u t my  permission.  Department  the  representatives.  copying or p u b l i c a t i o n  the  University  the  f o r s c h o l a r l y p u r p o s e s may by  the  I agree that  permission  department o r  f u l f i l m e n t of  written  ABSTRACT The pursuit were  relationships eye  tracking,  investigated  inpatients. of  the  were  measures.  tracking  and  a  but  psychiatric  impaired  clear  on  no  that  s i x out  evidence eye  is  any  that  of  there  variety  of  However, an too  in  a  t o be  the  individuals  not a  is  no  performance  chronic  schizophrenic  show  lateral of  the  age  impairment  absence  of  matched  tests.  of  relationships  tests  most  relationship  neuropsychological alternative  functions  possibility  impaired, and  between  and  eye  between tracking  assessed  i s that a  sample  currently  d i a g n o s e d as  ii  of  schizophrenic.  between might the  is the  study.  s t u d y sample  deficits  representative  and  in this  relationship  neuropsychological  diverse  the  ranges  conclusion  tracking  on  enlarged  and p o o r eye  parsimonious  As  i t is  d e f i c i t s  independently of  non-  patients  enlargement, and  eye  ventricular  the r e s u l t of r e s t r i c t e d performance The  any  normal  schizophrenic  ventricle  occur  between  group  ten n e u r o p s y c h o l o g i c a l  may  smooth  showed a b n o r m a l l y p o o r  group  lateral  measures.  impairment  more  of  The  homogeneously  tracking  30  size,  test  control  on t h e n e u r o p s y c h o l o g i c a l  not thought  for  a  patients,  of  tests  ventricles.  impairments  to  tracking  neuropsychological lateral  to  did  schizophrenic  was  of  the s c h i z o p h r e n i c p a t i e n t s accuracy  ventricle  significant correlations  Compared  Compared  there  sample  no  enlargement.  were  lateral  neuropsychological  using  There  volunteers,  between  was eye  emerge  range  of  TABLE OF CONTENTS  PAGE  ABSTRACT  i i  TABLE OF CONTENTS  i i i  L I S T OF TABLES  vi  L I S T OF FIGURES  v i i  ACKNOWLEDGEMENTS  8  INTRODUCTION  1  . . . .  RELEVANT LITERATURE Smooth P u r s u i t E y e T r a c k i n g Definition Prevalence o f SPEM D y s f u n c t i o n i n Schizophrenia Significance O f SPEM Dysfunction i n Schizophrenia Summary-SPEM CT S c a n F i n d i n g s Definition Prevalence o f L a t e r a l V e n t r i c u l a r Enlargement (LVE) Significance of Lateral V e n t r i c u l a r Enlargement i n S c h i z o p h r e n i a A r t i f a c t or coincidence? C l i n i c a l c o r r e l a t e s o f LVE Cognitive/neuropsychological function and CT s c a n a b n o r m a l i t i e s Summary o f CT S c a n F i n d i n g s i n S c h i z o p h r e n i a . N e u r o p s y c h o l o g i c a l and C o g n i t i v e F u n c t i o n i n g i n Schizophrenia D e f i n i t i o n and D e s c r i p t i o n . N e u r o p s y c h o l o g i c a l t e s t s and d i f f e r e n t i a l d i a g n o s e s of " f u n c t i o n a l " v s . "organic" conditions Summary o f c l a s s i f i c a t i o n s t u d i e s . . . . Selected 'descriptive' studies of neuropsychological impairment i n schizophrenia Summary o f d e s c r i p t i v e s t u d i e s  iii  2 2 2 5 6 8 9 9  12 14 14 16 18 26 28 28  29 32  34 42  TABLE OF  CONTENTS  (Continued)  C o n c l u d i n g comments on d e f i n i t i o n and d e s c r i p t i o n of neuropsychological and cognitive functioning in schizophrenia P r e v a l e n c e o f N e u r o p s y c h o l o g i c a l Impairment . Medication and neuropsychological performance Subject c h a r a c t e r i s t i c s ; e f f e c t of age, education and e t h n i c i t y on n e u r o p s y c h o l o g i c a l performance . . . S i g n i f i c a n c e on N e u r o p s y c h o l o g i c a l Deficits in Schizophrenia Summary o f N e u r o p s y c h o l o g i c a l F i n d i n g s i n Schizophrenia Summary o f R e l a t i o n s h i p s Among M e a s u r e s o f Smooth Pursuit Eye Movements (SPEM), Lateral V e n t r i c l e E n l a r g e m e n t (LVE) , and N e u r o p s y c h o l o g i c a l T e s t P e r f o r m a n c e (NTP) in Schizophrenia SPEM and LVE SPEM and NTP LVE and NTP SPEM, LVE and NTP C o n c l u s i o n s From L i t e r a t u r e R e v i e w  45 46 48 50 51 52  55 56 57  57 60 63  RESEARCH OBJECTIVES Hypotheses Group D i f f e r e n c e s C o r r e l a t i o n s Among VBR, Smooth P u r s u i t Eye Tracking, and Neuropsychological Performance Correlations Within Battery . .  67 68 68  METHOD  71 71 71 82 82 83 83 84 85 85 86 87  Subjects Chronic schizophrenic patients Normal C o n t r o l Group P s y c h i a t r i c C o n t r o l Group Measures Smooth p u r s u i t eye movement r e c o r d i n g . . Lateral ventricle sizes Measurement o f VBR v e n t r i c l e s i z e . . . . N e u r o p s y c h o l o g i c a l assessment Scoring neuropsychological tests . . . . Procedure  iv  68 70  TABLE OF CONTENTS (Continued) RESULTS  .  89 R e l i a b i l i t y o f VBR m e a s u r e 90 R e l a t i o n s h i p s Between D u r a t i o n of H o s p i t a l i z a t i o n , Age and S u b s t a n c e A b u s e and t h e P r i n c i p a l M e a s u r e s 91 Group D i f f e r e n c e s 93 R e l a t i o n s h i p s Among VBR, LRMS D e v i a t i o n i n E y e T r a c k i n g and N e u r o p s y c h o l o g i c a l Test Performance 101 VBR and e y e t r a c k i n g 101 VBR and N e u r o p s y c h o l o g i c a l Test Performance 101 E y e T r a c k i n g and N e u r o p s y c h o l o g i c a l Test Performance . . . 103 Correlations within the Neuropsychological Test Battery 10 3 Summary o f R e s u l t s 10 6  DISCUSSION Group D i f f e r e n c e s R e l a t i o n s h i p s Among VBR, LRMS D e v i a t i o n i n E y e T r a c k i n g and N e u r o p s y c h o l o g i c a l Test Performance VBR and e y e t r a c k i n g VBR and N e u r o p s y c h o l o g i c a l Test Performance E y e T r a c k i n g and N e u r o p s y c h o l o g i c a l Test Performance Subject variables Correlations within the Neuropsychological Test Battery S t a t i s t i c a l Issues Conclusion REFERENCES APPENDIX A:  108 108 114 115 117 120 121 122 125 126 129  TESTING THE IDENTITY MATRIX HYPOTHESIS  . . . .  138  APPENDIX B l :  CONSENT TO BE INTERVIEWED  139  APPENDIX B2:  CONSENT TO BE TESTED  140  V  LIST OF TABLES PAGE  Table  1  Age o f P a r t i c i p a n t s  75  Table  2  Educational Attainment o f P a r t i c i p a n t s  76  Table  3  Number o f P s y c h i a t r i c H o s p i t a l i z a t i o n s Schizophrenic Patients  Table Table Table  Table  Table  Table  4 5 6  7  8  9  f o r Chronic 77  Accumulated Duration o f I n s t i t u t i o n a l i z a t i o n f o r Chronic Schizophrenic Patients  78  DSM-III Subtypes of Schizophrenia S c h i z o p h r e n i c Sample  79  in  Chronic  Means, S t a n d a r d D e v i a t i o n s , and t - t e s t V a l u e s f o r VBR, LRMS D e v i a t i o n i n E y e T r a c k i n g a n d WAIS-R F u l l S c a l e IQ f o r S c h i z o p h r e n i c P a t i e n t s w i t h H i s t o r i e s o f A l c o h o l and/or I l l i c i t Drug Abuse ( n = l l ) compared w i t h S c h i z o p h r e n i c P a t i e n t s w i t h L i t t l e o r No U s e o f I l l i c i t Drugs o r A l c o h o l (n=10)  94  M e a n s , S t a n d a r d D e v i a t i o n s , and t - V a l u e s f o r VBR and Eye T r a c k i n g A c c u r a c y f o r Schizophrenic P a t i e n t s and N o r m a l C o n t r o l s  95  Means, S t a n d a r d D e v i a t i o n s , and Ranges (where available) f o r Neuropsychological Tests f o r S c h i z o p h r e n i c P a t i e n t s and N o r m a l C o n t r o l s . . . .  97  T - t e s t s Between S c h i z o p h r e n i c p a t i e n t s and Psychiatric Controls f o r the Neuropsychological Tests  98  Table  10  C o r r e l a t i o n s B e w t e e n VBR, LRMS T r a c k i n g E r r o r , D u r a t i o n o f H o s p i t a l i z a t i o n and t h e N e u r o p s y c h o l o g i c a l T e s t s f o r t h e C h r o n i c S c h i z o p h r e n i c Sample (n=30) 102  Table  11  C o r r e l a t i o n Matrix o f Neuropsychological S c h i z o p h r e n i c Sample (n=30) . .  vi  Tests f o r 104  L I S T OF FIGURES PAGE Figure  Figure  1  2  Distribution of Ventricle Brain Ratios f o r Schizop h r e n i c P a t i e n t s and V o l u n t e e r C o n t r o l s . . . . . . D i s t r i b u t i o n o f LRMS e y e t r a c k i n g a c c u r a c y f o r S c h i z o p h r e n i c P a t i e n t s and V o l u n t e e r Controls  vii  99  scores 100  ACKNOWLEDGEMENTS The  research  reported  o f many i n d i v i d u a l s . generous took and of  guidance  over  this  valuable  generosity  with  acknowledged. played  a  have  my  assistance  Crockett's  h i s time  and  role  graduate  special  t h e effort's  kindly  i n Dr. Iacono's  absence  my  i n a l l stages  training.  thanks  ongoing  expertise,  Iacono,  provided  Papagorgis  i n the preparation  Dr. David  had t h e o p p o r t u n i t y  express  Dr. D i m i t r i  o f t h e committee  Dr. W i l l i a m  critical  throughout to  and s u p p o r t .  thesis.  thesis represents  E a c h member o f my t h e s i s c o m m i t t e e  chairmanship  provided  i n this  I feel  t o work w i t h  of the text  guidance,  i s  gratefully  principal of this  a d v i s o r , has project  tremendously Dr. Iacono  f o r h i s unflagging  and  and  fortunate  and w i s h t o  support  i n this  research. The  present  cooperation Hospital. Dr.  research  and g e n e r o s i t y I would  like  would  of several  especially  B. L e d w i d g e and Mr. K. J u d d Finally,  major  role  t h a t went  I wish  i n my into  life  this  have been  viii  help  three  the long  Shine  without the  at  Riverview  t o thank Dr. J . Higgenbottom,  t o acknowledge  research.  individuals  fortheir  throughout  impossible  i n this stars  days  project.  who  played  and l o n g e r  on B r i a n , J e s s ,  a  nights  and K o r a .  INTRODUCTION  Over  the past  attention  decade  to describing  a n o m a l i e s w h i c h may schizophrenia credibility phrenics  as  i n light  researchers  have  p h y s i o l o g i c a l and  occur a  many  i n schizophrenic  biologically o f the clear  turned  neuroanatomical  patients.  based  Viewing  disorder  evidence  that  b e n e f i t from dopamine a n t a g o n i s t i c d r u g s  has  to schizophrenia.  observations ships very  among  to the level critical  schizo-  and  repeated  The  present  study  each  phrenia.  The purpose  relationship  smooth  test  scan  of lateral  measures  fairly on  extensive  ventricle  date  there  taneously of  size  has been  pursuit  performance,  eye  with  schizo-  tracking,  size.  neuro-  tomography  Although  on e a c h m e a s u r e  (CT)  there are  i n i s o l a t i o n and  and c o g n i t i v e f u n c t i o n i n g i n c o m b i n a t i o n ,  i s only  one  published  investigated a l l three  subjects  biological  i s t o d e s c r i b e the  and computed  ventricle  literatures  of three  associated  of the research  psychological  t o be a  f o r researchers.  o f which  between  these  relation-  v a r i a b l e s has proven  i s an i n v e s t i g a t i o n  measures,  or pre-  beyond  of describing systematic  biological  demanding c h a l l e n g e  Progressing  much  many  d e m o n s t r a t i o n s t h a t t h e r e may be a h e r i t a b l e l i a b i l i t y disposition  their  (Bartfai,  Levander,  1985).  I  study  which  has  v a r i a b l e s i n t h e same Nyback,  Berggren  to  simulsample  & Schalling,  2 RELEVANT LITERATURE  The to  following  this  three  study w i l l  sections  smooth  attainment findings of  samples,  current  review  relationships  consists  project  The  first  will  and  Eye  deviations abnormal  major  research  and  a  of  section  which The  has  fifth  rationale for  b a s e d on t h e e x i s t i n g  Smooth P u r s u i t  defini-  of  the variables.  conclusions  three  i v ) a summary  The f o u r t h  summarize  among  cognitive  i ) operational of  on  lateral  on t h e s e  i i ) the prevalence  issues.  of  and  The s e c t i o n s  i n question,  of general  research  findings  i i i ) the s i g n i f i c a n c e  on t h e m e a s u r e  investigated  the  attainment,  the literature  scan  to discuss  and m e t h o d o l o g i c a l  section  CT  and n e u r o p s y c h o l o g i c a l  be s u b d i v i d e d  schizophrenic  sections.  relevant  t o reviews o f t h e l i t e r a t u r e  eye t r a c k i n g ,  of deviant  literature  into five  i n schizophrenia.  measures w i l l  in  be d e v o t e d  enlargement,  functioning  o f the research  be o r g a n i z e d  will  pursuit  ventricular  tions  review  literature.  Tracking  Definition Smooth following motion  pursuit  movements u t i l i z e d  at velocities  Holzman,  & Levin,  more  less  or  targets  eye  movements i n tracking  nonvoluntary  They  conjugate  i n continuous  (Lipton,  are believed  i n the presence  the function  are  targets  up t o 40 d e g r e e s / s e c o n d  1983; Yee, 1 9 8 3 ) .  and t o s e r v e  (SPEM)  o f slow  of maintaining  a  Levy,  &  t o be moving stable  3 image  on  the  associates  retina.  (Holzman,  Holzman,  Proctor,  findings  that  in  1908  and  disrupted  Beginning Proctor,  &  C o u c h and pursuit  eye  1973)  in  Fox  reports  Yasillo,  Hughes,  originated  with  the  on  i n 1934,  Meltzer, their  work  by  of  Holzman & Hurt,  in  1974;  investigation  Diefendorf  numerous s t u d i e s  movements  and  psychiatric  of  and  Dodge  have  found  patients  and  pursuit  eye  their relatives. A  standard  movements screen forth  protocol  involves  on at  which  placing a  small  v e l o c i t i e s up  movements  of  techniques  although  reflectometry position  and  the  allows  quantitative  by  examining  channel,  subjects. involve  More  record  and  by  have  i n the  records eye  i t may  the  compare i t t o  the  a  (EOG)  and  on  and  a  in  Methods  target  form  for which  considerably  across  the  to  evaluated  occurrence r e l a t i v e to  records  of  scoring  performance,  position.  target  scoring  reliable  that  of  of  noting  programs  and  infrared  Both  some  a  The  variety  qualitatively  compared and  back  polygraph  movement c h a n n e l be  from  second.  with  stored  be  cm  driven  most common.  be  can  30  per  recorded  tracking  computer  is  degrees  differed  sophisticated  designed  cursor  computer.  performance  or  about  recorded  also  analysis  quantifying  specially  be  are  may  polygraph  obvious deviations target  and  Tracking  a  30-40  probably  performance  studies.  subject  or  may  position  inspection  tracking  dot  smooth  electrooculography  are  visual  measuring  the  to  eye  (IR) eye  for  sample  often the  of the  normal methods through  tracking  4 E a c h s c o r i n g method c o n s t i t u t e s of the  pursuit deficit.  focused  on  not  appear  precise  found  and  phrenic  Stark,  infrared derably  the  than  movement in  either/both amplitude other  "saccadic  the  suggest  "saccadic  saccades, and  patients  they  pursuit  that  0.5°  2.5°  at  a  pursuit"  eye  to  rate  of  tracking  of  "phase-lag"  visual  to  arc  be  as  the  errors  of  Levin,  findings  on  sophisticated to  be  techniques  opposite 1  schizo-  subjects.  SPEM  (defined in  more  two the  movements  impaired  to  that  describe  believe  they  affective-disorder  believe  They  which  reported  measurement  the  eye  using  they  of  smooth p u r s u i t  saccadic  other  (19 82)  intrusions"  occurring  smooth  in  does  and  found  produced  studies.  smooth  of  degrees  instrumentation  irregularities  They  of  Holzman  than  tracking  Iacono  patients  that  seen  schizophrenic  disrupted  phrenia.  and  movement  the  have  there  pattern.  They  and  those  eye  present  significantly  number  target)  precise  eye  of  from  with  average  recording more  aspects  individuals.  Merrin,  six  other  factors  each  the  pursuit  schizophrenic  tracked  behind  of  of  At  of  agreed-upon d e f i n i t i o n  abnormal two  aspects  1983).  qualitatively  amplitude  group  eye  the  normal  as  lag  Jones,  Koenig,  describe  patients  (defined  different  a consensually  of  differed  smaller  &  performance  patients  the  be  (1983)  tracking  a  to  nature  Koenig  eyes  (Iacono  definition  D i f f e r e n t measurement t e c h n i q u e s  qualitatively  performance  an- o p e r a t i o n a l  is  consiused  in  types  of  underlying in  a  schizo-  result  pairs  of  small  directions  3 per  (defined  second) as  of  to and  pursuit  5 tracking  accomplished  by s m a l l  saccadic  steps  o f about  1° i n  amplitude).  Prevalence  o f SPEM D y s f u n c t i o n  Recent show  reviews  impaired  suggest  smooth  that  pursuit  Latham, Holzman, Manschrech, findings  of the early  have e s s e n t i a l l y Holzman  &  Holzman,  al.  and  Lipton,  1980; M i a l e t  (1974)  study  e y e movement  eye t r a c k i n g  schizophrenic  45%  patients  performance found is  patients  Iacono,  patients  degree  11%  of  Tuason,  o f remitted  a state  i n 52% o f  (n=46); 22%  85% o f  of  of  manic  schizophrenic  relatives  i n 8%  of  o f normal  (1981) was  indicating  variable  Levin,  psychiatric patients  schizophrenics  i n hospitalized patients  not simply  (n=29);  and J o h n s o n  (Cegalis &  found  patients  degree  and  by  I n t h e Holzman e t  was  relatives  first  (n=19);  The  e t a l . , 1974)  1981; L i p t o n ,  21% o f n o n - p s y c h o t i c  first  (n=34);  psychiatric (n=72).  of  1983;  1983).  others  1981).  chronic  (n=19);  by  & Holzman,  h o s p i t a l i z e d schizophrenic  (n=9);  (Holzman  confirmed  recently  depressives  (Holzman,  o f t i m e and b e e n r e p l i c a t e d  & Pichot,  deviant  schizophrenics  1981; Spohn,  studies  the test  and h i s g r o u p ,  50% t o 80% o f  & Tole,  Holzman  stood  Sweeney, 1979; L e v i n ,  i n Schizophrenia  occurring  controls  found  that the  similar  t h e SPEM during  other  to  that  dysfunction a  psychotic  episode. It not  i s frequently  specific  acknowledged  to schizophrenia  that  and o c c u r s  SPEM  dysfunction i s  i n several  neurologic  6  disorders Spohn,  (Leigh,  such  Lipton,  as m a n i c - d e p r e s s i v e s  1981; L i p t o n  specificity,  prevalent normal  than  varies  been n o t e d  appears  a higher  i n chronic  1980).  twin  prevalence  patients  colleagues  and  considerable tracking While be  further  phrenia  serve  as  pursued  genetic  at this  proportion  SPEM  have  and a l s o  of  o f Iacono that  marker  o f t h e SPEM time  of  lend  deviant  for  1984; J o n e s ,  reported  Corvera,  that  schizophrenia. will  be n o t e d  research  not  that  a  in  schizo-  i n Parkinson's  disease  hypotheses.  Friedland,  Koss,  Torres-Courtney,  73% o f a  pursuit  literature  i t should  reported  and L y k k e n  & Loewenson,  (1973)  has  and  Nagel,  Rios  of  Holzman  e t a l . , 1983) and i n A l z h e i m e r . ' s - t y p e d e m e n t i a  1983).  and  disrupted  deficit  (Leigh  Thompkins-Ober,  more  characteristics  studies  o f e y e movement  been  characteristic  of tracking  has been c o n c e r n e d w i t h g e n e t i c  Abnormal  of  i n Schizophrenia  family  aspect  &  ( L i p t o n e t a l . , 1983).  studies  a  the lack  prevalence  to the proposition  particular  considerable  and  the twin  weight  may  this  studies  that  Rothenberg  i n nonpsychotic  the c l i n i c a l  S i g n i f i c a n c e Of SPEM D y s f u n c t i o n The  Lipton,  groups  than  198 3 ;  psychiatric  Despite  psychotic  somewhat w i t h  population;  i n other  (Levin,  disorders  I t also  & Jensen,  seems t o be more  other  i n psychotic  groups.  pursuit  et a l .,  SPEM d y s f u n c t i o n  schizophrenia  the  Lasker,  1 9 8 3 ; Y e e , 1983) and i s p r e s e n t  groups  of  Newman, F o l s t e i n ,  large  group  (Hutton, Stark,  and  &  Lopez-  (n=325) o f  7 patients smooth found  with  pursuit  possible  tracking  patients  lobes.  inhibition locus  suggest  located  two  Weinberger  o f a comparison  with with  large  30%  with  normal Sixty  (6/20)  schizophrenics rating  system  on a they  impaired  on  t h e eye t r a c k i n g  assessed  by  a  lateral  linear  ventricles.  measure  in  some  percent  preliminary between  task.  impaired with  On  tracking  that  ven-  performance  the basis sample  Ventricle  B a r t f a i et a l . report  of the  normal  83% o f t h e i r  of the frontal  20  patients  (9/14)  eye t r a c k i n g  scale.  that  be  schizophrenic  proficiency  rated  may  the association  report  showed  5 point  report  eye f i e l d s  impairment.  of the patients  B a r t f a i e t a l . (1985)  i n the  'saccadic  v e n t r i c l e s and 14  ventricles  have  schizophrenic  of a  size  four  eye  schizophrenic  of  investigated  (1982)  disorders i t  neuropathology  tracking  ventricle  are often  and p o o r  in  disorder  of tracking  ventricles.  enlarged  patients  that  showed  e t a l . (1981a)  impairment  and W y a t t  with  their  Levin  have  and l a t e r a l  patients  17  enlargement  i n the frontal  studies  schizophrenic  of  disruptions  associated  hand,  o f t h e smooth p u r s u i t  SPEM  patients.  tricles.  be  the t r a c k i n g  system'  disorders  diffuse neurological  might  They  date,  between  compared  SPEM  ventricular  the other  that  As  i s the result of a localized  frontal  results  that  On  hypothesized  To  with  performance  patients.  of neurological  abnormalities.  t o be a s s o c i a t e d  seems  the  a variety  size  horns few  of were was  o f the patiants  8 had  abnormal  found  ventricles.  No  significant  relationship  was  b e t w e e n v e n t r i c l e s i z e and e y e t r a c k i n g .  Summary-SPEM  Smooth p u r s u i t 50%  has been  t o 80% o f s c h i z o p h r e n i c s  degree  relatives.  include  and  Important  the following:  independent of  tracking  of voluntary  low m o t i v a t i o n ;  1)  found  about  45%  features  to  does  2) i t seems t o be a t r a i t  n o t appear  medication; more other  population  heritability  methodological movement precise  tracking.  identical  twins 7)  may  provide  to understanding  i s growing u n d e r s t a n d i n g issues  records.  involved  a  status;  i t appears  group  than  rate  high  similar  disorders  some  any  i n the  degree  types with  of  neuroanatomical  and c o n s e n s u s  i s deviant  of  known  schizophrenia.  i n measurement  o f what  3)  and i n m o n o z y g o t i c  In a l l l i k e l i h o o d t h i s  understanding  i s stable  antipsychotic  5) i t h a s a l o w b a s e  8 % ) ; 6) i t s h o w s  which  by  diagnostic  i n some n e u r o l o g i c a l  useful  there  that  a result  which  to schizophrenia  f o r schizophrenia;  o f pathology,  addition,  more  (about  a r e seen  information  eye  with  both i n normal  discordant  impairment sites  associated  relatively  clinical  or affected  not s p e c i f i c  psychiatric disorders;  normal  twins  t o be c a u s e d  4) w h i l e  strongly  be  first  impairment  and i s n o t s i m p l y  o v e r t i m e and i n d e p e n d e n t o f t h e p a t i e n t s ' it  of their  of the  i t appears  attention  t o be a b n o r m a l i n  In  on t h e  and s c o r i n g will  lead  i n deviant  of  to a eye  9  CT Scan F i n d i n g s Definition The  search  for structural  schizophrenics  began  shortly  abnormalities after  syndrome o f d e m e n t i a p r a e c o x . from  the  1920s  particularly  i n t o the  decreased  Kraepelin  1950s y i e l d e d cortical  cell  and  nerve  were s o o n r e c o g n i z e d  schizophrenia  thereby  discouraging  CT new  scan  (Johnstone, aspects scan  of  the  Crow,  with  Frith,  prominence  of  hemispheric  asymmetry.  of  ventricle  ratio  recent  ventricle sulci, The  to  total  on  the  scan  at  studies  fibre  density.  effort  their  in  in sulcal  atrophy.  Unfortunately  difficult  to  assess  prominence  from  most  b r a i n area  this CT  third  often  There  1976).  to  this  fairly in  utilized  brain  measure  of  brain is  and  ventricle  a  and  size,  ratio  shows  as  CT  a  i s increased as  the  atrophy,  expressed  which  1976  Several  ventricle  frequently  (termed  aspect scans  a  investigated with  cerebellar  section  are  appeared  Kreel,  size,  size,  largest.  patients first  &  measure  ventricle  area  VBR)  ventricles  having  Husband,  cortical  is lateral  or  schizophrenic  literature  including lateral  date  out  as n o n s p e c i f i c  further  b r a i n s t r u c t u r e have been  to  the  1983).  studies  addition to  described  of  some p o s i t i v e f i n d i n g s ,  deficits  (Seidman,  brains  Post-mortem s t u d i e s c a r r i e d  However, t h e s e  direction  i n the  the  lateral  interest of  in  cortical  structure  considered  is by  10 radiology than  e x p e r t s t o p r e s e n t more c o m p l e x m e a s u r e m e n t  v e n t r i c u l a r measures Lateral  an  index  ventricular  of non-specific  Weinberger  and W y a t t  of  or present  a  past  either  fluid  Ventricular dementia ranging mean  VBR  Neophytides, dramatic  be  easily  these  seen  used,  1982; 1983).  on  a CT  scan  (e.g.,  p a t i e n t s compared  subjects). point  Weinberger, out that  i s not the sort  In f a c t ,  mean  w i t h i n t h e normal old"  abnormal  this of  with  Torrey, sort  "Ventricular  there  and may size for  for individuals  i n the type  o f scanner  s c o r i n g methods, c u t o f f s c o r e  used  and  and  (Andreasen,  Zatz,  of  (p.738).  Laboratories differ  groups  a  ventricular  ventricular range  VBRs  L V E i n s c h i z o p h r e n i c p o p u l a t i o n s has  abnormality,  Recently  obstruction to  (p.506).  obvious  change  70 y e a r s  Jernigan,  involving  a s s o c i a t e d w i t h d i s o r d e r s s u c h as  (1979a)  scanning procedures,  comparison  one  marker  i n s c h i z o p h r e n i c p a t i e n t s i s modest  difficult.  define  or  i n schizophrenic patients:  patients falls  proved  tissue  i n demented  overlooked.  Defining  to  quite  structure.  " i t i s a biological  disorder, usually  brain  i n control  seen  approximately  state  enlargement  structural  enlargement  i n gross b r a i n  of  and W y a t t  enlargement  alterations  brain  16 t o 30  of 4  (LVE) i s c o n s i d e r e d t o be  circulation"  i s often from  1982).  enlargement  (1982)  degeneration  cerebrospinal  (Bird,  problems  Moses,  composition  Smith,  Jacoby,  & Berger,  i s evidence  of patient Dennert,  1982a;  of effort  Maser by  & Olson, &  Keith,  t h e major  11 psychiatric  CT l a b o r a t o r i e s  to standardize  as  (Maser & K e i t h ,  1983).  possible Studies  Jernigan using  by  Penn,  Belanger,  through  o r computer  t h e body  of  sophisticated obtained  measure have are to  computer  differences compare  objective  raw  solution  laboratory clinical  research  values.  by g r o u p s  o r computer  within  wishing  which they  Health  first  (NIMH)  CT  definitions  above a c o n t r o l  w i t h more  estimates.  et  While  t o be a  valid  demonstrated  t o compare  to  there  i t unwise  a l . 1982a)  Until  are available f o r findings,  a  group  by  data  c a n compare t h e d a t a  i n the National  scan  group  have  o f L V E ; 1) a VBR  short  from  each their  d e f i n i t i o n takes laboratories,  findings  o f Synek  o f 10 o c c u r  account  t h e second  and Reuben i n less  provided  than  of different  and o t h e r s  5% o f t h e n o r m a l  two  o f 2 SD  10.  While  practices  d e f i n i t i o n i s based  (1976)  than  Institute of  i n excess  g r o u p mean, and 2) VBR g r e a t e r  different  excess  highly  an  populations.  operational  the  provides  laboratories,  procedures  W e i n b e r g e r and c o l l a b o r a t o r s Mental  single cut  g r o u p s , w h i c h make  (Jernigan scoring  a  appears  i s collection of control  against  on  and h a s b e e n  reliability  between  volume  a n d by  m e a s u r e s o f VBR  ventricles  total  volume  standardized  utilization term  derived  by p l a n i m e t r y  inter-rater  area  a s much  (1977)  that  s i z e which c o r r e l a t e s  of ventricular  high  derived  the lateral  estimate o f v e n t r i c u l a r  VBR  and Y a s n o f f  e t a l . (1982a) h a v e d e m o n s t r a t e d  planimetry  procedures  that  in  on t h e VBRs i n  population.  12 Both  these d e f i n i t i o n s  (1982b)  have  are widely used,  commented  particularly  in  schizophrenia.  •  that  they  preliminary  but  may  stages  Andreasen  be of  too CT  P r e v a l e n c e o f L a t e r a l V e n t r i c u l a r Enlargement Johnstone  et  were  the  scan  studies' with  al.  sample  58y) all  first  and  t h e age  relative  ventricular  groups  ventricular  reported samples VBRs  size  scanned  in  for  the  a  Roy  normal of  groups.  CT  Johnstone  et  have  26  (mean  65  lateral  lists  50%  studies  equipment  Nine  207% The  —  normal as  the  assessed  reviewed  11  and  reported  these  studies  greater average  patients.  VBR.  group of  con-  lateral  include  a l . (1985)  control  o f the  ventricles  investigators  et  age  patients  reported  d i d not  same  VBR.  to  controlled  patients  l a r g e r mean VBRs i n t h e i r 35%  a l . ( 1979a)  of schizophrenic  many  Ninan,  terms  control  on  The  by methods o t h e r t h a n  r a n g i n g from the  which  Reveley  and  included  significantly —  by  et  found approx.  (1985)  in  (LVE)  contained  enlarged  i n samples  patients  which  ventricle  1985  cited  Pickar,  chronic  a l . sample  Reveley  enlargement  Boronow,  male  both studies  and  studies  schizophrenic  studies  1976  17  stringent,  research  to undertake  patients.  evidenced  enlargement  the  control  o f 50;  Weinberger  groups  et  controls.  between  of  of  patients  to  and  schizophrenic  consisted  schizophrenic  Many  research  the Weinberger  under  ducted  a l . (1976)  et a l .  schizophrenic than  the  mean  percentage  of  13 patients mean  w i t h a VBR  was  3 8%  have found  (range  6%  ranging  from  & Mandelbrote,  In a d d i t i o n  positive  studies  which  failed  Jones,  Kingsley, In  a  to  t o 7%  find  teristics  Reveley,  Kolakowska,  (Boronow e t a l . , 1 9 8 5 ) . i n prevalence rates for  there  are  Lipinski,  also  published  enlargement 1982;  Kitamura  &  Asai,  (Benes,  Gluck, Largen,  Schoolar, & Ravichandran,  published  t h e CT  might  (1982) account  open-ward  treatment,  neuropsychological self-care  Radu, Smith,  19 84;  1985;  Shima,  Trimble,  of  dimensions  are  prevalence  of  & Iacono  subjects the  with  &  to  ventricular  of s o c i a l ,  groups  may  to  enlargement.  be  charac-  disparities. vs.  medication,  o c c u p a t i o n a l and that  samples  impaired  on  evidence  a greater  A  critical  these  r e c e n t paper  the s e l e c t i o n  the  1983,  locked-ward  suggest  more  likely  (1986) s u g g e s t s t h a t  control  to  neuroleptic  chronicity  most  sponsored  sample  reported  respect  relatively  samples  NIMH  (see Maser & K e i t h  f o r the  levels  and  an  d i s c u s s e s some  response  status,  functioning,  comprised  after  scan i n Psychiatry  Luchins  which  shortly  r e s e a r c h samples  of  ventricular  J e r n i g a n e t a l . , 1982;  Comparing  tion  &  studies  lateral  ventricular  Cohen,  Tsukumo,  paper  review),  Smith  (Williams,  controlled  group  1978).  w o r k s h o p on for  of significant  15%  1980;  Baumgartner,  Masuda,  Recent  findings  LeMay,  Mundt, & G e r h a r d t ,  Kanba,  above t h e c o n t r o l  t o marked v a r i a b i l i t y  with  Calderon,  90%).  1985)  studies  Pearson,  to  prevalence rates  enlargement Arlen,  g r e a t e r t h a n 2 SDs  and  factor  by  composiin dif-  ferences the  between  many  studies  in  methodological  prevalence  factors  collectively  a f f e c t estimates  enlargement,  i t i s apparent  parameter from  a  will  require  wide  and  of the  that  LVE.  subject  In  light  variables  further  of  patient  of  which  prevalence of v e n t r i c u l a r  a clear understanding  the  variety  of  of  this  accumulation  of  samples  measurement  and  evidence  techniques.  Significance  of  Lateral  Ventricular  Enlargement  in  Schizophrenia The  brain  investigations Wyatt  (1982)  with as  investigators evidence o f LVE  remains  possibility in  or  that  for  tionalization  are  described  and  nonspecific.  subtle that  large  a  lateral  LVE  i s an  that  LVE on  history.  medicated  i n CT  scan  Weinberger While  of  and  several  schizophrenics  v e n t r i c l e s , the  and/or  in the LVE  have  Studies  basis  little also  and  this  to date,  of  occurs  b e t w e e n LVE  although  which  schizophrenic  correlational trend duration  Research  artifact,  significant  se,  by  proportion  coincidence?  simply  tionalization.  per  observed  significance  unclear.  finding  accounted  been  both  deviantly  abnormalities  patients  report  Artifact  tent  structure  patients  medication  no  in  that  cross  cannot  the  consis-  cannot  or  who  history  indicate  of medication or  possibility  is quite  in patients or  addresses  be  instituhave  of  institu-  there  sectional  never  is  no  samples  institutionalization be  ruled  out  without  15 longitudinal Owens,  data  (Johnstone,  Johnstone,  W e i n b e r g e r , De  Lisi,  Crow,  simply  occur al., of  an  age  i n young 1983;  young  1980;  patients  Kurtz,  size  and  (Golden,  Tachiki  &  Orzeck  t h a t LVE  is  been found  to  (Schulz,  Koller,  i n a number o f  Moses,  et  samples  Zalazowski,  1982/83;  the  possibility  rate  of  these that  Keith,  fairly in  studies;  et a l . ,  Weinberger  VBR  =  a)  there  by  of  Weinberger,  +  10  probably  under  40  the  et  Wagner  &  b)  general  age  age  =  Jernigan  ventricular  the  a  remarkably  (Weinberger  29.8  thought  5% et  base  review  (1983)  that  8.7  & Ahumanda volume  consistent of  normal  al.,  years, (1981)  remains  of  conclude  for 9 studies, +  of  numerous  of  Based  less  c o n t r o l groups  x mean  Zatz,  of  in  lack  which are  Wyatt  may  ventricular  are  estimates  population.  occurs  years  n=329,  0.8); in  valid  there  areas  f o r normal c o n t r o l s are  subject  3.9  in schizophrenia  However,  and  general  t h e mean VBRs f o r t h e  control  LVE  i s made d i f f i c u l t  1983).  reliable the  values  individuals list  &  LVE  VBR a  that  s c a l e s t u d i e s i n many r e s e a r c h  provide  that  evidence  patients  1985;  1982).  large scale epidemiological studies of  (Maser  smaller  VBR  Kreel,  anomaly s i n c e i t has  a c o i n c i d e n t a l occurrence  and  &  1982;  1982).  independent  to  Nasrallah,  Jagoe  convincing  schizophreniform  Addressing be  and  dependent  chronic  1976 ;  Frith,  W e i n b e r g e r e t a l . , 1982)  Kling,  al.,  al  Purman, Targom & W y a t t ,  There i s considerable not  et  x  1983 total mean  suggest constant  16 until  age  60,  suggesting  that  changes i n v e n t r i c u l a r s i z e In  summary,  artifact  of  supported  age,  and  The  work  framework and  for  the  Crow, C r o s s ,  disorder of  with  Crow,  two  the  and  s e r i e s of  Johnstone,  and  pathological  process.  course, Crow  characterized  intellectual  pathological In  contrast,  thought  symptoms drive),  process II  (flattening  chronic  irreversible  postulated  was  hypothesized  well  Owen  and  might  differ  cell  LVE.  a  a  (1982)  that  the  actually consist considerably  in  treatment,  and  to  defined  Type  symptoms  I  syndrome  (delusions,  schizophrenia,  r e v e r s i b l e outcome, and  good  absence  He  postulated  t h a t the  underlying  be  increased  dopamine  receptors.  affect,  characterized poverty  poor  sometimes,  p a t h o l o g i c a l process t o be  might  correlates of  (1982) p r o p o s e d  response  syndrome was of  has  Crow  d i s o r d e r ) , acute  might  research  studies.  positive  schizophrenia,  outcome,  The  is  such  (1982)  by  impairment.  a Type  simple  provided  which  response to n e u r o l e p t i c drugs, of  a  collaborators  schizophrenia  syndromes  symptoms,  hallucinations,  not  unusual.  f a c t o r s which  clinical/behavioral  currently called  being  is  Considerable  investigation of  first  presenting  as  LVE  marked  institutionalization  LVE.  Johnstone  overlapping  7th decade are  that  and  occurring  accepted.  determining  of  the  conclusion  c o r r e l a t e s of  concerned  p r o v e t o be  before  medication,  widely  Clinical been  the  spontaneously  l o s s and  of  response  speech, to  II  structural  negative loss  of  neuroleptics,  intellectual i n Type  by  impairment.  schizophrenia changes i n  the  brain.  There  these  are several  and a s s o c i a t e d  variable. large  while  positive  symptoms.  and  small  reported  Olsen,  patient  symptoms  (1980)  variables  Andreasen,  ventricle  using  Dennert,  had a  have  investigated  L V E a s an and S m i t h  (1982a)  preponderance were  independent  of  an a s s o c i a t i o n  t o be  associated (Luchins,  between  Two s t u d i e s with  poor  Levine,  CT s c a n  found  negative  response  by  and Wyatt  abnormalities  ventricular  & Meltzer,  found  characterized  Weinberger, Cannon-Spoor, P o t k i n  ratings.  medication  which  v e n t r i c l e patents  premorbid  ment  studies  to  enlarge-  neuroleptic  1984; Weinberger,  B i g e l o w , K l e i n m a n , e t a l . , 19 8 0 ) . Despite which  these  rather  has followed  these  replicate Owen  their  in a  schizophrenic intellectual larger these  (1985) sample  impairment,  ventricles  association  than  Williams  between  response  cognitive  impairment this  ventricular patients  reports  most  research  has f a i l e d  to  Patients and p o o r  of ventricular  institutionalized with  negative  drug-response  a matched  group  chronic symptoms,  d i d not have  of patients  without  e t a l . (1985) were u n a b l e t o f i n d an a n d symptom  to neuroleptics, i n . a sample  research  group  enlargement  i n their  few c o r r e l a t e s  o f 112  VBR  negative),  However,  found  patients.  features.  original  findings  findings.  et a l .  enlargement  promising  sample  was  type  (i.e. positive/  duration  of illness,  of schizophrenic  did find most  despite  that  common  patients.  significant  i n the  the lack  or  of  chronic overall  18 correlation  between  enlargement. investigated variety of  30  the  recent  of c l i n i c a l  to  find  variables In cular  or drug  recent  significant  i t appears might  symptoms,  to  poor  research  by  In  searchers  have  structure be  across  time  relates  that  the  as  a  poor has  tricular  not  deficits phrenic  been  have  in a  wide sample  They  were  clinical  that  ventri-  marker  a clinical  to  for  medication,  supported  a  syndrome  by  and  the  s e e n on  towards in  the  between  sulcal  possibility  CT  most  and  cognitive  that  and  and  abnor-  many the  neuropsychological  section also  functioning  Nonetheless  Masser  scan  increasingly negative  f r e q u e n t l y been  patients.  CT  re-  brain  scans of s c h i z o p h r e n i c s  previous  size  and  c o r r e l a t e s o f LVE,  v e n t r i c u l a r enlargement  and  by  function  the  intellectual  enlargement.  ventricle  a  size.  biological  response  (1985)  response,  e a r l y hope  characterized  investigated  noted  association  al.  c o r r e l a t i o n s between  addition to c l i n i c a l  tendency  of  et  findings.  associated with The  drug  ventricle  serve  outcome  abnormalities  ment.  Boronow  ventricular  b r a i n morphology  Cognitive/neuropsychological malities.  and  schizo-affective patients.  schizophrenia  negative,  specific  and  r e s p o n s e and  enlargement of  illness  study  f e a t u r e s , and  any  summary,  subtype  of  a s s o c i a t i o n between  schizophrenic  unable  of  A  duration  CT  scan  on  impairfindings  clinical  applies and  may  cor-  to  lateral  the ven-  abnormalities  in  cognitive/neuropsychological  reported Keith  to  co-occur  (1983) i n t h e i r  in  schizo-  report  on  19 the  NIMH CT  "knew  scan  o f no  workshop  published  impairment"  (p.275).  with  as  this  an  cite  Weinberger  study  showing  While there  entirely  VBR  and IQ s c o r e s  frequently  —  occurs  LVE without  i t does  statement  to find  appear  that  he  cognitive  a r e good g r o u n d s t o  factual  W e i n b e r g e r e t a l . (1979) f a i l e d  as s t a t i n g  disagree  --  indeed  a r e l a t i o n s h i p between  that  cognitive  i n s a m p l e s o f p a t i e n t s who  also  impairment  show CT s c a n  abnormalities. Before  presenting  measurement/definition first  relates  nition  between  examination,  tests,  there  i s considerable  are not interchangeable  Inconsistent result  A CT  i n relation  have  been  function.  i s poorly  and  on a  defi-  mental  neuropsychological  measures  o f t h e same  of useful  that  these  functions.  information  d i f f e r e n t measures  as  may  inter-  function. problem  involves  ventricular  to cognitive  function.  associated  and s e v e r a l  their  the use  enlargement  both measures  Unfortunately  understood  assessed  to indicate  t o be  The  i s undoubtedly  research  to follow, found  measures  IQ t e s t , and  loss  two  of mention.  there  functions  of either/both  i n the studies  cognitive  these  While  measurement/definition  prominence  abnormality  and  i n both  indicants of "cognitive"  measures  seen  other  treating  second  sulcal be  findings  from  changeable  of  a standard  findings,  a r e worthy  function."  the cognitive  status  tests  issues  research  to the v a r i a b i l i t y  of "cognitive  overlap  the  As  will  of structural with  impaired  relation  studies  and  have  t o each  failed  to  20 find  a  and  systematic  sulcal  relationship  prominence  McCalley-Whitters, 1984; al.  Weinberger (1982/83)  covariation  and  Rieder  suggested  that  pathological  Torrey, the  correlates  sulcal  procedures, studies  Weinberger,  control and  dependent  long  in  the  Torrey,  any  dementia  as  enlargement)  more  than  is  may  (1979a)  be  Jacoby,  suggested may  strongly LVE.  that  the  differ,  and  associated  with  Unfortunately  the  of  Weinberger,  and  Wyatt,  significant  fail  This  to  for  the  i s s u e may  intellectual with  &  1979b)  define from  the  including  LVE  different found  changes  of  trivial  in  in  atrophy  enlargement.  In  with  forms  considerable  cortical  1980;  relationships  be  CT  Some  Wyatt,  difference  analyse  by  index.  measures,  i t i s receiving  ventricle  this  Waldman,  &  have  independent  Kuperman,  widening  validity  a  et  significant  the  associated and  be  separately  on  Kling  well-visualized  abnormality.  literature  Wyatt  have  o f a number o f CT  however,  et a l . ,  particularly  as  prominence,  run;  &  sulcal  Neophytides,  abnormality  variables  structural  not  Donnelly,  g r o u p on  sulcal  the  are  compromising  (eg.  structural  may  find  &  prominence.  (1983b)  and  impairment  sulci  hand  Nasrallah,  Hamara  widening  intellectual cortical  sulcal  other did  size  Hamara  Lee,  abnormalities  o f LVE  ventricle  Dewan,  the  Neophytides,  two  &  On  a l . (1983)  processes.  McCalley-Whitters,  that  Pandurangi,  et  and  lateral  N a s r a l l a h , Kuperman,  a l . 1979b).  b e t w e e n LVE  Weinberger,  clinical  (e.g.  1983a;  et  between  attention aging  and  (sulcal this  area  21 investigators have  are also  different  clinical  Garron, Fox, Bergen, The al.  original  (1976)  similar  and found  ventricle  size  individuals  i n their  scores  and  "other"  no  findings  ministered and  found  would  and  that while  be expected  ciation al.  a compete  between  (1980)  t h e WAIS  whom  CT  fissures, sulci  "Mental  status  t o 15 y o u n g  scan width  Status  i n a normal  measures  worse  than  the other  size  group.  and VBR. - Reitan  schizophrenic  fissures,  of  who a d -  examination  scored there  and any Similar  (1982/1983)  patients  scores  scores  patients  the schizo-  i n Neurology"  o f LVE, width  Test  found  ventricle  the Halstead  of Sylvian  were a v a i l a b l e .  They  population  chronic  19  psychiatric patients  schizophrenic  et a l .  schizophrenic  administered  with  schizophrenic  by K l i n g  mental  WAIS  testing  study  and IQ m e a s u r e s , b u t f o u n d  r e l a t i o n s h i p between  are reported  between CT  significantly  i n the chronic  (n=14)  test  In t h e second  o f 7 3 mixed  psychiatric patients).  functioning  and H i n t o n  o f -0.70  p a t i e n t s on a l l s u b t e s t  scores  o u t by J o h n s t o n e e t  (the Withers  completed  sample  1982; Kaszniak,  of cognitive  a v a i l a b l e f o r 14 c h r o n i c  significant  WAIS  exam  p a t i e n t s performed  psychiatric  carried  measures  (1979a)  seem t o  1979).  study  status  (Bird,  and c o g n i t i v e f u n c t i o n .  et a l .  (WAIS  t h e two m e a s u r e s  a correlation  Weinberger  phrenic  & Huckman,  incorporated  t o a mental  that  correlates  CT s c a n  battery)  5  finding  lower  was no  than asso-  Donnelley Battery  et  (HRB)  patients  on  interhemispheric  and w i d t h  of  cortical  on t h e HRB were c o m b i n e d i n  a  standardized  (AIR) of  fashion  to  form  (Russell, Neuringer,  15  patients,  abnormality that  —  8  had  where CT  exceeded  the  AIR  (5 p o i n t  performance investigators hit  rate  differences eight  of  range  80%  the  components. of  and  to  for  7  defined  as  any  of  impaired"  predict  CT  They  normal  and  subtests  of  Digit  Object  the  for  that  each  of  four  found  measures  and  "average"  an  the  overall  significant  scan  groups  Design, on  on  Picture  a l l three  failed  four  on  (Comprehension,  Block  the  no  enlargement  with  WAIS  they  group  showed  between  a b n o r m a l CT  Span,  the  performance)  also  the  Rating  a c u t t i n g score  status  Assembly),  I t i s unfortunate  abnormality  was  In  and  (which f a l l s  Similarities,  Arrangement  scans  1.55  (12/15).  eleven  1970).  Utilizing  "mildly able  Impairment  above.  of  between t h e  Arithmetic,  rates  scale)  were  of  Goldstein,  abnormality  control  and  Average  abnormal  of brain structure l i s t e d the  &  the  to  specify  measures  of  IQ the  brain  structure. A  series  borators  of  show  relations  between  32.3)  with  because group  a  of  the  of  suspected  considerably  from  1  higher  on  (LNNB) and chronic  LNNB.  Half brain to  by  C.J.  classification  performance  Battery  group  ranged  studies  impressive  psychological assessed  three  24  than  the  VBR.  Golden hit  of  the  (mean seen  12.0 in  et  and  had  within  +  5).  These  CT  (1980a)  (mean  been  VBR  corNeuro-  al.  patients  The  other  colla-  Nebraska  Golden  subjects  damage.  rates  Luria  schizophrenia  and  referred  the  entire  ratios  studies  age  and  are are  believed  to reflect  procedures  a  between  systematic  the Nebraska  ( W e i n b e r g e r , Wagner, & W y a t t , al.  (1980a)  making  d i d n o t have  comparison  unwise.  They  did,  group  1983).  of their  VBR  however,  state  classified  the VBR  eight  as b r a i n  LNNB s c a l e s  (tactile,  pathognomic, multiple  which  left  that  with  hemisphere,  were  rated  other  sulci.  was  90%.  Graber,  was  and r i g h t  Golden,  et  al.  and B l o c k  (1982)  G o l d e n e t a l . (1980b) s t u d y chronic  schizophrenics.  achieve  an o v e r a l l h i t r a t e  ten  false positives.  (1980a)  26 were  rules  diagnosed  normal  agreement  ventricles;  and 26 h a v i n g  forsulcal  LNNB  prominence  Chu,  applied  the rules  derived  to a cross-validation  16  normal  o f LVE f r o m  Ruedrich,  the rules  as  as h a v i n g  Arial,  Using  a  t h e p r e s e n c e o f L V E and s u l c a l  for prediction  Overall  with  gave  set of interpretive  s u l c a l prominence  Maclnnes,  using  arithmetic,  hemisphere)  Golden  and 22 a s h a v i n g  81%.  would  regression  writing,  assessed,  The o v e r a l l h i t r a t e  performance  samples  a VBR c u t o f f o f  A multiple  of a  O f 42 p a t i e n t s  as showing  study,  - 60% o f t h e i r s a m p l e  o f 0.72.  the accuracy  ventricles  labs  Golden e t  n o r m a l and 16 a s a b n o r m a l by t h e LNNB; 20 were r a t e d enlarged  CT  for this  using  reading,  t o LNNB f o r d e t e r m i n i n g  enlargement.  and o t h e r  group  scores  scoring  had s i g n i f i c a n t c o r r e l a t i o n s  expressive,  correlation  investigated applied  damaged.  i n  Unfortunately,  a control  >10 a s a d e f i n i t i o n o f a b n o r m a l i t y be  difference  Coffman, i n the  s a m p l e o f 43  to predict  LVE they  o f 77% w i t h no f a l s e n e g a t i v e s and  The m u l t i p l e  c o r r e l a t i o n b e t w e e n t h e 14  LNNB s c a l e s  and  VBR  the  et  al.  Golden  Golden  et  al.  was  (1980a)  i n -the  found  the  magnitude o f the  study  but The  are  not  -  relation,  (half  psychological be  free of  this  the  correlated of  of the  et  al.  obtained  in  between  (1982b)  the  studies  w h i c h c o r r e l a t e w i t h VBR Five  with  three  Differences  Golden  scales  LNNB  of  VBR  scales  correlations  high.  While  which the  might  subjects  the  i n both were  14  LNNB  and  scales  studies,  significant  reported  the  be  1980  been  assessment w h i l e the  other  sampling high  the  procedure  degree  of  1982 and  by  while in  Golden's  study  expected  had  brain dysfunction)  sort  replicate  study.  that  one  other.  impressively  characteristics  s i m i l a r to  correlations.  sets  the  VBR  and  specific  significantly  non-overlapping  very  (1980a)  are  were  0.76,  to  had  boost  referred  group sample  the  for  cor-  neuro-  h a l f were b e l i e v e d  s t u d y was was  not  flawed  nonetheless  association  found  able  i n the  to by to  earlier  study. Recent enlarged  additions  ventricles  psychological  to  40  schizophrenic  mean VBR  of  the  that  the  ventricles 36  control  more t h a n  patients  classified  patient  given as  literature  predictive Williams  and  group  and  to  impaired  al.  (1985)  significantly 15%  above t h e  cognitive  impaired.  et  of  failed  find  neurostudied  schizo-affective patients.  s a m p l e was  2 s.d. a  the  be  performance.  group o f  of  to  of  the  The  greater  than  patients  had  c o n t r o l g r o u p mean.  assessment,  Cognitive  a  13  (36%)  impairment  was  Of  were not  associated Owens  et  with al.  conducted  v e n t r i c u l a r enlargement (1985)  with  schizophrenic  a  out-patient  33  patients  with  et  ventricular  and and  a  f u l l  a  with  were n o t  and  a  institutionalized groups  impaired  and  and  diagnostic  groups  chronic  19  (1984)  report  extensive  Neuropsychological  linearly  such  that  significantly  on  The  subjects  and  as  in this  such the  their  Hinton) .  Gilmore,  the  significant  battery  of  than study  results  schizophrenic  Within  However,  and Owen  r e l a t i o n s h i p between  measure There  of  was  at  cognitive  an  both  excess  of  extremes  of  Edwards,  c o r r e l a t i o n s between  neuropsychological  B a t t e r y , and  only  chronic  DeMeyer, H e n d r i e ,  tests  VBR (a  L u r i a - N e b r a s k a  Weschler  i n d i v i d u a l s with  better  related.  curvilinear  Battery,  of  neurotic  ventricular size  cognitive function  DeMeyer,  study  consisting  disorder,  sample,  scores  Withers  size.  very  of purely  from  the n e u r o t i c o u t p a t i e n t s .  Ha 1 s t e a d - R e i t a n  Scale)  patients.  8 first-episode schizophrenics,  six  significant  size  (the  Franco  the  obtained  comparison  schizophrenic  function  ventricle  5  i n p a t i e n t s and  a l . found  patients  and  112  these  g r o u p d i f f e r e n c e s i n VBRs were b e t w e e n t h e  inpatient  function  of  bipolar  Among  schizophrenic  cognitive  findings  schizophrenics,  outpatients.  the  sample  patients  18  significant  report  in  Adult  larger  i n d i v i d u a l s with  Intelligence  VBRs small  performed ventricles.  were o f m i x e d p s y c h i a t r i c d i a g n o s i s  are not  directly  patients.  comparable to  studies  26  Summary o f CT Scan F i n d i n g s i n S c h i z o p h r e n i a Many a s p e c t s samples  have  summarized structure  by  the  lateral ment  index  table  and  rates been  at their  a VBR>10.  vary  episode,  that  treatments such  on  briefly  of  brain  t h e two  i s the ventricle  brain  of the ventricles slice  a VBR group  mean,  i t i s believed  that  studies  r a t e o f 20%.  patients  particularly  manic  histories  of  and t h o s e  I t i s therefore  samples  a VBR 5)  Prevalence I t has  schizophrenic 6) LVE i s n o t  chronic  with  by  o f 10  in  depressives.  drug  two  abnormal  but i s found  and o l d p a t i e n t s ,  long  of  enlarge-  o r i n some  ( 0 % t o 60% r a n g e ) . samples  the  than  i n schizophrenic as  and  showing  greater  c l a s s i f i e d  and h o s p i t a l i z a t i o n ,  interventions.  2) A  3) V e n t r i c u l a r  either  a prevalence  i n young with  o r prominence.  t h e CT  representative  populations,  those  measures  a control  be  to schizophrenic  i s found  aspects  5% o f a n o r m a l p o p u l a t i o n .  across  p a t i e n t s may e v i d e n c e  LVE  above  although  widely  psychiatric  size  largest.  as  not  than  suggested  specific  be  In schizophrenia  4) LVE i s s u b t l e  would  i n less  area  defined  neuroradiologists occurs  from  deviations  often  and may  Several  widening  of the skull  i s usually  cases,  sulcal  of ventricle  ventricles  standard  schizophrenic  investigated variables are l a t e r a l ventricular  (VBR) d e r i v e d  inner  1)  review  by CT s c a n .  (LVE) and  used  i n this  the following:  a r e assessed  enlargement  ratio  investigations with  been d i s c u s s e d  most f r e q u e n t l y  commonly  o f CT s c a n  and  and  other 7) first  somatic  no h i s t o r y o f  not believed  t o be a  simple  artifact  of  However,  there  prevalent  i n more  milder  forms  calls  Type  is  of  abnormalities  this  data  Several tural  a  findings. atrophy  as  research  is  suggest  neuroanatonically  are  sulcal  11)  cognitive  their  sample  distinct  groups  i m p a i r m e n t was  which  had  structural  both  to  brain  include  clear covariation  of  construct  has  b i o p s y c h i a t r i c research.  9)  the  / Type I I  association  quite  suggest  have  high  levels  that  cortical  independently  based  of  chronic  are  clinical  and  difficult on  at  recent  least  two  schizophrenics  Owens e t  over-represented  of  contradictory  i s more  there  struc-  cognitive  different  that  largest  of  /  occur  widening  impairment.  the  to  Crow  medication.  Speculations  possibility  structural  neuroleptic  I  may  sulcal  with  syndrome  i n c o n s i s t e n t and  and  those  postulated  w i d e n i n g may  e v i d e n c e marked c o g n i t i v e  found  the  with  have demonstrated  LVE.  the  of  more  other  neuropsychological  Unfortunately than  to  Type  body  v e n t r i c u l a r enlargement  assess  of  in  be  intellectual  investigators  by  and  may  course,  respect  the  and  Some  indexed  correlates.  who  with  although there 10)  is  investigated  several  LVE  Along  LVE  than  irreversible  variables,  abnormalities and  8)  response  have  that  patients  syndrome  equivocal  institutionalization.  descriptors  chronic  considerable  association,  to  II  poor  studies  impairment  of  Type  c l u s t e r of  generated  the  or  expect  Schizophrenia.  and  are  to  disorder.  among  symptoms,  impairment, While  reason  the  abnormalities, negative  medication,  seriously-ill  are II  age,  al.  (1985)  in portions  smallest  of  (greater  28 than et  1  s.d.  smaller  a l . found  than  c o n t r o l group)  that smaller ventricles  marked c o g n i t i v e i m p a i r m e n t  Neuropsychological  than  ventricles.  DeMeyer  were a s s o c i a t e d w i t h  more  l a r g e ones.  and C o g n i t i v e F u n c t i o n i n g i n S c h i z o p h r e n i a  D e f i n i t i o n and D e s c r i p t i o n Neuropsychological mance on  tasks  expression  status  designed,  is  inferred  from  test  or b e l i e v e d t o measure the  of brain function.  As  Lezak  perfor-  behavioral  (1981) d e s c r i b e s i t  "The d i s t i n g u i s h i n g c h a r a c t e r i s t i c of neuropsychological a s s e s s m e n t i s i t s e m p h a s i s on the i d e n t i f i c a t i o n and m e a s u r e m e n t o f p s y c h o l o g i c a l deficits, f o r i t i s p r i m a r i l y i n deficiencies of intellect, e m o t i o n a l i t y and control that brain damage i s m a n i f e s t e d b e h a v i o r a l l y " ( p . 8 5 ) . Thus,  many  neuropsychological  quantifying with  known  providing brain  differences organic  performance  syndromes  measures  of  a  and  were between  normal  "deficit"  designed  individuals  controls,  presumed  to  by  be  thereby  caused  by  damage. The  majority  psychiatric utility  of  neuropsychological  populations  has  of neuropsychological  patients some  in  instruments  with  'functional'  investigators utilize  including  intelligence  have  only  used  Designs-Test,  the the  tests  and  Benton  designed  the  to  studies  with  assess  the  in discriminating  'organic'  full  tests,  popular  been  research  diagnoses.  neuropsychological great  screening  majority  tests  Visual Retention  (e.g. Test  between While  batteries  of  studies  Memory-for(BVRT) ,  the  29 Trail one  Making of these  given 31  Test,  study  and t h e B e n d e r  instruments  i s used  (Heaton & Crowley,  c l a s s i f i c a t i o n  neuropsychological (HRB), and f o u n d greater  1981).  and/or  consuming  single  Malec  measures  u s i n g  Often  only  collection  in a  (1978)  reviewed  both  s i n g l e  the H a l s t e a d - R e i t a n  i n general  d i s c r i m i n a t o r y power  Test).  f o r data  a t t e m p t s  tests  that  Gestalt  t h e HRB f a i l e d than  many  Battery  t o demonstrate  of the less  i n differentiating  time-  'functional'  and  'organic' p a t i e n t s . Neuropsychological "functional" Heaton, Heaton  and J o h n s o n  and C r o w l e y  (1981)  between group  patients,  and e l e v e n  review  comparisons compared  f o r impairment.  selection  studies,  provided  cumulative  estimates  psychological ting  update  by  118 c l a s s i f i c a t i o n Ninety-nine organic  that  relatively  organic  s a m p l e was composed  psychiatric  i n t h e areas  However, et a l .  o f median  were  tests  and  studies  90% o f t h e s t u d i e s had  Heaton  estimates  of the  attempts  p a t i e n t s t o standard  particularly  These  f u n c t i o n a l from  tional  and a s u b s e q u e n t  and d e s c r i p t i o n .  of individual  classification.  by  psychiatric  weakness  of  review  between  flaws,  diagnoses  An e x t e n s i v e  They n o t e d  3 o r more m e t h o d o l o g i c a l sample  (197 8)  1960-1978.  utilized  scores  and d i f f e r e n t i a l  vs. "organic" conditions.  Baade,  published  tests  despite (1978,  percent  indicated  that  of the  1981)  correct neuro-  successful i n discrimina-  patients  except  of chronic/process  when  the  func-  schizophrenics.  30 The  median  functional  vs.  psychiatric disorders median  percent organic  samples  t o mixed  hit  rate  reported  normal  (Heaton  controls for  34  schizophrenic essentially  encountered Golden LNNB In  and  chance l e v e l  with  collaborators  (1980b) and  that  there  conclusions  may  Benton  1981).  mental  i s the 1965  for  organics  However t h e  organic  same 36 and  median  chronic/process  patients  was  54%,  classification  rates  prediction. rather  dismal  schizophrenics with  1980;  the  HRB  Purisch,  discussion  90% of  are  the  (Golden,  Golden, correct  these  findings  be  to  i n these  as  studies.  1977)  the  and  by  Golden  the  was et  (1983) i n d i c a t e  validity  Golden  of  1978).  classification  Thompson  some q u e s t i o n  studies  & Hammeke,  Moses, C a r d e l l i n o and  reported  in  involving  discriminate  from  approximately  However  made  This  of  utilizing  non-psychotic  and  & Crowley,  these  chronic  studies  achieved. al.  to  reports)  disorders.  Spreen  to  classification  (84  from  they  attempts  (Moses & G o l d e n ,  these  by  patients  Exceptions  75%  schizophrenic  attempts  rate  was  correct  ranging  classification  hit  for  et  al.  of  the  (19 82b)  state  " I t appears p o s s i b l e t h a t previous s t u d i e s comparing schizophrenics with b r a i n - i n j u r e d groups d i d not n e c e s s a r i l y m e a s u r e what t h e y t h o u g h t t h e y were measuring. F o r e x a m p l e , P u r i s c h , G o l d e n and Hammeke ( 1 9 7 8 ) f o u n d d i f f e r e n c e s between t h e schizophrenic and n e u r o l o g i c a l g r o u p s . This study established that neurological and schizophrenic patients p e r f o r m e d d i f f e r e n t l y on t h e L u r i a - N e b r a s k a B a t t e r y , not that the s c h i z o p h r e n i c s w e r e n o r m a l , as c o n cluded", (p.84)  31 Overall c h r o n i c  the  weight  of  the  s c h i z o p h r e n i c  neuropsychological  tests  &  i n d i v i d u a l s with  Crowley,  1981).  are  predictions they  can  be  no  p r e d i c t , hence  75%  et  al.  neuropsychological regard  to  the  deficits*. chronics  on  butable  to  outcome disorder. et  al.  suggest  commonly  term  While not  (1978) that  of  question  to  nor  motivational  poor  this  that  these criteria  the  then  medication  may  addressed  alternative  explanation  al.  is  performance  an  at  group's poor  with  generalized  often -  by  attri-  seen and  as  an  thought  this  possibility,  Heaton  adequate  explanation.  They  confined  to  a l l i n d i v i d u a l s with  tests.  They  affect  test  a later  point  i n the  discuss  chronic  the  performance, in this  w h i c h i s most c o m p e l l i n g of  on  performance  d e f i c i e n c i e s perform  "groups  samples  ' f u n c t i o n a l ' and  r u l e out  do  neuropsychological  that  by  schizophrenic  of  held  i t as  r a n g e on  (1978)  out,  imposed  institutionalization  able  patients  be  (Heaton  diagnostic  deficiencies -  and  which w i l l  the  t e s t s was  disorder  that  the  " f u n c t i o n a l problems" are not  schizophrenic  lity  discuss  explanation  motivational long  pointed  ceiling  tests of chronic  was  patients  brain dysfunction  than  a  discriminating  techniques.  a l l manner  of  be  (1978)  popular  It  may  in  when  e x c l u d e d ,  psychiatric  (1978)  more v a l i d  current neurodiagnostic Heaton  disturbed  Malec  are  useful  known o r g a n i c As  indicates that  p a t i e n t s  emotionally/psychologically from  evidence  or  chronic thought impaired possibi-  an  issue  review. f o r Heaton  process  The et  schizo-  phrenics a  may  look  significant  organic  on  proportion  neuropsychological  tests  of  are  such  patients  because organic"  (p.141)• The  Heaton  et  al.  (1978)  direction  for neuropsychological  Golden  al.  et  (1982)  articulate  review  signaled  research the  in  change  a  shift  in  schizophrenia.  in perspective  as  follows "The CT s c a n r e s e a r c h - as w e l l as t h e d a t a f r o m many o f t h e s t u d i e s r e v i e w e d by H e a t o n e t a l . (1978) . . . s u g g e s t t h a t t h e r e a r e a t l e a s t s e v e r a l subg r o u p s o f s c h i z o p h r e n i a , some o f w h i c h show b r a i n dysfunction. This conclusion clearly necessitates t h e a d o p t i o n o f a new research strategy i n neurop s y c h o l o g i c a l research with schizophrenia. Rather t h a n compare s c h i z o p h r e n i c s t o n e u r o l o g i c a l p a t i ents, our focus should be on i d e n t i f y i n g those s c h i z o p h r e n i c s w i t h b r a i n d a m a g e and eventually d i s c o v e r i n g how such p a t i e n t s d i f f e r i n age of o n s e t , r e s p o n s e t o t r e a t m e n t , symptoms, l i k e l i h o o d o f e n d i n g up i n c h r o n i c i n s t i t u t i o n s o r j a i l or s i m i l a r s e t t i n g s and o t h e r s u c h f a c t o r s i m p o r t a n t i n u n d e r s t a n d i n g t h e s e s u b g r o u p s " (p.89)  Summary definition expected  of  of in  the  classification form  chronic studies  Classification  studies  between  provide nature  a or  patients.  'brain  great extent  deal of  are  not,  in  damaged'  the  vs.  information deficits  the  themselves,  'non  regard  impairment  patients,  i n which t e s t s  of  With  neuropsychological  schizophrenic  classification  mize  of  studies.  brain  exhibited  be  majority  of  to  damaged'  relevant by  to  a  to  very  are u t i l i z e d  to  useful. dichotodo  defining  not the  schizophrenic  33 The  usefulness  discussed  above  (Golden  et  1981).  With  chronic  In  the  Heaton e t  growing  dysfunctions  belief  classification aim  overview,  provides  of  their  us  information;  a)  studies  few  chronic tests  modalities;  b)  schizophrenic  of  various  brain  impairment;  regions instead  impairment; statistically  c)  the  and  do  the  many  severity focal"  and  (p.212)  more  of  assess  picture  suggest,  as  to  does  to  do  so  on  variety on  function  show  of  organics.  deficits  clear  one  of  a of a of  focal diffuse  cannot  diffusely  Seidman  impairment  "appears  likely  a  samples  samples  with  poorly  the  is  out  descriptive  do in  exhibit  to  from  failure  patients  appear  from  known  be  brain  1983).  form o f n e u r o p s y c h o l o g i c a l patients  not  of  impaired,  with  carried  pieces  schizophrenic  (Seidman,  conclusions  schizophrenic  often  to  overall  differentiated  damaged p a t i e n t s These  believed  Fletcher,  neuropsychologists.  consistent  are  and  patients  patients  sort  sizable proportion  r e q u i r i n g performance  t e s t s which  the  investigators  Satz  schizophrenics  schizophrenic  of  range  from  important  range  many  of  neurologically  were  relatively a  are  a  disturbs  separating  with  by  that  them  longer  studies  a l . , 1978;  patients  no  group  questioned  discriminating  express  wide  comparison  been  schizophrenic  The the  has  a l . , 1981;  difficulty organic  of  be  to  be  diffuse  (1983),  evidenced mild or  to  by  that  chronic  moderate  bilateral  in  than  34 Selected impairment cation for  'descriptive'  i n schizophrenia.  studies  designed  differential  to  were  damage.  assumption  that  to  8  general  disorder.  schizophrenia  disorder. findings sarily vs.  Given in  seen  organic  reflection  test  of  ('acute  from  not  'functional*  group  been  a  patients  concept  "actual"  constituted  widely suffer  assumption;  weakness  from  but  a  as  a a  subgroup  a  neuropathological  positive  neuropsychological  individuals in  that  the  with  schizophrenia  believed  a  Over  re-appraisal of  of  aand  e x t e n s i v e l y pursued.  has  the  i s now  Heaton,  both  performance  n=24,  this  held  test  are  no  sensitivity  rather  as  a  longer to  neces-  functional  potentially  valid  of brain dysfunction.  interesting  utility  It  conditions  Chelune, an  commonly  were  the  differentially  findings i n schizophrenia concurrent  this  a  the  tests  with  d e s c r i p t i o n of  in  was  schizophrenic as  and  there  r e - a p p r a i s a l of  unitary of  and  years  neuropsychological  of  schizophrenics  impairment  i n terms  tests  Because  investigation  neuropsychological  6  validate neuropsychological  the  brain  past  classifi-  that  to  the  the  conducted  sensitive  contradiction  above,  generally  demonstrating  'organic*,  stated  neuropsychological  were  of  not  As  of  diagnoses  intention  priori  studies  two  brain  Lehman,  study mean in  and  designed level  and  Robinson to  examine  pattern  discriminating a  groups  of  damage, n=24,  diffusely and  (1979) c a r r i e d  of  the  diagnostic  neuropsychological  schizophrenic brain  chronic  out  damaged  brain  group, patients  damage,  n=24).  35 The  schizophrenic  Endicott's  1968  were v o l u n t a r y The  group  WAIS  short and  control  sample used  formed but  HRB  analysis.  significantly  and c h r o n i c  worse failed the  Schedule.  given  groups,  scores  standard  studies. issue  from  differ  the chronic  individuals. research less  and c h r o n i c from  been  of  f o r pattern group  b r a i n damage  b r a i n damage p a t i e n t s  each  other  per-  sample  i n pattern  o f performance  with  patients been  of  means  and  those  and  of  other  t o assess  brain  considered  mixed  the  in  results.  frequent  the  performance damaged earlier  1981, f o r d i s c u s s i o n )  and w i t h  because  t h e WAIS and  with  of neuropsychological  & Crowley,  methodology,  present  i s well-designed  has  between  c o n t r o l sample hence, i t  samples  schizophrenic issue  investigators  groups.  from t h e i r  t h e study  patterns  interest  These  of T-scores  their  d i d not  but d i d s i g n i f i c a n t l y  group.  i n t h e form  This  brain  C h e l u n e e t a l . (197 9)  (see Heaton  adequate  normal  On t h e  However,  between  member  b r a i n damage g r o u p s d i d n o t d i f f e r .  t o compare  o f whether  150  b e t t e r than the acute  deviation derived  not possible  a  schizophrenic  On t h e WAIS, t h e s c h i z o p h r e n i c  differences  only  A l l subjects  to the  and  b r a i n d i s o r d e r and s c h i z o p h r e n i c  HRB  and  sample'.  Unfortunately,  is  were  the schizophrenic  to find  Spitzer  t o produce a normative p r o f i l e  significantly than  on  damage  t e s t s the acute  differ  HRB  neurological  not d i f f e r e n t l y  Acute  based  stay inpatients. full  both  level  diagnosed  P s y c h i a t r i c Status  group,  and  was  with  I t has  failure  of  36 neuropsychological diffusely in  level  the  use  brain  tests  disordered  of performance. of* 150  age  of  more  pattern  valid  norms  than  an  and  derivation  samples  to  vary  efforts  at  finding  do  of  diffuse  patients  be  with  of  high  age  and  use  damaged  and  (1979),  profile  for  allows  i n the  patient  general  population  level  differences  and  In  light  in pattern  profile  al.  for  of  pattern  groups  control subjects  education).  of  et  responses  adequacy  degree  brain  by  control  test  test  obtained  methodological a  to Chelune  normative  between  schizophrenic  education-matched  analysis  not  differences  and  According  "ideal"  would  (which  found  i n demonstrating  of  their  analysis,  the  between  the  similarity  schizophrenic  samples  is  interesting. A p a i r o f s t u d i e s by and  Taylor  and  Abrams  neuropsychological and  zation  impairment  of  Taylor tests  which  battery" Test  Test, and  et  al.  they  comprised  Test,  Hooper  vs.  of  to  Single  as  the  Benton's  Organization  consisted  of  52  a  battery  data  Peabody  Double Test,  laterali-  impairment. of  psychological  Test  Simultaneous  (BVRT).  patients with  Picture  Repetition  Raven's  on  schizophrenic  r e l a t e d to  or b i l a t e r a l  Sentence  and  in  (1981),  "Smith's n e u r o p s y c h o l o g i c a l  WAIS,  Benton V i s u a l R e t e n t i o n  study  used  Abrams  interesting  impairment  hypotheses  diffuse  (1981)  refer  provide  cognitive  a discussion of  (PPVT),  Pegboard  (1984)  and  patients,  T a y l o r , R e d f i e l d , and  Vocabulary  Test,  affective  Purdue  Stimulation  Progressive The  test  Matrices,  subjects  in  disorders  this (both  mania and  and e n d o g e n o u s  8 patients with  hemisphere  depression) , "coarse"  17 s c h i z o p h r e n i c  brain  f u n c t i o n " was a s s e s s e d  Verbal  I Q , PPVT,  Sentence  speed,  and r i g h t - s i d e d e r r o r s  Stimulation  Test.  measured  performance  by  Raven's M a t r i c e s ,  disease from  hemisphere  BVRT, l e f t - h a n d e d  Peg Board  e r r o r s on t h e D o u b l e S i m u l t a n e o u s  order  t o compare  o f age, s e x , handedness,  treatment,  covaried  In  the hierarchical  function", found  education  into  regression  significantly  was.  from not  manic  individuals differ  from  t h e CBD s a m p l e .  scores  were n o t while  related  to  group d i f f e r e n c e s subjects  subjects,  CBD; t h e a f f e c t i v e  each other,  drug  hemisphere  significantly  schizophrenic  or depressive  with  the  these 5  to performance,  p e r f o r m a n c e and t h e f o l l o w i n g p a i r - w i s e  than  in  for and  treatment  test  impaired  Test.  f o r t h e v a r i a n c e due t o t h e s e  was s t i l l  found:  and l e f t -  test  o f "dominant  variables, diagnosis  were  Hooper,  were done w i t h  and d r u g  related  A f t e r accounting  similarities  speed,  level,  five  and  IQ,  the equation.  s e x , age, handedness,  t o be  f u n c t i o n i n g " was  controlling  education  WAIS  Simultaneous  out o f the neuropsychological  d i a g n o s i s was e n t e r e d  on  Peg Board  Stimulation  while  m u l t i p l e regression analyses  variables before  groups  "Dominant  hand  performance  sided  effects  right  on t h e D o u b l e  o n WAIS  diagnostic  (CBD).  performance  Repetition,  "Nondominant  patients  were  more  but not d i f f e r e n t  disorder  but d i d s i g n i f i c a n t l y  groups d i d better  than  38 In  the  regression  function"  i t was  treatment  and  performance. versely lithium  al.  related level  found  and  or  to  was  variables  were  were t h e  WAIS  subtests  and  variables  the  Taylor  tasks  i s probably  and  in  et  that  were i m p a i r e d  and  that  less  of  CBD from  nondominant  tasks  whereas  from  et the  manics  other  function  discriminated  but  did  and  Object  power In  the  on  these of  these  among  the  shows patient  dysfunction  dominant  Affective disorder  o f nondominant hemisphere  84% four  summary,  analyses  dysfunction  manics  Assembly  rate  of  the  groups  Using  hit  inflated!). of  tests,  Test.  overall  analysis  between  s a m p l e showed b i l a t e r a l  tasks.  serum  The  hemisphere  Comprehension,  than  in-  subjects.  discriminatory  well  differ  each  to  impairment.  sample.  discriminent  hemispheric  were  variables Taylor  from  outcome  age  greater  d i d not  an  related  impairment,  with  different  the  hemispheric on  less  the  drug  performance,  to those  a l . obtained the  level,  increasing  patients  stepwise  schizophrenic  performed  due  statistically  patterns  nondominant  with  significantly  report  The  and  Hooper V i s u a l O r g a n i z a t i o n  comment  different  not  Information,  (they  authors  or  hemisphere  a l l significantly  b e t t e r t h a n CBD  dominant which  education  associated  groups  significantly  both  groups.  was  schizophrenic  Interestingly using  level  for variance  depressed  "nondominant  neuropsychological  exposure  that  of  age,  were  associated  depressives  perform  that  diagnosis  accounting  manic  found  Education  neuroleptic After  analysis  but  not  patients  function.  39 In  another  cognitive  study,  functioning  normals,  using  included  a  test,  in  the  attributable the  on  et  to  al.  age,  schizophrenic  rated  found  that  showed  subjects  impairment  w h i c h was  temporal  regions.  In  hypothesis  They  originally  cited  schizophrenia  show  the  only  schizophrenic  a  suggest as  aphasia threshold State, Each  impairment  impairment,  those  control  and  of for  drug  to  exhibited  severe  this  with  conclude  the  frontoauthors  respect  to  the  left-hemisphere which  bilateral their  were  dysfunction  studies)  that  that  diffuse  i n the  hemisphere  between  their  'cognitive'  studies  1969  of  bilateral  study,  the  left  variance  They s t a t e  is exclusively a  for  for  administration,  controls did.  even  described  quarters  marked  Flor-Henry's  They  to  more p r o n o u n c e d  that  correlation symptoms.  to  literature  evidence  (e.g.  for  of  three  discussing  that schizophrenia  disorder.  in  in  an  42 that  batteries.  h a n d e d n e s s , and  none o f t h e i r  conflicts  tasks'  Mini-Mental  similar  study,  cognitive  address  and  scales.  (1981)  schizophrenic  compared  subjects  signs,  blindly  procedures  subjects  impairment, w h i l e  the  for laterality  sex,  (1984)  stimulation, auditory from  5-point  investigators  their  was  statistical  Taylor  neurological  Luria-Nebraska  region,  impairment  Abrams  'neuropsychological  items  and  and  schizophrenic  soft  protocol  each hemispheric  Using  of  and  Halstead-Reitan,  global  62  tachistoscope  determinations,  participant's  of  v a r i e t y of  assessment  screening  Taylor  actually foci own  and data,  40 and  those  from s t u d i e s  be  most  parsimoniously  diffuse add find  cognitive  that that  their the  fronto-temporal  using  a variety  interpreted  impairment  studies  and  impairment regions.  of t e s t  in  reflect  schizophrenia.  those i s most They  to  strategies,  by  other  make t h e  bilateral  However,  investigators  pronounced  in  the  following  "This pattern of b i l a t e r a l cortical d y s f u n c t i o n w i t h dominant fronto-temporal accentuation i n s c h i z o p h r e n i a may reflect selection for specific psychopathological features. Studies using diagnostic criteria for schizophrenia that rely h e a v i l y on t h e p r e s e n c e o f f o r m a l t h o u g h t disorder, the first-rank symptoms of S c h n e i d e r , and e m o t i o n a l b l u n t i n g and t h e n f i n d the p a t t e r n of d y s f u n c t i o n noted above r a i s e the p o s s i b i l i t y t h a t these phenomena a r e a s s o c i a t e d w i t h d o m i n a n t hemisphere ( p a r t i c u l a r l y fronto-temporal) dysfunction. The c o g n i t i v e p a t t e r n that we and others have observed i n s c h i z o p h r e n i c s may thus r e f l e c t t h e c h o i c e of diagnostic c r i t e r i a , and one might logically predict that patients with formal thought disorder, first-rank symptoms, and emotional blunting should demonstrate dominant fronto-temporal i m p a i r m e n t . " (p. 200)  report  with the  they often  dominant  interesting  speculation,  They c o n c l u d e t h e i r  can  following,  ". . . l a t e r a l i z e d d o m i n a n t fronto-temporal dysfunction may give the schizophrenic syndrome i t s c h a r a c t e r i s t i c stamp, b u t t h e diffuse bilateral i m p a i r m e n t may ultimately lead n o s o l o g i s t s to return s c h i z o p h r e n i a t o i t s o r i g i n a l c l a s s i f i c a t i o n as a d e m e n t i a . " (p. 200)  Finally, interesting  a  parallels  studies  (1981,  battery  of  and  patients study  that  on  (eg. Card of  controls.  validated  the  Montreal  to  the  Word  and  parietal  lobe  15  P e r f o r m a n c e IQ verbal  phrenia  In  was  IQ  authors  left  Gotman  frontal  lobe  within  normal  The  19  and  lower  points  6 points  by  Design  limits  r i g h t and Verbal  lobe  Complex  the  the  tests  Wisconsin on  tests  sensitive Corsi  to  Block  R i g h t - L e f t  had  a  control  lower than the  non  schizophrenic  Backward,  than  and  functioning  Figures,  sample  left  figures),  Fluency,  on  found  subjects  poor performance  function,  this  mean  group,  Fulltheir  c o n t r o l group,  and  lower.  conclude  i s accompanied  Rey  to  schizophrenic  points  They  schizophrenic  frontal  in  atrophic  o f W e s c h l e r s t o r i e s and  contrast  (eg.  static  of  lobe  schizophrenic  Hospital.  tests  al  extensive  t e s t s used  with  et  parietal  s e n s i t i v e to  on  r i g h t and  Forward  Differentiation). IQ  (e.g.  recall  function  D i g i t s  group,  tests  Fluency,  Test).  performed  WAIS  on  functioning  s e n s i t i v e to  The  Neurological  an  some  intelligence  DSM-III  patients  control  impairment  lobe  on  and  shows  Taylor  general  temporal,  age-matched  been  from the  assess  30  Sorting  The  to  and  patients  their  tests  (1983)  Whishaw u t i l i z e d  diagnosed  temporal  Scale  and  carefully  Chicago  Span,  differences  frontal,  memory s u c h as  tests  Whishaw  30  marked  Verbal  and  and  in  from  temporal  Kolb  Kolb  right  relative  showed  to  1984).  and  have  lesions  by  psychological  left  function  study  that  the  data  suggest  a selective bilateral  that  schizo-  dysfunction  of  the  frontal  normal  and t e m p o r a l  functioning  alternative  are less  tests  used,  better  digit be  described  span  very  duals;  and  that  i n frontal  their  higher  patients  d i d not differ  did better  damaged  than  performances  their  screened brain level  blood  lobes  data groups  damaged  from  the  authors  been  studies  of  Chelune performed  On  t h e WAIS brain  argue  b)  indicate indivi-  structural  e t a l . (1979) at a  removed,  signifi-  and  damaged  patients  When  profiles  the groups. that  chronic  schizophrenic  patients.  conclude  i n d i v i d u a l s a r e compared, be f o u n d ,  be  shown t o  On  when  the basis carefully  differences  but s c h i z o p h r e n i c  level  of tests  of n o n i n s t i t u t i o n a l i z e d schizophrenics  o f performance w i l l  of  of schizophrenics.  chronic  among  might  They  than both the acute  d i f f e r e n c e s were  other  abnormality;  evidence  sample  lobe  deficit  of schizophrenic  b r a i n damaged  similar  have  flow  cortex  patients.  acute  p e r f o r m a n c e were v e r y  the  an  a) t e s t s s u c h as  hemisphere  reported  on t h e HRB  brain  of  of  schizophrenic  level  than  specific  that:  of d e s c r i p t i v e studies.  diffusely  of  left  within the p a r i e t a l  Summary  i f parietal  Differentiation  and c e r e b r a l  absence  discuss  impairment.  i n t e r p r e t a t i o n on g r o u n d s  function  c)  a  relatively  They  disorders  having  of  functioning, schizophrenics  and R i g h t / L e f t  abnormality  but  than  that  as e x h i b i t i n g d i f f u s e  metabolism  abnormal  cantly  rather  sensitive to diffuse  glucose  found  sensitive to diffuse  then  this  lobes.  suggesting  and t e m p o r a l l o b e  against  i n the presence  of the parietal  possibility,  tests  frontal  lobes  and  i n mean subjects  43 would the  be  expected  HRB  that  damaged  to  show a p a t t e r n  et  a l .  of  schizophrenic  (1981  diffuse patients.  coarse  damage  nondominant impairment,  performance  frontal  lobe  scores  of d i f f u s e l y  sensitive  to  found  frontal  p e r f o r m a n c e on Thus  the  few  light  of  expect  a)  only  t h a n one  by  the a  and  on  brain  reviewed  'subgroup  et  al.  to  to In  individuals assess  an  lobe  of  a  subgroup  function,  b)  studies  the which  normal  consistencies  be  such  as  expected  in  which  we  would less  schizophrenics,  of  indicate  that  neuropsychological  and  tests  considerable  findings  that  on  with  identifiable  is a significant  Kolb  Results  under  of  lesions.  some  sample o f  illness a  lobe  probably  global  dominant  sample.  (1979) m i g h t  and  accentuation  measure  findings.  with  to  deficits  presents  with  dominant  addition  to  hypothesis',  a representative  classification  likelihood  (1981) were u n a b l e  performance  temporal  Chelune  and  of  of  from  two  deficits samples  schizophrenic  contradictory  dysfunction,  severity  al.  intended  certain proportion,  h a l f of  members  marked  their  tests s e n s i t i v e to p a r i e t a l  apparently  reported  et  global  (1984) f o u n d  tests  literature  those  in  function.  Abrams  on  found  intended  function in their  (1983)  )  patients  tests  and  deficit  Whishaw  on  hemisphere Taylor  1983  Taylor  schizophrenic  brain  ,  impairment  distinguish  be  battery  patients.  indicative  a  test  i s i n d i s t i n g u i s h a b l e from t h a t  Taylor  and  of  the  neurologic numerous  'chronicity'  f a c t o r i n determining deficit  will  to  be  or the  found.  44 The  Chelune  et  "rigorously voluntary  more  these  patients  sample by  The  median  and  organic and The  studies global  and  a  et  studies  hit  rates  groups  are  et  Whishaw  with for  for  neurologic treatment  were  a)  disease,  b)  facility  and  c)  potentially contributing in  other  study  (1978)  studies.  may  under  "acute or  the  reactive  studies  using  these  (1981)  and.Taylor  to  Given  resemble  those  headings  of  schizophrenia".  d i s t i n g u i s h i n g between  al.  in  reports  lobe-sensitive  and  Abrams  Taylor  and  Abrams a l s o  tests.  demonstrating  i n neuropsychological  (1983) s t u d y  temporal  psychiatric  populations  parietal  (1984)  do  not  report  were  specify  parietal  studies  not  show  and  consensus  Kolb  on  Taylor and  on  differ  frontalwith  in  that  parietal  different tests Taylor  of  Kolb  consistent  studies  used  In  The  p e r f o r m a n c e on  tasks  tests.  the  is  (1984)  prevalence  impairment  unfortunately  which  lobe  dysfunction, and  impaired  Abrams  high  which  investigators  function  considered  (1984),  marked  tests  a  and  functioning.  ( 1 9 8 4 ) ; however t h e s e  These  assess  Abrams  stay  than  al.  consistent  impairment  localized  out  sample  respectively.  Taylor  do  short  sample  Taylor  lobe  rule  DSM-II c r i t e r i a ,  Heaton  69%  to  schizophrenic  characteristics this  classification  and  by  in  heterogeneous  reported  77%  (1979)  screened"  were d i a g n o s e d a  al.  and  to  Abrams  in  their  battery  were  any  case,  although  these  the et  Whishaw  issue al.  of  diffuse  (1981),  (1983)  Taylor  studies  vs. and are  45 concordant tests  with  respect  comments  neuropsychological one  (i.e.  proceeds eye  and  an  be  cal' and  and  and  referents.  CT  been  the  (or  be  defined.  purposes  important  'intelligence' not  be  asserted  also  as  distinct  scores  i n t e l l i g e n c e  in  from For  is  patients,  a  appears  specific  deficit,  and  little  inadequate  between  be  attempt  to  terms might Even  f u n c t i o n may of  conventionally  the  measures  'neuropsychological purposes  general would  schizophrenia.  variety  to  abnormalities  i n which these  present  finally  'neuropsychologi-  review, an  and  review  of  function'  i t will  be  be o p e r a t i o n a l l y  tests,  including  thought  of  as  measures.  apparent  schizophrenics,  on  tests,  neuropsychological It  in this  impairment,  of  distinction  attempted.  as  d e s c r i p t i o n of  there  terms  this  senses  that neuropsychological  defined  from  The  of  inappropriate)  potentially  on  function.  abnormalities  cognitive dysfunction)  e n u m e r a t e t h e many d i f f e r e n t  will  scan  f r o m what w o u l d n e c e s s a r i l y be  apply  and  topics discussed  - have a wide v a r i e t y  For  frontal  definition  'cognitive' function -  dysfunction  and  deficits  i n c r e a s e i n t h e number o f ways  have  and/or  gained  the  tracking deficits,  exponential  might  on  bilateral  cognitive functioning i n schizophrenia.  through  neuropsychological be  observing  b e l i e v e d s e n s i t i v e to temporal Concluding  As  to  and  perform  b r a i n damaged  from  the  literature  particularly  i n a manner comparison  reviewed  chronic  that  some  schizophrenic  statistically indistinguishable groups.  Deficits  are  found  in  46 such  a wide v a r i e t y  there  of tests  that  many  investigators  conclude  i s a s u b g r o u p o f s c h i z o p h r e n i c p a t i e n t s who a r e g l o b a l l y  impaired  and who  probably  order.  Despite  repeated  sufficient  number  suffer  from  a diffuse  findings of this  brain  sort,  there  o f i n c o n s i s t e n c i e s and o u t r i g h t  are a  contradic-  tions  i n the literature  tests,  o r any measurement p a r a d i g m , a s t h e most a p p r o p r i a t e o r  sensitive  measure  such a t h i n g  Prevalence  on  this  published  reports  data  o f impairment  scores  derived  from  (1980)  and R e i d e r  Rating  method  Donnelley of  young  a large  reviewed  to assess  populations.  degree  e t a l . (1980) c l a s s i f i e d chronic  To d a t e  schizophrenics  that  there are collect  r e p r e s e n t a t i v e sample o f  do p r o v i d e  (1979) u s e d  and  procedures  as t h e f a c t  as s c h i z o p h r e n i c . estimates  samples t h a t a r e based  neurologic  et a l .  scarce,  to systematically  be c u r r e n t l y d i a g n o s e d  i n their  from  not absolute.  o f attempts  who w o u l d  i s rather  i n v e s t i g a t o r s , as w e l l  Some o f t h e s t u d i e s rates  i f indeed  d i a g n o s t i c and s a m p l i n g  i s relativistic,  neuropsychological individuals  deficit',  Impairment  parameter  confounded w i t h  by i n d i v i d u a l  'impairment' no  'the s c h i z o p h r e n i c  o f Neuropsychological  necessarily  s p e c i f y i n g any s e t o f  exists.  Information  applied  of  to preclude  dis-  o f impairment 9/15  on c u t t i n g  Donnelley  the Average  et a l .  Impairment on  t h e HRB.  (60%) o f t h e i r  as i m p a i r e d  o f the  and R e i d e r  sample et a l .  47 (1979)  found  5/8  (62%)  of  a similarly  diagnosed  sample  were  impaired. Taylor compared Abrams  their  Kolb  function; remaining  authors the  normal  Whishaw  subjects  to  Kolb  however,  75%  of  severe  the  25  report  would  performed  that  schizophrenic  enumerate  in  The sample  above  which  more  used  of  populations,  such  the  the  Obviously development  as  not  relative  only  5 of  normal  frontal  and  attempt  for  temporal  follow  was  to  their  range  "impaired".  impairment  and*  schizophrenic  necessarily  "nonimpaired"  rates"  standard  an of  test that  extent even tests,  neurologic  of  that  While  the  greater  in  to d i s t i n g u i s h or  individual  subjects  so  of  might  could  be  the  from  a  given  situation  validity.  At  and  the  the  3  HRB. and  psychiatric  test  for psychiatric disorder  criterion  with  diagnosed  in  for  development  compare  similarly  ideal  except  indexes  derived  "impairment"  more  actually arbitrary  impairment,  norms one  are  impairment  approach  performance of other  determine  of  do  definitions  satisfactory  standard  they  "prevalence  application  known  vs  level  ' Taylor  62  that  (1983)  rates.  specific  studies  group  not  classified  mean  "impaired"  to provide  be  Whishaw  dysfunction  (1983) r e p o r t  i t does  and  c o n t r o l groups.  whole b a t t e r y o f t e s t s which assessed  lobe the  to  and  approximately  and  schizophrenic  the  A  that  (1984)  e x h i b i t e d moderate  normals.  as  Abrams samples  found  subjects  30  and  scores  to  patients  and  individual.  would  be  the  patients,  with  present,  however,  48 impairment  must  i n general  control  sample  patient  samples,  function  be d e f i n e d  or t o c u t o f f scores and p r e v a l e n c e  o f these  Medication effect  behavior  of schizophrenic  neuroleptic  neuropsychological  tions over  preclude a time  neuroleptic reviewed  to  full  span use.  complex  tion,  sufficient Heaton  test  on  be a  psychotic that  are the result Ethical  the effect  Crowley  performance.  They  i s flawed  (1981)  of  consideraissue  of chronic  selectively  groups  fail  possible  indicated  by t h e f a i l u r e classes,  and b l o o d  much  of  researchers  failure  to use  inattention to  levels  concomitant  to consider  factors  that of  of patients,  t o c o n t r o l f o r other  some s t u d i e s as  the  investigation of this  t o address and  Given the  the p o s s i b i l i t y  deficits  r e l a t i o n s h i p s o f dose  learning  be t h e r e f o r e  on t h e e f f e c t s o f n e u r o l e p t i c d r u g s on  homogeneous  and f a i l u r e  addition,  specific  i n neurologic  performance. have  d i s t i n g u i s h the e f f e c t s o f drug  the  will  patients,  experimental  t o date  diagnostically  In  drugs  performance  the literature  research  rates  be s e r i o u s l y c o n s i d e r e d .  neuropsychological the  developed  and n e u r o p s y c h o l o g i c a l  must  to a  definitions.  powerful  medication  relative  drug  o f medicatreatments.  tolerance  in re-test  and  performance  changes. The  majority  of studies  o f acute  tration  of neuroleptics  subjects  s u c h as c o l l e g e s t u d e n t s .  effects  o f acute  typically  administration  or short-term have  utilized  adminisnormal  These s t u d i e s measure of neuroleptics  at  side  various  doses.  Heaton  tration  in  and  higher  anticholinergic zine)  impair  tests.  doses  speed, side  are  coordination of  and  not  effects  course  seem  more  induced  abnormalities  ability  being  tested  In  long  tern  effects  frequently paradigm  a  for  clinical  neuroleptics  involves  sort.  The  condition  as  by  was  of  a  and  a favorable  extrapyramidal some  or  motor  early  in  the  shortly  after  significant  drug-  performance  which  and  of  the  19 8 1 ) .  develops  on  with  the  and  early  there  is  long-term  to  (1981) c i t e that  A  neuropsychological  period  assignment  suggest  motor  i n p s y c h i a t r i c symptoms.  washout  Crowley  (eg.  or  neuroleptics  effects  drug  group  neuroleptic,  of  cognitive  anticholinergic  that  be  Crowley  treated  random  findings  there  may  tolerance  drug  patients  Heaton  dose  improvement  assessing in  conditions.  there  thiorida-  and  on  administration,  and  significant  and  acute  suggest  administration  diminish  followed  produce  adminis-.  function  performance  ( H e a t o n and  performance  month  little  i n neuropsychological  type  with  motor  cognitive  to  dosage,  acute  piperazines  studies  drug  of  have  impair  The  in  the  the  impair  tasks.  with  variety  in  likely  which  increases  side  to  neuroleptic  vary  a  that  chlorpromazine  haloperidol  marked  will  on  report  neuroleptics  (eg.  neuroleptics  do  but  the  properties  trifluoperazine) and  (1981)  of  performance  The  effect  Crowley  of drug 4  relative  at  courses  of  least  one  and  placebo  studies  of  to  placebo  the  e f f e c t of neuroleptic  this  drugs  on  50 attention  and  able e f f e c t  simple  ethnicity  characteristics;  on  shown  to  psychological  tests  (Bak  &  Matthews,  considered subjects  and  are  with  a  1980;  Although  i n age,  age,  measur-  education  this  and  has  re-  on  neuro-  Karzmark,  Heaton,  is  with  marked  noted  Age  performance  Greene,  most u s u a l l y  an  to  be  s a m p l e s composed  of  effects  issue  of  age  on  i n subjects entering  test their  80s. level  has  on  the  accuracy  'normal'  vs.  'brain  individuals educated educated brain  and  1984).  varying widely  Education effect  interact  of  performance.  when r e s e a r c h i s c o n d u c t e d  performance 70s  effect  neuropsychological  been  Grant,  not  on more c o m p l e x c o g n i t i v e p r o c e s s e s .  Subject  peatedly  i n f o r m a t i o n p r o c e s s i n g but  who  tend  damaged.  individuals  (Adam,  Lehman, 1980; Karzmark persons,  The  more  &  et  a l . (1984),  developed  and  variables  Ratings  on  the  normals,  AIR  HRB.  correlated  education  1982;  using  491  found  significantly  (r=-0.54),  and  damaged and  well  less  well  brain  Heaton,  &  1977).  equation  Average  with  as  damaged  neurologically  that  of  misclassified  Anthony,  an  the  whereas  for  & Reitan,  predict  They  be  true  cross-validated to  Non-brain  to  is  Grain,  significant  intelligent,  likely  converse  a  classifications  classified  F i n l a y s o n , Johnson,  demographic  (r=0.23),  more  Boake,  have  status.  correctly are  to  test-derived  younger,  be  individuals  of  found  damaged'  are  to  been  in age  occupation  this  normal  that  uses  Impairment sample  (r=0.66), (r=-0.43).  of race  In  a  51 regression in 59%  AIR  analysis using  scores  f o r the  research studies or  typically  alternately  applied  by  attributable  cannot  neuropsychological  tests.  attempt  to  to  obtain  statistical  et  variance  accounted  variables  use  Taylor  of the  for  and  ignored  in  sample.  demographic  utilizing  v a r i a b l e s , 65%  d e r i v a t i o n s a m p l e was  i n a cross v a l i d a t i o n Clearly,  these  a l . (1981,  differences in  fairly  be  Small  homogeneous  techniques 1984)  to  subject  sample  such  as  control for  status  on  groups those  variance  demographic  variables.  S i g n i f i c a n c e on N e u r o p s y c h o l o g i c a l The in  importance  of  reported  D e f i c i t s i n Schizophrenia  neuropsychological  schizophrenic patients i s c r i t i c a l l y  First,  i t must  be  determined  neuropsychological dysfunction phic,  and  tests  not  or treatment  reasonable simply  secondary  determining  the  schizophrenic  prognostic The phrenic  an  factors.  deviant  a valid  artifact  Further,  phenomena,  clinical  then  of  significance -  i e . are  associated  with  are  these  the  brain  demogra-  are  not  task  of  deficits  in  neuropsychological important  of  on  grounds f o r  deficits  remains  of  issues.  performance  clinical,  i f there  there  t o two  indication  that neuropsychological  patients  systematically  i s indeed  simply  confidence  whether  related  impairment  deficits  etiological  or  factors?  occurrence patients  and  of  c o g n i t i v e impairment  i t s a s s o c i a t i o n with  in  poor  some  schizo-  prognosis  are  52 observations logical  as o l d a s t h e d i a g n o s i s  literature  i s quite  impairment  i s most  common  patients.  Further  research  this  correlation,  psychological development product  bute  provide  schizophrenia  been  not clear  ambiguities  valuable  o r i s a by-  i n the interpretation of  descriptive information o f a broadly  based  aspects  Findings  some and  recent contri-  'new l o o k '  at the  i n this  Overall,  review  a n d may  s t u d i e s show t h a t c h r o n i c  difficult  dysfunction.  tests  and f u l l with  schizophrenia,  the c l a s s i f i c a t i o n  t o d i s t i n g u i s h from  brain  When p o p u l a r  diagnoses  accuracy.  classification  be or  patients are  essentially  In contrast,  diffuse screening  are applied  damage  as  differential  individuals with  batteries  have  summarized  schizophrenic  of brain  investigators report  classification  literature  neuropsychological  neuropsychological  prior  i n Schizophrenia  of the neuropsychological  diagnosis  correct  i n the  i n schizophrenia,  1)  of  implicated  syndrome.  discussed  groups  neuro-  psychopathology  follows:  very  whether  syndrome.  Summary o f N e u r o p s y c h o l o g i c a l Several  i l l  the antecedents o f  i s causally  findings  t o t h e emergence  that  in chronically  address  and c h r o n i c  the present  neuropsychological studies  must  Neuropsycho-  i n demonstrating  and s e v e r e  impairment  of that c l i n i c a l  Despite  consistent  as i t i s s t i l l  o f severe  itself.  and  to  chronic  chance  level  t h e median l e v e l o f  between b r a i n damaged p a t i e n t s and l e s s  disturbed  schizophrenics  patients  i s approximately  descriptive  studies  impairment  occurring  pattern  on t h i s  impairment temporal normal  lobe  ment,  with  prevalence  an  review  impaired  cutting  report  scores  or normal  of  severe changed  sample  lobe  over  tests.  3)  and  report  impair-  groups f o r the  earlier  in  o f p a t i e n t s who p e r f o r m  in  control  standard  groups.  impairment The  of chronic  controls, Taylor  vary  a l .  60% and  described  as e x h i b i t i n g  diagnostic  et  schizophrenics.  and Abrams  reports  Average  scale f o rreporting  as i m p a i r e d  samples  that  i n samples o f  discussed  to either  and r e s e a r c h  i snot  to assess  dysfunction  studies  4) B e c a u s e  most  Difficulties  comparison  i t difficult  of schizophrenics  time,  (1983)  e t a l . (1979) c l a s s i f i e d  impairment.  on  to frontal  Donnelley  t o normal  their  research  o n t h e HRB.  respectively of their  Relative  deficits  sensitive  (AIR) i s a commonly u s e d  s e v e r i t y o f impairment  of  that the  of neuropsychological  make  relative  suggest  and Whishaw  the proportion  range  (1980) and R e i d e r 6 2%  on t e s t s  Four  majority  investigators report  of appropriate  patients.  psychiatric  The  However  Some  and K o l b  patients,  Impairment R a t i n g the  tests.  the definition  of  of the neuropsychological  of neuropsychological  schizophrenic  2)  generalized  on p a r i e t a l  and t h e c h o i c e  schizophrenic  this  marked  function,  attainment  associated  75%.  involves  matter.  i s most  types  i n schizophrenics,  neuropsychological  unanimous  other  o f the nature  o f impairment  common  or  75%  moderate t o  practices  have  considerably i n  the  extent  to which the  chronicity derive  severity  cumulative  chronic, is  and  vs.  lower  in  rate  despite  of  shortly when  that  have  a who  ability  on  state. been  6)  the  most  be  early  There  are  evidence  clear  that  psychotic  i n the  of  Age,  IQ, with  course  that  attention their  and  education attainment  level on  and  neuropsychological  tests.  The  neuropsychological  impairment  There  neuropsychological  7)  are  performance  The  of  in  most  medication  functioning; increased  information  an  unmedicated  ethnicity  have a l l  i n research of  findings  awaits  are  tests.  utilizing  p o s s i b i l i t y  deficits  or  times  typically  exhibit  significance  the  a  research  (ie. during  i n schizophrenia  remains  5)  neuropsychological  considered  at  administration  simple  performance  most  effects  antipsychotic  medication  in  patients  symptoms.  neuropsychological  on  to  neuropsychological  of  dosage  D e m o g r a p h i c v a r i a b l e s must be  research.  is  Available  medications  on  stabilized  to  to  as  there  occurs  detrimental  in  the  effect  relative  Nonetheless  p a t i e n t s , and  marked  i s evidence  of  impairment  impairment  understood.  increases  tests  associated  patients.  possible  acute/reactive schizophrenic of  effects  f a c t o r s such  neuropsychological  well  positive  patients  processing  not  marked  side  pronounced). may  may  after  the  of  on  i t i s not  neuroleptic medication  is  neuroleptics  illness,  severely-ill  presence  performance  of  converging  i n groups  relationship  of  schizophrenic  chronic  the  suggests  rates  acute  considerable  frequent  sample i s d e s c r i b e d  not  of  further t h a t valid  55 indicants may  be  of  brain  more  generalized  realistic  behavioral  disturbance. will  Testing  require  useful  would  remissions. be  most  decoupling  be  ships  disorder the  of  in  severe  behavioral  to  between  will  be  the  psychiatric  Particularly  in  high  samples  of  patients  i l l ,  risk  who  disturbance  impairment  not  from  i n the area  biological,  appears  patients,  impairment  possible.  significance  and  evidence  unremitting  8)  of  performance  etiological,  on  Research  neuropsycho-  o f documenting  neuropsychological  of c l i n i c a l ,  with  to  research.  i s often  establish  scores  interpretation  severely  tests  It  this  further  assessment  patients.  impaired  associated  correctness  common  deficits  variables  attribute  However, as n e u r o p s y c h o l o g i c a l  likely  logical  in psychiatric  investigations  neuropsychological most  to  considerable  longitudinal  to  dysfunction  and  relationand  other  prognostic  significance.  Summary o f R e l a t i o n s h i p s Among M e a s u r e s Smooth P u r s u i t E y e Movements  (SPEM),  L a t e r a l V e n t r i c l e Enlargement  (LVE),  and N e u r o p s y c h o l o g i c a l in  This brief  final  summary  sections. research  of  The which  purpose has  Performance  (NTP)  Schizophrenia  section of several  Test  of  the  literature  studies of  examined  this  cited  review  will  i n the previous  section  associations  is  to  be  a  three  highlight  between  various  56 combinations (SPEM),  of  measures  lateral  chological  SPEM and  ventricle  pendulum  (1982)  patients  the  large  with  The  and  other  eye  rated  was  20  movements  and  thirty  neuropsy-  of  study).  anterior  f o r the horn eye  on  by  SPEM, LVE  They  found  of  lateral  most index  movements.  than  small  the  few  changes  ventricle eye  ventricle  by  a  suggest  impaired  association  for a f u l l  patients  size),  but  SPEM.  between (see  the  description  in their  in anterior  with  swinging  i t does  with  trackers  patients  Sixty impaired  B a r t f a i e t a l . (1985) NTP,  normal  investigatory  generated  Nonetheless  and  impaired  showed  the  associated  that  of morphological  measure  tendency  be  with  W y a t t was  were  qualitatively.  association  ventricles.  subjects  percent  movements  the  patients  enlarged  ventricle  c a r r i e d out  section  evidence  impaired  (LVE),  assessed  i n v e s t i g a t i o n which assessed LVE  following  linear  of  with  e n l a r g e d v e n t r i c l e s may  SPEM and  had  14  of  Wyatt  T h i s work by W e i n b e r g e r and  nature.  this  eye  (NTP).  proficiency  compared  subjects.  of  and  percent  tracking  The  and  tracking  ventricles,  that  pursuit  LVE  between  in  smooth  enlargement  t e s t performance  Weinberger  four  of  horn  size  they  to  have  good  or  sample  noted a  (a a  larger  slightly  57 SPEM and  NTP  Holzman addressed  or  to  and  find  following  LVE  and  are  several  as  of  on  literature  included  frequently gators  and  NTP  tunately  other  reported and  there  a  which  investigators  or  full  scale  IQ See  discussion  the  of  this  aspect  i s evidence that  which  have  nence  and  the  influence  standardized focused cognitive  across on  that  lateral  the  of  i n the brain  level on  of  ventricle size;  studies.  Several  in  sulcal  In  sulcal  Unfor-  with  respect  CT  u p p e r most CT  scans;  scan  cut  prominence  and  addition  r e l a t i o n s h i p between  functioning  marked  from  most  investi-  functioning.  of  scan  morphology  brain  structure  ratings  CT  and  literature  the  review  proportion  between  cognitive  and  this  a sizable  prominence.  relationship  consensus  addressed  section of this  impairment  than  in  have  function  out  sulcal  deficits i s no  considerable not  pointed  assessments of  assessing  there  educational  proficiency.  for  i n a previous  cognitive  measures  have  prominence  is  partial  'Cognitive/neuropsychological  the  These  tracking  studies  indicated  I t was  has  and  SPEM, LVE  abnormalities').  to  s c a l e IQs,  1982)  NTP  relationship  has  between  (1979,  a l . study.  There  (see  Sweeny  performance.  attainment on  and  between W e c h s l e r  tracking  section  et  Cegalis  correlations  educational  Bartfai  and  associations  attainment, failed  (1974)  to  sulcal  schizophrenia  studies promi-  there  are  58 other  investigations  "structural aspects while  not  abnormality  report  (1979b)  found  intellectual  that  of the strongest  brain  structure  investigations tions  LVE a  and l e v e l involving  are reports  and c o g n i t i v e correlation  Golden  et a l .  ficient and  o f 0.72  VBR.  0.76  claims  measures  functioning,  functioning  o f the s u l c i  Withers-Hinton  reported  a multiple  G o l d e n e t a l . (19 82)  found  a multiple  ventricle  size  assessing  between  derive  and  between  scales  scores  reported and VBR;  Battery  failed  to find  able  ranges  i n levels  able  proportion  al.,  1983a  correlations  of cognitive  of individuals  scales  and VBR.  the relationship  significant  coef-  correlation of  between  and n e u r o p s y c h o l o g i c a l / i n t e l l e c t u a l  have  from  combina-  correlation  Nebraska  studies  i t appears  relationship  Luria  Some  do  LVE and  J o h n s t o n e e t a l (1976)  14 L u r i a N e b r a s k a  structhey  between  eight  between  1985) ..  between  measures.  between  between  Thus  ( 1 9 8 0 ) , and  f o r an a s s o c i a t i o n  of a significant  (1980a)  visualized  In overview,  of cognitive  impairment.  o f -.70  and W y a t t  cognitive  between  impairment.  associations  performance.  o f several morphological There  scan  of the relationship  impaired many  Waldman,  and i m p a i r e d  the extent  CT  and c o g n i t i v e  Weinberger,  et a l .  the relationship  (on s e v e r a l  structure)  Donnelly,  tural  assess  abnormality"  of brain  Weinberger  which  despite  performance  evidencing  LVE  and a  lateral function reasonreason-  (Nasrallah  & 1983b; W e i n b e r g e r e t a l . , 1979; W i l l i a m s  et  et a l . ,  Two novel and  recent  additions  to  the  r e l a t i o n s h i p s between measures lateral  ventricle  size.  VBR/neuropsychological  direction  opposite  summary  scores  Battery,  the  .59  These of  Scale.  with  subtests  -.77,  VBR IQ,  and  treatment-resistant (half  were  slightly not  higher  specific  tended  psychiatric patients  Owens  response et  tionship in  a  This  al.  to  b e t w e e n VBR  sample  of  110  unexpected  Withers  and  suggested cognitively  reported and  scores  In  this  a  scores  than  on  scale of  scores  at  both  a l . that  schizophrenic  sample  of  mixed  may  patients.  and  had  al.  study the  chronicity  diagnosis.  extremes  the  performance  and  of  two  One  test  patients. with  ventricle  be  and  rela-  Hinton  patients  in  Finally,  curvilinear  schizophrenic  there  a  i t assesses  by  of  IQ.  sample,  DeMeyer e t  the Withers  excess  Adult  Halstead  l a r g e r VBR's  significant  total  WAIS v e r b a l  full  Rather  rather  an  impaired  the  the  Nebraska  the  with  with  have  institutionalized  et  with  .79  selected  of  Owens  Wechsler  neuropsychological  finding  Hinton to  and  treatment  (1985)  the  o f VBR  schizophrenia.  a  poor  and  O v e r a l l , the  b e t w e e n VBR  of  Luria  .73  to  relationship sample  the  using  found  for  psychiatric patients  mean IQ. to  (1984)  on  schizophrenic).  patients  al.  correlations in  correlated  c o r r e l a t i o n s were o b t a i n e d  13  et  reported  functioning  predicted  Battery,  correlation  performance  nonschizophrenic  is  individual  The  I n d e x was  diagnoses  a  normally  have  cognitive  test  that  Halstead-Reitan  Intelligence Impairment  and  to  of  DeMeyer  significant  IQ,  literature  low size  groups group  of  would  60 be  expected  group  of  to  exhibit  ventricular  cognitively  impaired  which are  s m a l l compared  SPEM, LVE  and  The  as  used  in  the  that  most  by  they  examined  present  of  their  impairment  p a t t e r n on by  of was  visually  a 5-point  subjects  were  Finger-Tapping Necker  cube.  have  eye  ventricles  study. 18  of  particular  v a r i a b l e s as  Bartfai  et  worse  for  deviance  The  eye  They  Eye  from  the  Trail-Making  their  Test,  on  the  movement  obtained  scores  and  found  stimulus  tracking ratings  c o r r e l a t e d with  the  patients  performance  administered.  those  a l . report  schizophrenic  to  measures  found  of  t r a c k i n g impairment.  scale.  Test,  (1985 ) i s  same s e t  of  rated  then  They  al.  related  neuropsychological were  the  sample  that  records  et  research  some d e g r e e  three  may  another  t o t h e n o r m a l c o n t r o l mean.  Bartfai  exhibited SPEM  patients  while  NTP  study  interest  enlargement,  on  the  reversals of  f o l l o w i n g c o r r e l a t i o n s between  smooth p u r s u i t t r a c k i n g p r o f i c i e n c y o f a s i n u s o i d a l t a r g e t the  neuropsychological  tapping  left  hand;  =  for of  r  .56  Necker  Cube  subjects  However,  r =  (p<0.01)  Trail-Making  significance of  hand;  Test  tests: -.49  r  =  -.45  (p<0.10)  and  reversals.  r  =  -.5 3  Bartfai  et  Test  they  on  suggest  the that  basis  of  subjects  A;  (p<.05)  r  eye who  index  =  and  fingerright  .37  f o r the  al. failed  d i f f e r e n c e i n a n t e r i o r horn created  for  (p<0.05) f o r f i n g e r - t a p p i n g  for Trail-Making B;  a  to  between  (NS)  number find  a  groups  tracking proficiency. tracked  more  poorly  61 tended good  to or  report  have  wider  slightly findings  impaired relating  measure o f l a t e r a l Despite Bartfai ways.  et  schizophrenic females)  et  in  differ  from  23  to  the  s a m p l e were o u t p a t i e n t s ,  one  one  hospitalization,  third  In  contrast,  the  considerably  are  were  advantages  samples.  one  subjects  who  While the  and  may  sex,  numerous  confounds  to  measurement  pursuit the  eye  and  involving  In that  report 1 )  of  and  the  study  the  discusses  males,  42  years.  (11 Two  at  the  which  to  sophisticated  of  obscure the et  of  measurement  a  were  to  of be  heterogeneity  the  status  relation-  present  and  for  study respect smooth  i n terms  battery.  research and  only  types  a l . with  size,  of  testing.  both  the  7  chronic  hospitalization  of Bartfai  results  study  DSM-III time  of  chronic.  i s more l i k e l y  addition,  ventricle  had  as  in this  implicit  and  thirds  subjects  neuropsychological the  significant  subjects  q u a n t i f i c a t i o n techniques  tracking, lateral  extensiveness  following  illness  variables. from  the  18  i n general,  introduce  considerably  to  group  e t a l . sample  of  differs  tests  were c l a s s i f i e d  drawbacks  duration  between  not  a heterogeneous  A l l were m a l e  age,  ships  do  several  participating  representative of schizophrenics in  in  inpatients  Bartfai  authors  present  h a l f of the  more homogeneous.  schizophrenics There  30  the  consisting of  and  The  with  width.  report  age  subjects  neuropsychological  a l . s a m p l e was  patients  ranging  the  than  tracking.  similarities,  (1985)  Bartfai  ventricles  eye  ventricle  apparent al.  The  lateral  of The  project  computerized  scoring  of  smooth  pursuit  eye  tracking  extensive neuropsychological battery Intelligence  scale  ventricle  size  tion  a  with  normal stand  large  et  width  Lateral  This  used  1985).  The  computer  in  tion  are  routinely  this  for  considerable  any  hence  and  may  were  the  Bartfai  al.  in  of  subject  al .  linear lateral  found  to  correlation  of  any  size  be  have  of  the  (Reveley,  two  on  of  a the  presenta-  comparable  to  did  not  include  i t is  not  possible  deviant their  s i m i l a r i t y of et  the  While  actually  significance  a  administered  not  et  pursuit  by  computerized  t h e i r measures;  the  differences  were  the  Bartfai  despite the  volume  of  tracking  lowest  minutes.  results  sample  of  ventricle  tests  10  of  been  the  ventricular  the  of  horns  and  lateral  refinements  estimated  consistently  of  Finally,  Overall,  study  and  volunteer  smooth  ratings  was  anterior  lasting  i f their  variables,,  unknown.  size  conjunc-  techniques  assessed  visual  has  of  a  an  lateral  in  include  2)  Weschler  of  planimetry  measurement  administered,  standard  groups  determine  the  method  measure  that  the  neuropsychological  studies.  control  to  the  session  a  a full  above m e t h o d o l o g i c a l  using  indexes  a  i s not  other  scans  inter-rater reliability,  commonly  to  of  3)  investigators  c r i t e r i o n measures  tests  and  ventricle  measurement  lowest  of  contrast These  including  mechanical  The  performance  ventricles.  with  series  in  al.  deviance.  by  group.  somewhat  tracking  the  estimated  control  Bartfai  (WAIS-R)  performance;  on  any  of  findings  is  purposes  study,  between  there  characteristics,  are  measure-  ment  techniques,  differences et  make  a l . , two  the  the  and  of  control  study  approaches  between  size,  use  present  distinct  relationships ventricle  and  smooth  to  the  the  investigation  of  eye  lateral  pursuit  neuropsychological  preceding  matters  of  review  t r a c k i n g  Repeatedly  has  patients  these v a r i a b l e s .  view o f  probably  This  schizophrenia composed  of  smooth  as  of  a  deficits  deviant  individuals  currently  diagnosed  as  is  apparent  that  majority  synthesis present  of of  the the  study.  to  research  would  address  subgroup  each  of  deviant  discussion  for  the  date  issue  findings  of  and  pursuit  eye  some,  not  to  more  be  the  three  schizophrenic.  this  normal contem-  is offered and  as  a  for a l l  However, i t  The as  which  variables  studies  issue.  not  homogeneous  predicted  of  and  but  w i t h the  the  in  rates  a heterogeneous d i s o r d e r number  standing  to  schizophrenia.  that  i s consistent  discussed,  designed  in  relative  It  specifically  that  the  abnormality,  subgroups.  equally  is clear  progress  demonstrated are  tracking,  prevalence  scan  performance  research  schizophrenic  porary is  the  CT  Bartfai  Review  with  significance  dysfunction,  neuropsychological  r a n g e on  dealt  of  performance.  definition/description,  clinical/theoretical  all,  has  report  These  and  C o n c l u s i o n s From L i t e r a t u r e  The  groups.  an  were  not  following attempt  rationale  for  at the  Attempts diagnostic A or  research  posit  a  phrenics  to  delineate  classification  typical  to  be  clinically  or  the  have  to  the  dimension  ways  in  subgroup  on  which  variable which of  formed  on  issue  which  such  paranoid,  premorbid  poor premorbid  Potkin,  or  good  Kleinman,  pointed  out  current  Weinberger,  in  the  research  in  biological  and  d i m e n s i o n s w h i c h may  attempts  when  &  is to  delineate  of  non(Wyatt,  1981). this  increasingly understand  or  vs.  status  As  review,  turning  to  causes  of  the  the  subgroups w i t h i n  other  clinical  Jeste,  characterizing  with  Historically  paranoid  statement  schizophrenia in  as  Luchins,  introductory  variables  schizophrenia,  vs.  for  of  dichotomies  schizo-  investigated  differ  phenomenological  find  differ  then  basis  history.  of  disorder.  the  the  i s to  groups  are  they  the  within  have a l o n g  Subgroups  aspects  been  subgroups  'schizophrenia'  classification  significant  subgroups  describe  differentiated.  this  determine  and  approach  variable  may  respect  to  underlying  the  diagnostic  category. CT Wyatt  scans  et  al.  tion". unable part  of  to  eye  movement  (1981) c a l l  They  they  disease  and  point  divide  model.  subgroups  compromised  "biological  out  that  schizophrenia  attribute this  to  However,  i s subscribed by  measures  to  a long  they to,  "enormously h i g h  add the  tools  date  into  are  examples  that  researchers  bias even  success  variance  what  for subclassifica-  biological  held  of  of  have  been  subtypes.  toward when the  i n almost  In  a  unitary  the  concept  endeavor  is  a l l current  65 measures  on s c h i z o p h r e n i c  p. 100).  At present  are of  insufficient  a  i t appears t h a t  i n providing  homogeneous  the  (Wyatt  forvalid  An a l t e r n a t i v e  u s e o f c o m b i n a t i o n s o f measures which  measures  also  putative  subgroup  from  aids  dimension.  i n describing  stage  research  measures  a s a more  preliminary  stage  i n this  are believed  fashion  i t clearly  to validate adequate  might  be  to tap  combination of  the c h a r a c t e r i s t i c s o f the  However,  strategy  measures  identification  approach  Use o f a  i n a more a d e q u a t e  s i n g l e measures.  e t a l . , 1981,  single biological  a basis  subgroups.  similar underlying  of  patients".  t h a n would requires  a  result multi-  the use o f a combination  basis  endeavor  of classification. involves  A  simultaneous  measurement o f t h e v a r i a b l e s o f i n t e r e s t i n a s i n g l e s a m p l e o f subjects  i n order  As gators  indicated  who  characterized  suffer  and d e f i c i t s  current  brain  measures  of  disorder  that  which  measure  f o r detecting  i n a population  be  Johnstone, &  lateral  of putative  investigation  might  I t i s speculated  dysfunction,  each  investi-  schizophrenic  (Crow, C r o s s ,  1984).  indicants  i s an  many  that  ventricular  i n neuropsychological  and s p e c i f i c i t y  project  review,  i s a subgroup  & Abrams,  i t i s assumed  sensitivity  a  eye t r a c k i n g  a l l potential  Further,  i n this  there  from  an a s s o c i a t i o n .  as a form o f dementia  pursuit  enlargement,  these  that  1982; T a y l o r  smooth  are  repeatedly  speculate  patients  Owen,  t o demonstrate  performance  brain  disorder.  has weaknesses i n this  disorder.  of the covariation  expected  t o have  The of  a moderately  high  prevalence  issue  of  cannot  be  the  whether  of  allow  form  a useful  then  be  and  these  a  determined  extent  should  of  an  in this  estimate  combination with  parameters.  Clearly  d y s f u n c t i o n does  relationship  investigated  clinical  brain  dysfunctions.  of  manner. between the  What c a n these  likelihood  for defining respect to  or  does be  the  major  not  exist  assessed  variables. that  they  a subgroup which meaningful  is  This might might  psychosocial  RESEARCH OBJECTIVES  The the  primary  relationship  pursuit in  purpose o f t h i s  a  between  patients. interest  of carefully The  because  each  measures  schizophrenia expect  this  seriously this  i s  indeed  literature  the  present  interest.  significant t o be  most  institutionalized  to relate  schizophrenic  a  I f d e v i a t i o n s on of  a  subtype  neuropathology, highly  i s of  t o be e i t h e r  of  one m i g h t  represented  patients of the sort  sample To  the results  i t i s necessary exhibits  address  psychological  among  assessed  t o others i n  the extent  t o which  s t a t u s on t h e m e a s u r e s o f  issue,  f o r VBR  two  control  o f a group  and e y e t r a c k i n g .  groups  to that  patients  and t o norms o b t a i n e d  involved  i n selection  of non-schizophrenic from  test  o f an a p p r o p r i a t e  tests  The  of the schizophrenic  compared  The advantage  t o assess  study  are  A group o f normal v o l u n t e e r c o n t r o l s  performance  neuropsychological  of this  deviant  this  i n the design.  as c o m p a r i s o n s  simple.  feature  performance  measures  i s considered  a  smooth  study.  the  included  these  size,  test  chronic  to, brain dysfunction.  subgroup  ill  among  o f them  involving  In order  serve  ventricle  diagnosed  relationships  sign of, or sensitive  in  lateral  i s the investigation of  e y e t r a c k i n g , and n e u r o p s y c h o l o g i c a l  sample  these  study  used  of using  with  manuals. comparison  group i s  psychiatric The i s s u e s group f o r  schizophrenics  non-schizophrenic  neuro-  are not  psychiatric  68 patients for  i s that  this  group  psychiatric status  comparison from  t h a n would  normal  patterns  In tests  The  differences addition,  size  analytic  obvious  drawback may  which  r e l a t i o n s h i p s among sample  conservative norms  derived  i s that* non-  exhibit  peculiar  make i n t e r p r e t a t i o n  will  the  neuropsychological  be e x a m i n e d .  The s m a l l  s o p h i s t i c a t e d m u l t i v a r i a t e and f a c t o r  analyses.  intercorrelations  test  of control  difficult.  precludes  theoretical  by u s i n g  and d e f i c i t s  i n the schizophrenic  sample  i s a more  psychiatric patients  o f strengths  o f group  some m e a s u r e  p e r s e , and  be o b t a i n e d  samples.  schizophrenic  provides  Nonetheless,  i s a  means  of  examination  linking  this  of  study  to  and e m p i r i c a l s t a t e m e n t s i n t h e l i t e r a t u r e .  Hypotheses Group  Differences It  will  i s p r e d i c t e d t h a t t h e sample  differ  direction smooth  significantly  of greater  pursuit  from  impairment,  eye t r a c k i n g ,  of schizophrenic  the control  groups,  subjects i n the  on t h e m e a s u r e s o f 1) VBR,  and 3 )  neuropsychological  2)  test  performance.  Correlations  Among  Neuropsychological It  VBR,  Eye Tracking  and  Performance  i s predicted  relationships  Smooth P u r s u i t  that  there  among t h e p r i n c i p a l  will  measures:  be  the  following  69  i)  Ventricle'  brain  ratio  performance w i l l *  and  smooth  pursuit  be c o r r e l a t e d s u c h t h a t  larger ventricles  will  be f o u n d  eye t r a c k i n g  individuals  with  t o h a v e more i m p a i r e d  eye  tracking. ii)  Ventricle will  be  brain  ratio  correlated  v e n t r i c l e s  and n e u r o p s y c h o l o g i c a l  such  w i l l  be  neuropsychological ("normal") iii)  Smooth  more  individuals impaired  on  those  more  be  impaired  SPEM  and  be o f two s o r t s : a  diffuse  impairment  dysfunction, would  correlated  sensitive  such  tests.  be The  a) i f SPEM  brain t o be  impairment  disorder related  to  one  global i f SPEM  o f a marked, o r s p e c i f i c  frontal  be e x p e c t e d  strongly  to frontal  tests.  then  b)  i t might  be most  and  neuropsychological  i s a result  battery).  smaller  eye t r a c k i n g w i l l  impairment  considered  the  (SPEM)  the neuropsychological  with SPEM  will  on t h e n e u r o p s y c h o l o g i c a l  tracking  larger  on  with  movements  impairment  lobe  with  i m p a i r e d  than  performance  between  associated expect  eye  with  performance could  might  more  tests  p u r s u i t  relationship  is  individuals  ventricles.  neuropsychological that  that  performance  that  associated function  impaired with  eye  tests  (six of ten i n  Correlations Within Although study,  there  w i t h i n the  not are  Battery central  certain  to  the  major  hypotheses  c o r r e l a t i o n s which might  neuropsychological  test  b a t t e r y on  the  be  of  the  predicted  basis of  the  literature. i)  WAIS-R  Verbal  correlated  and  the  Performance  other  measures  IQ's  are  of  predicted  to  be  neuropsychological  performance. ii)  The  neuropsychological  Test,  Finger  Fluency tests and  Test,  are  would  Tapping and  believed be  the  test  Test,  schizophrenic patients.  Trial  Wisconsin  sensitive  expected  battery  to  be  to  i n c l u d e s the Making  Card frontal  Sort lobe  Category  Test, Test.  Word These  functioning  c o r r e l a t e d i n the  sample  of  71 METHOD  Subj e c t s Chronic  schizophrenic  schizophrenic mental  patients,  hospital  patients.  recruited  (Riverview  form  that  the  consecutive exclusion included  obtained  sample  admissions,  who  Statistical  Manual  (DSM  Association,  1980)  schizophrenia,  i i ) were m a l e  were s u f f i c i e n t l y diagnostic without  interview  documented  been t r e a t e d Initial from  verbal  a  screening  computerized  information  and  diagnoses,  Diseases  System  initial  of  schizophrenia  these  give  of the  using  pool  was  presence  of  inclusion  and  I n d i v i d u a l s were  35  Diagnostic  years  and  Psychiatric of  chronic  o f age, i i i )  to p a r t i c i p a t e i n the  written  consent,  conditions  which  and  and,  the  provided  secondary  iv)  v)  were  had  not  was  done  demographic  psychiatric  and  International Classification  (ninth edition).  subject  consenting  hospital population  data-bank  o f males  From  examined  t h e computer  under  identified.  i n d i v i d u a l s were  illness,  under  to  dependence.  principal  medical  an  and  neurological  f o r substance  of  diagnosis  and c o o p e r a t i v e and  the  i) satisfied  for  subjects.  and e x e c u t e d  I I I ; American  criteria  chronic  provincial as  composed  f o r the study.  i f they,  III  large  designed  was  male  served  satisfied  selection criteria i n the project  a  Hospital),  R e c r u i t m e n t p r o c e d u r e s were c a r e f u l l y insure  Thirty  The to  neurological  age  35  with  hospital  determine diagnoses,  data  of  base  diagnoses  records  of  duration  of  history  of  treatment  f o r substance  dependence,  hospitalizations,  and t o r e c o r d  in  interview  the diagnostic  selection there  procedures.  were  no  psychiatrist project  with  Using  clear was  t h a t was  grounds  contacted  and  t h e p a t i e n t was  were  l a g time  t h e h o s p i t a l computer  initial  group  possible  to contact  in  this  the study;  interview,  103  had  them  one  Five one  t h e CT  been  about  expressed  paranoid  diagnostic refused not  refused  felt group  the  as p o t e n t i a l  interview.  Of  base,  t o be u n s u i t a b l e unsuitability  by was  25  discharged  Due t o  discharges  patients before  From  patients could continue  i n the i t was  a pool  after  n o t be  o f 78  t o be t a k e n  included  the s e l e c t i o n  the neuropsychological  testing,  from t h e h o s p i t a l  extremely  hostile  and  about t h e e x p e r i m e n t e r s d u r i n g t h e t h e remaining  8 patients  the diagnostic  (5 m o n t h s ) .  of patient  l o c a t i o n and one was concerns  subjects  and met t h e s e l e c t i o n c r i t e r i a  to  t o do  to participate,  meet  to discuss  the study.  o f these  refused  scanner  permission  data  two were t o o s e r i o u s l y d i s t u r b e d to  his  and t e s t i n g  35 were i n t e r v i e w e d  study.  information  individual,  i n processing  through  for  o f the  the  identified  a  inpatients,  as p a r t  requested.  of recruitment  of  assist  s e l e c t i o n p r o c e d u r e o u t l i n e d a b o v e , 10 3  admissions  week  previous  w h i c h would  conducted  to exclude  over the p e r i o d several  information  of  I f , on t h e b a s i s o f c h a r t e d  the subject  consecutive  number  criteria their  were  43  individuals,  interviewed  f o r the study,  physicians.  determined  by  In  a number  and this  20  but d i d 15  were  latter  of factors  73 including; risk  i ) the patient  was c o n s i d e r e d  an e x t r e m e  elopement  o r had r e c e n t l y b e e n v i o l e n t , i i ) t h e p a t i e n t was  disorganized discharged (iv)  or inaccessible,  before  a selection interview  the patient  having  Comparisons  using  had  a neurological  (n=20)  subjects  took  part  available  who  been  could  was  be a r r a n g e d o r ,  rediagnosed,  often  refused  i n the study  from  refused  the Riverview  had a mean  be  done  Hospital  data  age o f 27.9  not  Hospital  differ The  study  1974  thirty  )  given  State as  a  an  o f 1.9  significantly  were  Present  and had  average  on e i t h e r o f t h e s e patients  a structured  Examination part  interview  was c o n d u c t e d  extensive  experience  (PSE) (Wing,  with  diagnoses  f o r DSM-III  f o r each p a t i e n t  and d e c l i n e  The groups  based  relevant i n level  to do  variables.  interview  Cooper,  &  using  patients  diagnostic  the  Sartorius,  t h e PSE and t h e d i a g n o s t i c  checklists  information  o f admissions  by one o f two Ph.D. p s y c h o l o g i s t s  Symptom  chart  age o f  o f t h e s e l e c t i o n procedure.  to selecting schizophrenic  by  Hospital of  who p a r t i c i p a t e d i n t h e  diagnostic  relevant  completed  number  (SD 2.3) a d m i s s i o n s .  schizophrenic  routine  to Riverview  (SD 4.27)  (SD 2.1) w h e r e a s t h o s e who p a r t i c i p a t e d had a mean  Riverview  o f admissions  could  2.6  3.71)  as  to participate  an a v e r a g e  (SD  number  who  and  28.2  t o be  disorder.  who  information Subjects  recently  between  and t h o s e  bank.  i i i ) the patient  grossly  for  This with issues  research.  criteria  were  on t h e PSE, and s u p p l e m e n t e d  to duration  of illness,  of functioning.  The  previous diagnosis  o f DSM-III c h r o n i c (see T a b l e above  5)  were d e t e r m i n e d  issues  included  by  in  two  project  interview  supplemented  noted  that  despite  were  found  be  information, recorded  summary  of  accumulated  in  the  schizophrenic schizophrenic  as  age  of  a  having  duration  of h o s p i t a l i z a t i o n  one  half  two  and  less  years four  t h a n two  the  one  years  should  be  patients  were  often  3  levels  and  4  for a l l  present  h o s p i t a l i z a t i o n s and  six  finish  from  admissions.  i n mental  and  Tables  community  patients  of  educational  Seventy  h o s p i t a l i z a t i o n s was  20%  criteria  contradictory  reports  institutionalization  number  2 months.);  and  study.  one  to  patient  also  well.  p a t i e n t s d i d not  8  presented  of  diagnostic  some  of  to  extensive  i n diagnosis,  patients.  5  DSM-III  taken  in  patient  was  care  h i s t o r i a n s who  of  and  It  completed of  an  the  diagnosis  records using  subtype  each  information.  number  year  ICD-9  study on  Thus  chart  the  length  an  based  2 present  involved  schizophrenic  by  charts  1 and  b a s i s o f c o n s e n s u s on  the  inconsistencies  in their  Tables groups  poor  the  hospital  for  schizophrenia  the  the  had  to  diagnosed  to  on  and  diagnosticians.  according  independently chronic  the the  schizophrenia  for  schizophrenia  for  high  1 to The  12,  with  range  of  sample  had  spent  institutions,  h a l f years in hospital.  in hospital,  had and  patient  80%  for  of  the  accumulated  (from  10  30%  years  four  spent  It is interesting  the  range  more t h a n  50%  of  one  The  spans s e v e r a l y e a r s  chronic  (23)  school,  college.  total  the  percent  a  between  had to  and  spent  note  75  /  Table 1 Age of Participants  Groups  Schizophrenics  Mean SD Range  (n-30)  Normal Controls (n=29)  Psychiatric controls (n=21)  28.2  24.2  25.4  3.71  5.74  5.5  22-34  16-42  17-34  76  Table 2 Educational Attainment of Participants  Groups  Schizophrenics  Educational Leve I  (n=30)  Normal Controls (n=29)  Psychiatric controls (n=21)  number (%)  number (%)  number (%)  Grade 9 or less  9 (30%)  Grade 10 to 12  19 (63%)  7 (24%)  15 (70%)  Post secondary training  1 (3%)  14 (48%)  2 (10%)  BA/BSc  5 (17%)  2 (10%)  Post Graduate  1 (3.3%)  1 (5%)  Not Known  1 (3%)  1 (5%)  2 (6.8%)  77  Table 3 Number of Psychiatric Hospitalizations for Chronic Schizophrenic Patients  Number of Hospitalizations  3  Number of Patients  Mean Age of Group  1-3 hospitalizatIons  1  33.0  4-6 hospitalizations  15  28.5  7-9 hospitalizations  10  27.2  10-12 hospitalizations  4  30.3  Note. There are no significant  differences  in age between the  groups Average number of admissions for entire sample is 6.7 (SD 2.6)  a  78  Table 4 Accumulated  Duration of  Institutionalization  Chronic Schizophrenic Patients  Duration  (In  months)  3  Number of Patients  Mean Duration for Group  Mean Age of Group  11  10.,3 m.  28.,3  24 m,. to 47 m.  12  33..2 m.  27..7  48 m.. to 83 m.  5  60..4 m.  27..8  84 rn. to 113 m.  2  92..2 m.  32..0  2  i .to  23 m.  for  Note. There are no significant  differences  in age between the  groups Average  a  accumulated  duration of  sample is 33.6 months (SD 25.69)  hospitalizations  for  entire  79  Table 5 DSM III Subtypes of Schizophrenia In Chronic Schizophrenic Sample  Groups  Measure  Number of Patients  Paranoid Subtype  Disorganized Subtype  Undifferentiated Subtype  21  Mean age (SD)  28.3 (3.72)  28.2 (3.30)  28.0 (4.47)  Mean Cumulative Duration of HospitalIzations (SD)  32.5 (27.4)  44.2 (36.29)  29.0 (20.24)  80 that  there  a r e no s i g n i f i c a n t  grouped  on  the  basis  hospitalizations. extended long  care  age d i f f e r e n c e s b e t w e e n  Five  locked  of  number  patients  ward,  or  d u r a t i o n  i n t h e study  12 were  subjects  on wards  were  o f  on an  designated f o r  t e r m p a t i e n t s , and 13 p a t i e n t s were o n w a r d s i n t e n d e d f o r  admissions The  of less  exclusion c r i t e r i a  treatment  f o r substance  specifically subjects  t h a n s i x months.  been  study  dependence.  treated  had h i s t o r i e s  f o rthis  included  While  f o r substance of extensive  history of  n o s u b j e c t s had  dependence,  substance  several  abuse  and/or  d e p e n d e n c e i n v o l v i n g a l c o h o l , m a r i j u a n a , LSD, and a v a r i e t y o f illicit drug  s t r e e t drugs.  and a l c o h o l  Schedule Spitzer,  1981).  various  drugs  use  social,  individuals  Robins,  were u s e d ,  one i n d i v i d u a l  street  drugs  this  occurred),  recorded  claimed  i n patients  reports i s  requires  u s e , number o f drug  &  specific o f times  and a l c o h o l  functioning.  Some  drug  use h i s t o r i e s  t o be u s i n g  vast  quantities of  several  charts  Interview  their  large  of their 1  and work  amounts  i n hospital;  while  minimize the extent  of daily  using the  Williams,  patient  as t h e DIS  t o exaggerate  and d r i n k i n g he was  Croughan,  and t h e e f f e c t  familial,  appeared  Diagnostic  of several  the duration  (e.g.,  months w i t h i n  Helzer,  particularly  about  was i n t e r v i e w e d  o f t h e NIMH  The a c c u r a c y  questionable,  on  portions  (DIS-III:  information  Each subject  past  daily  during  hospital staff patients drug use.  and i n f o r m a t i o n  were Based  several  denied believed  that to  on m a t e r i a l  obtained  from t h e  81 DIS  i t i t estimated  extensive  alcohol  marijuana  over  sniffing,  extended  etc.);  11  alcohol two  11  periods  patient  had  of  periods had  refused  abuse  several  of alcohol  marij.uana  had  with  he  had  basis,  drugs  o r on a d a i l y  once;  used  glue  a daily  i l l i c i t  five  the questionnaire  that  use o f  frequent  u s e on  and had r a r e l y u s e d  t o answer  h i s t o r i e s of  (e.g. d a i l y  months,  them f r e q u e n t l y  drugs  i n h i s chart  drug  experimented  tried  illicit  of the subjects  illicit  b u t had n o t u s e d  used  noted  or  subjects  patients  never  that  said  and  basis;  they  had  alcohol;  and one  although  i t was  marijuana  on  several  occasions. All  subjects  drugs;  the  i n this  majority  simultaneously.  daily  were  as  fluphenazine  participated period  as  also  a  s e v e r a l  were  monthly  although  mild  not  medications dosage i n  attempted;  had  is first be  and CPZ  been  for agitation.  parkinsonian  most  medicated  signs  movements  side  many on a  injection  orders  high,  initiated.  showing  depot  standing  generally  i n the study  to  antipsychotic  medication  was  and d i d n o t e x h i b i t t h e marked  thought  taking  of daily  had  of haloperidol  when m e d i c a t i o n was  on  equivalents  well  levels  were  2 to 3 d i f f e r e n t oral antipsychotics  and  administration medication  (CPZ)  given  basis  were  Calculation  chlorpromazine patients  study  f o r  PRN  Although  patients  f o r an  of  who  extended  effects often  seen  None o f t h e p a r t i c i p a n t s of and  tardive  dyskinesia,  akathisia  were  not  82 uncommon.  Twenty  f o u r were l e f t Normal recruited community  the  from  centers, CT  to  psychiatric  in  scan  and  any  1  (t(57)=3.17  or of  levels  significantly  of  and  are  scale  of  and  very  standardized  for  or  handed  and  VBR,  served  for  of  these  reliable  ventricle  abuse  for  Ages  and  are  and  groups  w h i c h has  measurement and  listed  group  for  scoring and are  is  patients  Procedures  schizophrenic  ratio  the  control  recording  for  either  schizophrenic  subject  brain  control  screening  relatives.  educated.  schizophrenia  a  t r a c k i n g measures.  c o n t r o l sample  chronic  the  as  centers,  h i s t o r y of treatment  drug  and  volunteers  employment  volunteer  the  male  psychiatric  degree  i s better of  a  no  volunteer The  identical  study  was  first  than  p a t i e n t s . Both  procedures  his  p<.01) and  tracking  29  colleges  given  alcohol  the  younger  measurement  large  of  group  were  2.  scanning,  control  A  right  s m o o t h p u r s u i t eye  subjects  or  Tables  were  community  insure that there  participant  subjects  practice clinics,  and  problems  educational  the  Group.  family  control  interview  of  handed.  Control  group o f the All  six  CT eye  volunteer part  developed  of  a  highly  and q u a n t i f i c a t i o n smooth  pursuit  eye  tracking. Psychiatric  Control  neuropsychological obtained patients. Sciences  for  a  From Center  Group.  tests  sample  of  Control  administered  group in  this  nonschizophrenic  a computerized  data  P s y c h i a t r i c Care  bank a t  Unit  scores  the  for a l l  study  were  psychiatric U.B.C.  (H.S.C.-P.C.U.) a  Health group  83 of  21  males  under  inpatients  at  t h e age  the  neuropsychological  diagnosed  abusers,  as h a v i n g  disordered  were w e l l this  diagnosis.  Test  controls  had  P.C.U. and had i n f a c t hospital.  For three  12  this any did.  category. post  Only  1 subject  personality  nonschizophrenic f o r the patients  a t t h e H.S.C.-  technician at this  measures  administered  c o n t r o l scores 75% o f s u b j e c t s  there  available.  In  had g r a d e 9 t o  schizophrenics  i n the schizophrenic  significantly  were i n  s a m p l e had  whereas 5 o f t h e c o n t r o l  T h e two g r o u p s do n o t d i f f e r  of 7  as t h e e x a m i n e r f o r  training  of the chronic  as  substance  schizophrenic  as a t e s t i n g  o f the nine  secondary education  as  2 as  but  settings  extensive  worked  w h e r e a s 9 3%  composed  administration procedures  p s y c h i a t r i c c o n t r o l sample, education  was  who,  referred for  5 diagnosed  unspecified  were f e w e r t h a n 21 p a t i e n t s w i t h the  been  disorders,  across  received  selected  group  and t h e c h r o n i c  standardized  study  had  This  anxiety other  psychiatric  were  as d e p r e s s e d ,  and 4 w i t h  psychiatric  35  hospital,  testing.  individuals 2  of  subjects  i n age.  Measures Smooth eye  pursuit  movements  were  e y e movement r e c o r d i n g . recorded  i n a  a t U.B.C.  H.S.C-P.C.U. u s i n g  procedure.  With  stabilized  subjects generator  observed  a 5 mm  at a frequency  of  .4  a well  i n a chin  luminous  spot,  hz  pursuit  psychophysiological  laboratory  head  Smooth  and f o r e h e a d  driven  f o r 20  standardized rest  by a s i n e wave  cycles  of  target  84 oscillation, cm  from  displayed  the  on  subject's  the  placed  left  eye  target  Dynograph  computerized  scoring  program  the RMS  blink  which a l i g n s the  a  waveform  be  model  by  of  each  orbital  eye.  rims  of  monitored.  Eye  on  a  Beckman  type  FM  recorder  for  by  target  and  The  eye  the 16  eye  computer-based  best  to  cycles  eye  o f RMS  logarithmic  expression  in is  tracking  for  between standard  typically  transformation  of  program  adjusts  difference  scores  form  tracking.  a computer  movements  root-  wave  of  tracking channels,  subject's  the  movement  t h e n computes t h e  skewed m a k i n g t h e  a  equal  utilizing  distribution  appropriate  by  value  of  i s obtained  the  a more  a  the  s i g n a l and units.  analysed  for  the  use  Vetter  deviation  and  scores  canthi  to  recorded  silver/silver  inferior  artifacts  generates  amplitude d i f f e r e n c e s  positively  outer  and  t r a c k i n g was  which  deviation  deviation  the  superior  and  (RMS)  target  target  at  were  using  p o s i t i o n were r e c o r d e d  o f eye  mean-squared from  movement  30  positioned  analysis.  Accuracy  The  at the  Eye  techniques  placed  allowed  movements and R-612  (EOG)  electrodes  Electrodes  o s c i l l o s c o p e screen  eyes.  electro-oculographic chloride  an  of  RMS  accuracy  for  i n t e s t i n g group d i f f e r e n c e s . Lateral  third  ventricle sizes.  generation,  Somatom DR2) Hospital.  high  located  at  Scanning of  done w i t h o u t  injecting  Subjects  resolution, total the  an  and  scanned  body s c a n n e r  U.B.C. H e a l t h  a l l patients  were  Sciences  volunteer  enhancement c o n t r a s t  on  a  (Siemens  Acute controls  medium and  Care was with  85 a  scanner  setting  window  allows  ventricles scanned  perfectly  parallel axial  which  to  showed  selected  23.5  cm by 17.5 cm  scan  largest,  compensating the  was  the  to  and  a  measured  by  was  on  used  times,  and  to  and  The form  CT  scan  largest  film  of  16  to  a  VBR. film  of  at  their  a Sokkish  19908  t o measure  the area  of  of the brain  i n order  to  The a r e a averaged,  to give ventricular  s i x times  were  to  at t h e i r  ventricles  box,  the area  three  100  The  The e n l a r g e d  lateral  light  f o r the r a t i o .  multiplied  size.  this  lateral  f o r 13  enlarged  brain ratio.  t h e two v e n t r i c l e s  denominator was  measured  and  27;  Subjects  thickness.  ventricles  ventricle  attached  ventricle  was  8 mm  of  of the  f o r u s e i n measurement  showing  the v e n t r i c l e  area  line  subject  o f VBR  calculate  across  cantho-meatal  the l a t e r a l  ventricles  at a level  dose.  polar planimeter  lateral  80  the radiation  of  format  section was  the  f o r each  Measurement  of  adequate v i s u a l i z a t i o n  sections  was  the  setting  while minimizing  successive section  width  lateral  and t h e n  summed  size.  averaged  ratio  o f each  to  provide  of ventricle  t h e VBR  as  The b r a i n  to  the  brain  i t i s reported  in  most p u b l i s h e d s t u d i e s . Neuropsychological assessment  was  interview approximately comprised the  carried  rooms  The  out  the  three hours  o f two  patient.  on  assessment.  sessions  at  The  neuropsychological  Riverview  various  Hospital  wards.  Testing  and was u s u a l l y c o m p l e t e d organized  following tests  around  were  using took  i n one day  a lunch  break f o r  administered  following  86 standardized Adult  procedures  Intelligence  o u t l i n e d i n the  Scale  - Revised  hours a d m i n i s t r a t i o n time), D,  with  Background  approximately Victoria time),  10  min  Revision  Trail  administration  Benton V i s u a l  administration -  and  B  Right  and  (TAPR & TAPL - a p p r o x i m a t e l y  10  Fluency  Test  time),  A  (WF  -  Verbal  Auditory  Learning  min  administration time),  (WCST - a p p r o x i m a t e l y Scoring according manuals.  For  different obtained  the  were u s e d :  Visual  Retention  P r o c e d u r e ; CAT  second taps  min  Hand  number  A of  test.  test,  Form  min  administration  (RAVLT  -  Card  Sorting  were in  with  study  total  B  of  the  and right  hand  number Trail  index  the of  finger  10  second  trials;  WF  =  often  following the  Benton  Interference  seconds  hand  over  TAPR five,  index  total  Test  taken  Test;  taps  the  several  Categories  Making  TAPL = a v e r a g e number o f l e f t  five,  the  Background  test  are  e r r o r s on  number o f e r r o r s on  Test  scored  the  tests  performance  number o f  10  time). Tests  this  time),  approximately  described  of  =  min  Word  tests.  TMT  10  administration time),  For  D  Test-  administration  Finger  administration  measures  (BVRT-  approximately  the Wisconsin  BVRT = t o t a l  Revision;  trials;  -  Form  Test  procedures  same  = total  parts  over  and  15  1.5  Tapping  5  Test  min  related  scores  average  min  Test,  Categories  a number o f t h e n e u r o p s y c h o l o g i c a l  from  complete  20  standard  but  - Victoria  Left  neuropsychological  to  Retention  time),  (TMT  approximately  Rey  Weschler  Procedure  approximately  Test  manuals;  (WAIS-R - a p p r o x i m a t e l y  Interference  (CAT  Making  test  to = 10  finger  number  of  87 words g e n e r a t e d alphabet recall item the  with  on f i v e  list  used  total  i n response  to three  one minute  allowed  different  letters  per l e t t e r ;  RAVLT  i m m e d i a t e and 1 d e l a y e d i n t h e Rey A u d i t o r y  number  o f t h e 128 c a r d s  of errors used  which  recall  Verbal  trial  o f the =  f o r t h e 16  Recall Test;  occurred  during  i n t h e W i s c o n s i n Card  total  WCST =  presentation  Sorting  Test.  Procedure Schizophrenic by  patients  the procedures outlined e a r l i e r ,  had  been  given  permission  approached  on t h e w a r d  recruiter  t o an  project.  interview  t o which  conclusion whether  of this  interview were  detailed  consent  a  2 hour  written  f o rthe rest criteria  f o r m was u t i l i z e d  project;  ( i ) a 2.5 h o u r n e u r o p s y c h o l o g i c a l  test  CT  and i i i ) a two h o u r Subjects  terminate research  were  testing  protocol  battery  informed  a t any t i m e .  the subjects  of  that Upon  major  selection atthe paid  $5  o f t h e study.  and i f t h e y  three  tests.  research  consent;  d e s c r i p t i o n o f t h e remaining  scan  the  a l l i n d i v i d u a l s were  selected  were  t o accompany t h e  as c o n s i s t i n g o f f o u r  gave  i n d i v i d u a l s met t h e d i a g n o s t i c a second  the study,  to discuss  involved  the subject  o r n o t they  to continue, a  room  stage  subjects  and f o r whom t h e r e c r u i t e r  and r e q u e s t e d  was d e s c r i b e d  The f i r s t  as p o t e n t i a l  to discuss  interview  The study  portions.  If  identified  which  wished  provided  stages  of  battery,  the  ii) a  psychophysiological  they  were  completion  were p a i d $35.  free  to  of the  88 Neuropsychological by  a single  the  scan  Within  University  transport  procedures span  than  three  Columbia  radiologists.  by  was  the  highly  With  to completion  driven  Riverview and t h e CT  standardized  few e x c e p t i o n s  of testing  was  controls, a l lpsychophysiological  and CT s c a n n i n g the of  testing.  supervision  inpatients  These  using  t h e same  the schizophrenic  administration  first,  The  the less  p a t i e n t s . Both  of the rest  to  control  by  one  working  span  materials groups  followed  testing those group  neuropsychological  patients  hour  and t e s t  usually  identical  tested  technicians  a three  tests  for  were  Crockett. over  were  psychiatric  referred  testing  tested  t h e WAIS-R  The  individuals  o f D r . D.  typically  procedures  patients.  neuropsychological  given  the subject  were done u s i n g  recruitment  the normal  consisted  with  weeks  weeks.  with  break)  two  British  CT s c a n s  from  procedures  were  of  by h o s p i t a l  time  used  the next  Hospital  a week o f t h e d i a g n o s t i c  s e r v i c e where p s y c h o p h y s i o l o g i c a l t e s t i n g  were d o n e .  For  done a t R i v e r v i e w  examiner, u s u a l l y w i t h i n  interview. to  t e s t i n g was  by  of  under  i n this (with  a  two the  group lunch  as t h o s e  used  of subjects  were  a break  then  of the neuropsychological  and  battery.  89 RESULTS  The The  results of  first  ventricle the  section brain  t h i s study reports  ratio.  relationship  of  s u b s t a n c e abuse t o important the  to  assess  pertinent  lateral  effect as  the  they  major  s a m p l e and  ventricle  size, test  group  to  measures,  predicted  between patients reports square  values  the on  sample. with  one  tailed,  and  to  controls  test  or  section  between t h e  chronic  the  in  the  The  in  this  controls  neuropsychological  VBR, test  on  and  all  corrected  differences schizophrenic fourth log  section  root  t r a c k i n g , the  mean and  schizophrenic  section in  of  schizophrenic  mean  tests.  directional tests, between  measures  tracking  m e a s u r e s o f VBR,  presented  relationships  third  the  performance  It is  of  Bonferroni  eye  and  interpretation  and  i n  with  on  than  assess  of  variables  eye  As  utilized.  used  study.  The  pursuit  impaired  d e v i a t i o n  Correlations  hypothesized tracking  more  r e l a t i o n s h i p s among t h e  neuropsychological  affect  hypotheses.  neuropsychological  (LRMS)  concerned  subject  performance.  psychiatric the  is  hospitalization,  these  might  smooth  be  were  of  sections.  measurement  c o n t r o l g r o u p s on  1 - t a i l e d t - t e s t s are  probability  of  f o r comparisons  the  neuropsychological was  the  section  duration  assesses group d i f f e r e n c e s schizophrenic  for  in five  p r i n c i p a l measures i n the  the  to  second  age,  p r i n c i p a l measures  data  presented  reliability  The  the  are  are  accord  smooth  tested with  pursuit  performance.  the eye  Because  90 there  were  no  relationship result  specific  between  a  priori  any i n d i v i d u a l  about  was  made  by d i v i d i n g  number  o f r e l a t i o n s h i p s examined  there  were  corrected findings  10  related  =  .005.  battery  Means, s t a n d a r d  Table  size  7.  Finally,  a fifth  and e y e t r a c k i n g a c c u r a c y and  standard  tests  WAIS-R  IQ i s r e p o r t e d  Scale  analyses  tests,  Because  the Bonferroni section  f o rthe schizophrenic  neuropsychological  further  o f .05 by t h e  variable.  d e v i a t i o n s , and t - v a l u e s  Means  Full  f o r each  presents  within the  sample.  f o r t h e measures are displayed i n  deviations  are displayed  i n Table  i n Table  as i t i s r e d u n d a n t w i t h  test  Bonferroni  t o t h e r e l a t i o n s h i p s between t e s t s  neuropsychological  ventricle  t h e p-value  neuropsychological  p-value  the  neuropsychological  and t h e m e a s u r e s o f VBR and LRMS, an o v e r a l l  adjustment  of  hypotheses  f o r the  8.  Note  that  8 but n o t used i n  t h e WAIS-R V e r b a l and  Performance IQs.  Reliability The during  reliability measurement  chronic in  study.  comparing  o f over  Interjudge  the planimetry  indicating  randomly  measurement  200 CT  scans  was  measures A  a high  selected  reliability  CT  o f VBR  Pearson level  was  f o r two  correlation  were  participated obtained  of reliability.  scans  assessed  i n c l u d i n g t h e 30  and 29 n o r m a l c o n t r o l s who  f o r 25 CT s c a n s .  obtained 20  o f t h e VBR  schizophrenics  this  raters  o f VBR m e a s u r e  rank  by  independent of  .93 was  In addition  ordered  by  a  91 neuroradiologist Spearman  rank  ranking  order  to lateral  correlation  and t h e p l a n i m e t r y  providing VBR  according  an i n d i c a t i o n  Between  between  measure  the  o f VBR  size; the  neuroradiologists high  (r=.80)  o f the v a l i d i t y o f planimetry  obtained  as a measure o f v e n t r i c l e  Relationships  ventricle  was  size.  Duration  o f Hospitalization,  A g e and  S u b s t a n c e Abuse and t h e P r i n c i p a l Measures Despite  considerable  hospitalization (range  across  2 months  range  t h e sample  t o 113  correlated  used  study.  Duration  .02 w i t h  VBR,  i n this  correlated  r =  deviation. duration  Table of  r=.40,  individuals significantly  and  VBR  was  r  hospitalization between -.33  that  and  with  measures  LRMS  was  tracking between i n the  higher  some IQs.  any o t h e r  Scale  IQ was  of the Age  principal  older  was n o t measure.  age and LRMS was r = .01; between age  .08; a n d  was  sample  r =  between  .20.  age  and  The c o r r e l a t i o n  a g e and t h e 10 n e u r o p s y c h o l o g i c a l  t o .24.  was n o t  the tests  age and WAIS-R F u l l  t o have  between =  .30 w i t h  the correlations  i n this  correlated  correlation  patients  of hospitalization  and r =  displays  between  tended  The  variable  of  battery.  correlation indicating  this  any o f t h e p r i n c i p a l  h o s p i t a l i z a t i o n  neuropsychological The  10  with  duration  of schizophrenic  months),  significantly  i n total  tests  duration  of  coefficients ranged  from  In  order  substance  to  abuse  address  might  the important  have  a significant  effect  tracking  or neuropsychological  computed  t o compare t h e g r o u p o f p a t i e n t s w i t h  of  substance  abuse,  test  possibility  t o those  performance,  patients  history  o f substance use.  As m e n t i o n e d  patient  reports  information  were  difficult  with  respect  duration DIS is  and c h a r t  to evaluate. t o documenting  less  f o r assessing  difficult  to divide  groups,  one w i t h  charted  information)of  another  group  information, exposure  dependent  been  were often  glue  quantities  basis  poly-drug  of daily  f o r periods  never used  basis  o f weeks  into  two  report  and  abuse,  and  report  and  minimal  abusers  i n the  However, i t  or  chart or  no  i n this substance  use o f marijuana  f o r more t h a n  over  two weeks,  o f i n t o x i c a t i o n on a  t o months,  t h e group  drugs;  covered  Individuals  and many  classified  and a l c o h o l u s e , t h e r e  any i l l i c i t  actual  were two i n d i v i d u a l s who had  to the point  Among  section,  and  self  to patient  as s u b s t a n c e  on a d a i l y  alcohol  o r no d r u g  by  o r no  the case  sample  of i n d i v i d u a l s with  had h i s t o r i e s  abusers.  drugs  substance  or alcohol.  history  and d r u g u s e  particularly  (both  substantial  classified  shiffers  had u s e d  minimal,  was  evidence  drugs  were  had l i t t l e  the patient  according  consists  t-tests  and a l c o h o l u s e .  o f s e v e r a l months; t h e r e  several daily  which,  to i l l i c i t  who  periods  ample  eye  notable  on a l c o h o l  specific  drug  o n VBR,  i n t h e method  o f u s e f o r e a c h o f many i l l i c i t  sections  sample  This  who  that  were  two who had u s e d  as  five  were  having who had  marijuana, but  not  more  than  more  than  over  a  five  had  of  been  but  weeks  never  had  times;  times  period  group three  five  been  never  or  one  individual  period  of  six  months  several  years  seven  period  drinks  greater  at  of comparisons  a  least  one  had  had  basis  been  but  did beers  subjects  10  more  than  very  minimal  contradicted  by  differences  between  WAIS-R F u l l  chart  Scale  and  use  of  or  information.  There  these  f o r VBR,  groups  but  alcohol  never the  much for  histories  of  charts  denial  alcohol  was  eye  a  results  whose  were no  a  altogether  in their  subjects  drugs  once;  d r u n k as  extensive  and  interview),  use  6 presents  with  this  a week d u r i n g  week  (as r e c o r d e d  by  regularly  only  drinking  a  Table  or  not  a t some p o i n t s  evening  marijuana  drunk  s u b s t a n c e abuse and/or dependence confirmed  used  individuals in  stopped  months.  between 11  daily  d r u n k two  had two  had  Two  two  had  but  two  who  months.  and  than  on  occasionally  regularly;  as  three  drunk;  drunk  before;  and  of not  significant tracking,  or  IQ.  Group D i f f e r e n c e s The not  schizophrenic  differ  (see T a b l e  significantly  one  the  control  control  with  7 f o r means and  and  11.57).  of  patients  the  group  Three  of  mean the  group s u b j e c t s  to  c o n t r o l group  VBR,  t(57)=.39  None o f t h e  subjects  had  ( c o n t r o l group  schizophrenic had  normal  respect  SD's).  c o n t r o l group  and  a x  did  p>.l,  schizophrenics,  VBR  > 2 SD  +  2SD  is  a  patients  and  four  VBRs w h i c h were between 1 and  above VBR of 2  of the SD  94  Table 6 Means,  Standard  Deviation  Deviations  and t-test  In Eye Tracking  Values  and WAIS-R  Full  for VBR, Scale IQ  LRMS for  Schizophrenic Patients with Histories of Alcohol and/or IIII Icit Drug  Abuse  (n=11)  Compared with  Schizophrenic  Patients  with  Little or No Use of I l l i c i t Drugs and Alcohol (n=10)  Groups  5  Drug and/or Alcohol  Measure  VBR  (n-11)  Little or No Drug and/or Alcohol use (n-10)  Mean (SD)  Mean (SD)  t-value  6.99 (2.24)  6.83 (.57)  .228  2.33 (.26)  2.22 (.21)  .095  84.18 (9.44)  82.10 (8.68)  .053  LRMS deviation in eye tracking WAIS-R Full Scale IQ Note:  a  There are no significant differences between groups on any of the principle measures, all ps>.1, two tailed.  Groups were formed on the basis of information obtained from patient's charts and Interview on the drug and alcohol portions of the Diagnostic Interview Schedule.  95  Table 7 Means, Standard Deviations and t Values for VBR and Eye Tracking Accuracy for Schizophrenic Patients and Normal Controls  Groups  Schizophrenics (M=30)  Control (n=29)  Measure  Mean  SD  Mean  SD  t-value  Ventricle Brain Ratio  6.75  1.70  6.53  2.52  .39  Log Root Mean Square Error (LRMS) in Eye Tracking  2.23  .25  2.04  .14  3.62*  * p< 0.005, one tailed t test, df 57  96 above  t h e c o n t r o l group  of  9.05).  Figure  of  ventricle  subjects. and  mean  ( c o n t r o l group  1 i s a graphic  brain  ratios  display of the distributions  f o r the schizophrenics  I t i s c l e a r from t h i s  standard  x + 1SD i s a VBR  and c o n t r o l  f i g u r e t h a t t h e means,  e r r o r o f measurement  f o r t h e two g r o u p s  ranges  a r e very  similar. The  situation  tracking. less  7).  deviation  Figure scores  9 presents  means  of the schizophrenic S i x o f t h e 11 correction  schizophrenic psychiatric Test, the  group  Learning  o f t h e LRMS  and c o n t r o l s . of the  schizophrenic  of the psychiatric control of t-test  group.  c o m p a r i s o n s between t h e  s a m p l e and t h e p s y c h i a t r i c c o n t r o l  comparisons f o r multiple  were  significant  t-tests.  did significantly  Card  Sorting Test,  V i s u a l Retention  Test.  differences psychiatric  c o n t r o l group (see  less  The well  with  chronic  than the  c o n t r o l s f o r WAIS-R P e r f o r m a n c e IQ, t h e C a t e g o r i e s  the Wisconsin  Benton  right  the results  o f eye  significantly  representation  performance  Table  Bonferroni  evidenced  for the schizophrenics  to that  i n t h e case  t h e normal  2 i s a graphic  was compared  group.  group  eye t r a c k i n g than  Neuropsychological sample  different  The s c h i z o p h r e n i c  accurate  Table  i s quite  controls Finger  groups;  there  were  schizophrenic  d i d not differ Tapping,  Making  and t h e Rey A u d i t o r y  On 4 o f t h e t e s t s between  and l e f t  Test,  the T r a i l  no  Verbal  significant  patients  f o r WAIS-R  and Word F l u e n c y .  Test,  Verbal Table  8  and IQ,  97  Table 8 Means, Standard Deviations and Ranges (where available) for Neuropsychological Tests for Schizophrenic Patients, Psychiatric Controls and Normative Groups Reported in the Literature Groups Schizoprenlcs  Neuropsychological Tests  Mean  (SD)  WAIS-R Verbal IQ WAIS-R Performance IQ WAIS-R Ful1 Scale IQ Categories Test (errors) FInger Tapping - Right Finger Tapping - Left Word Fluency Test Wisconsin Card SortIng Test (errors) Trai1 Making Test total time for A and B (seconds) Benton Visual Retention Test with background interference procedure (errors)  87..13 80..37 82..13 43..27 45..67 41..73 32..23 49..17  (12.9) (9.2) (8.5) (13.4)  Rey Auditory Verbal Learning Test - total recal1 over 6 traiIs n=30,  a  b  n-21,  c  n=20,  d  3  Controls  Range  Mean  (6.9) (13.1) (16.8)  132-70 101-63 102-66 63-8 59-29 51-20 58-6 87-14  91.95° 90.67° 90.76° 28.00° 45.95° 40.37° 33.81° 30.18  191..07 (93.7)  562-85  9,.90  (6.9)  (4.4)  18-1  33..70 (12.5)  54-6  n=11,  6  (SD)  d  Norms Reported in L iterature Range  (14.8) 128-71 (15.4) 118-69 (14.6) 126-72 (16.0) 57-1 (7.3) 61-32 53-30 (5.5) (12.9) 67-9 71-8 (20.9)  129.24° (53.1) 284-61 4.36°  51.83  (2.8)  10-1  (10.1)  61-38  Mean (SD) 100 (15) 100 (15) 100 (15) 20.24 (9.5)9 46.7 (5.3) 43.2 (5.3) 33 (50% percentile) 24.9 (19.4)J f  f  f  h  h  86.3  k  Not avai table  69.3  1  n-6,  f Weschler Adult Intelligence Scale-Revised Manual (1981) 9 Norms for Victoria Revision of the Halstead Categories. 37.2 years, mean Full scale I.Q. 116. n  Labreche (1982). N = 50, mean age  Norms for Finger Tapping Test from control study by Lome Yeudall (1978), n=46, ages 26-30.  ' Taken from Spreen Aphasia, Edition A, within the profile, the 10th and a score  and Benton (1968), Neurosensory Center Comprehensive Examination for Profile Form A (Normal Adults). Scores are listed on a percentile basis a score of 33 falls at the 50th percentile while a score of 22 falls at of 49 at the 90th percentile.  J From Manual for Wisconsin Card Sorting Test, Heaton (1981) n=150. k Norm for Trail Making Test taken from Yeudall (1978) n=46, age 26-30. For comparison to the schizophrenic sample and psychiatric controls, times for the A form and B forms have been added together. ' From Lezak (1983). reported by Lezak.  The value reported is the sum of the means for the six separate trials as  Table 9  98  T-tests Between Schizophrenic Patients and Psychiatric Controls for the Neuropsychological Tests  Neuropsychological Test  t-value  Degrees of Freedom  Probabi1ity  a  WAIS-R Verbal IQ  1.20  49  p > 0.1  WAIS-R Performance IQ  2.74  49  p < 0.005*  Categories Test (errors)  3.57  48  p < 0.0005*  Finger Tapping - Right  .14  49  p > 0.1  Finger Tapping - Left  .77  49  p > 0.1  Word Fluency Test  .42  49  P > 0.1  Wisconsin Card Sorting Test (errors)  2.71  39  P < 0.005*  Trail Making Test - total time for A and B  2.99  49  P < 0.0025*  Benton Visual Retention Test with background Interference procedure (errors)  4.75  39  P < 0.0005*  Rey Auditory Verbal Learning Test total recall over 6 trials  3.84  34  P < 0.0005*  * Starred entries are significant with one tai led probab i1 ities as I isted in table. a  The t-tests are one tailed with Bonferronl adjustment for multiple comparisons.  Bonferroni  adjustment was made by dividing the p-value of 0.05 by the number of comparisons computed. Because there 10 neuropsychological tests, the Bonferroni corrected p-value = 0.005.  99 13.00  12.00  11.00  10.00  9.00  8.00  7.00  6.00  5.00  4.00  3.00  2.00  1.00  Schizophrenics  Controls  n=30  n=29  FIgure 1. Distribution of Ventricle Brain Ratios for Schizophrenic Patients and Volunteer Controls. Note 1.  The horizontal bars denote the mean VBR for each group while the lines above and below the bar indicate the standard error of measurement. Mean for schizophrenia Is 6.75, standard error is .305. Mean for controls is 6.53, standard error is .460 units.  100  2.9 2.8 2.7 2.6 2.5 2.4 2.3 2.2 2.1 2.0 1.9 1.8 1.7 1.6  Figure 2.  Schizophrenics  Control  n=30  n=29  Distribution  of  LRMS eye  tracking accuracy  scores for Schizophrenic Patients and Volunteer Controls. Note 1.  The horizontal bars denote then mean LRMS for each group while the lines above and below the bar indicate the standard error of measurement. Mean for schizophrenics Is 2.23, standard error of measurement Is .25. Mean for control group Is 2.04, standard error of measurement is .14.  101 presents for  t h e means, s t a n d a r d  the neuropsychological  control  group;  means  Relationships  Analyses  n o t confirmed.  the  schizophrenic  associated correlation  such  less  The c o r r e l a t i o n  larger  between  was  less  lateral  better  to  the  central  VBR  that  that  size  individuals  with  accurate between  than  eye VBR  zero  ventricle  eye t r a c k i n g a n d LRMS  ventricle  tracking,  and LRMS i n  ( r = -.34) and  size  tended  t o be  performance.  The  i n the volunteer  control  n o t s i g n i f i c a n t ( r = .18).  relationships  neuropsychological 10 shows  statistically  between  performance  the correlation  neuropsychological is  pertain  and N e u r o p s y c h o l o g i c a l T e s t P e r f o r m a n c e .  hypothesized  Table  i n E y e T r a c k i n g and  The p r e d i c t i o n  exhibit  sample  with  g r o u p was a l s o VBR  comparison.  be r e l a t e d ,  would  was  that  f o r normative  study.'  would  ventricles  indicates  f o r t h e s c h i z o p h r e n i c and deviations  section  a n d eye t r a c k i n g .  eye t r a c k i n g  o f scores  Performance  i n this  hypotheses o f t h i s  larger  for  and r a n g e s  Among VBR, LRMS D e v i a t i o n  Neuropsychological Test  VBR  tests  and s t a n d a r d  groups have been i n c l u d e d  and  deviations,  tests  the correlations  and  t h e Word F l u e n c y T e s t .  were  ventricle  supported  coefficients  and VBR. None  significant.  are  lateral  None o f t h e  by t h e d a t a .  between  o f these  T h e two l a r g e s t  t h e 10  correlations coefficients  b e t w e e n VBR and WAIS-R V e r b a l These c o r r e l a t i o n s  s i z e and  IQ, and VBR  are i n a  102  Table 10 Correlations  Between  VBR, LRMS  Tracking  Error,  Duration of  Hospitalization  and the  Neuropsychological Tests for the Chronic Schizophrenic Sample (n=30)  Neuropsychological Test  VBR  WAIS-R Verbal IQ  LRMS  institutionalization  a  .40  -.17  .08  WAIS-R Performance IQ  -.24  -.33  -.14  Categories Test (errors)  -.14  .37  .06  Finger Tapping - Right  -.22  -.02  .08  Finger Tapping - Left  .00  .12  -.11  Word Fluency Test  .32  -.28  .09  Wisconsin Card Sorting Test (errors)  .00  .19  .16  Trail Making Test - total time for A and B  -.03  .22  -.08  Benton Visual Retention Test with background interference procedure (errors)  -.02  .09  -.18  Rey Auditory Verbal Learning Test total recal I over 6 trials  -.06  -.05  -.01  Note 1:  No s i g n i f i c a n t  relationship  were  found  between  Institutionalization and any Neuropsychological Tests. correlations  between the neuropsychological  deviation and institutionalization hypotheses. a  D  test  are directional  VBR, LRMS  0  deviation  or  Tests of the significance of  battery  and VBR, LRMS tracking  one tailed  tests  as stated in  Bonferroni correlated p-value = .005  LRMS Is the log root mean square eye tracking error Institutionalization  was determined from the hospital  hospital for all recorded hospitalizations. month.  records by adding the time spent in  The final figure was calculated to the nearest  103 direction larger IQ  opposite to that predicted, i n that individuals  ventricles  scale  and  Eye None and  tended  to perform  Tracking  of  the  to  have  higher  b e t t e r on  and  Neuropsychological  hypothesized  12  shows  tracking  the  relationships  correlation  deviation  and  the  on  t h e Word F l u e n c y  n e u r o p s y c h o l o g i c a l performance  Table  scores  was  Performance.  between  eye  supported  by  tests  Verbal  Test.  Test  coefficients  10  the  with  tracking the  data.  between  which  make  LRMS  up  the  neuropsychological battery.  Correlations w i t h i n the Neuropsychological Test Battery A  ten  by  ten  redundant Pearson a  l a r g e number  Type  I  error  coefficients test  to  X  obtaining for  the  be  to  correlations,  is  an  zero.  equals  hypothesis.  the  by  the a  identity  For  11.  important  the  number  (1980)  which  2  to  of  value reject  matrix,  matrix  100.7  non-  With  such  of  consider  significant a  method  a of  special  (1980)  matrix 61.65  as  of  a means  with  of  Appendix 45  (df=45)  non-  (p<.05)  null  hypothesis  or  a l l correlations i n Table  are  case  the  displayed  to  i n a matrix  r a t e p r o t e c t i o n (see  case  X  a  45  to  provides  is  Steiger  error  required i n order  value obtained null  test,  wise In  containing  that a l l correlations  described  procedure) .  matrix  equal  This  is  to  Steiger  hypothesis  2  i t is  contributing  obtained.  matrix  i s shown i n T a b l e  correlations  experiment  redundant would  of  zero.  statistic  A  coefficient  as  the n u l l  equal  correlation  13  (p<.05), a l l o w i n g r e j e c t i o n  that  the of  are X  2  the  104 Table 11 Correlation Matrix of Neuropsychological Tests for Schizophrenic Sample (n=30)  1  2  3  4  5  6  7  8  9  VIQ  PIQ  BVRT  RAVLT  TAPR  TAPL  TMT  WCST  CA"  1) VIQ 2) PIQ  .25  3) BVRT  -.17  -.46**  4) RAVLT  .24  .09  -.15  5) TAPR  .05  .16  -.16  .33*  6) TAPL  .07  .02  -.011  .38*  7) TMT  -.28  -.36*  .55**  -.24  -.15  -.17  8) WCST  -.33*  -.47**  .08  -.25  -.12  -.19  .08  9) CAT  -.40*  -.23  .33*  -.23  -.07  -.19  .24  .42*  .15  .21  -.08  -.33*  .00  10) WF  .43**  .25  .00  .63**  Note. Abbreviations stand for the following  tests ordered from 1 to 10.  .08  VIQ = WAIS-R  Verbal IQ; PIQ = WAIS-R Performance IQ; BVRT = Benton Visual Retention Test, Form D, with Background Interference Procedure (errors); RAVLT = Rey Auditory Verbal Learning Test - total recall over six t r i a l s ; TAPR = Finger Tapping Right; TAPL = Finger Tapping Left; TMT = Trial Making Test total time for A and B (seconds); WCST = Wisconsin Card Sorting Test (errors); CAT = Categories Test (errors); WF = Word Fluency Test. * p > 0.05  one-talled, df = 28  ** p > 0.01 one-tailed, df = 28  105 Within  the matrix  significant  o f 45 c o r r e l a t i o n s ,  at a probability  significant  correlations  relationships  between  attainment  or  coefficients,  pairs  score  and t h e o t h e r The  R  prediction  Verbal  and  and L e f t  Learning  Test  remaining correlates  of tests an e r r o r  score  tests  Tapping  the T r a i l  Finger  Sorting are  Test,  three  less. matrix  2  tests  Fluency  are.  Test.  Making  and Word  Test,  test  correlations  equals  i s applied  zero  amoung  o f 31.4 i s compared  with  these  tests,  a tabled  X  2  IQ  Visual  tests  thought  (Finger  Tapping  Wisconsin  Fluency  hypothesis  the  Test.  Test,  of the n u l l  IQ  Performance  functioning  Trail  Verbal  t h e Benton  Sorting  Verbal  Scale, the  Sorting  Test,  Card  lobe  Test,  Although  Test)  significant at a probability  of correlations  redundant value  Left,  remaining  IQ  of s i x neuropsychological  Categories  correlations  either  Card  Making  to frontal  Tapping  the  by t h e d a t a .  with  and t h e W i s c o n s i n  When t h e X  attainment  and t h e Rey A u d i t o r y  the Wisconsin  Amoung t h e g r o u p  and  i s supported  with  Right,  IQs  neuropsychological  sensitive  i s an  b e t w e e n WAIS-  correlates  be  positive  of significant relationships  a n d t h e Word  Test  show  coefficients.  are not correlated  with  one  scored f o r  show n e g a t i v e  Test  to  f o r errors  A l l  consistent;  a r e both  i n which  Categories  Retention  which  scored  Finger  five  one t a i l e d .  are directionally  Performance  neuropsychological Right  o f .05 o r l e s s ,  two t e s t s  both  13 c o e f f i c i e n t s a r e  that  Card there  o f .05 o r the entire  t o t h e 15 n o n the obtained  X  2  (p>.05) o f 24.99  106 allowing Right  rejection  and  correlated Test,  Left  of the n u l l handed  hypothesis.  Finger  Tapping  a s a r e t h e Word F l u e n c y  and t h e W i s c o n s i n  Card  Among t h e s e  Test  are  tests,  significantly  and t h e T r a i l  Sorting Test  Making  and t h e C a t e g o r i e s  Test.  Summary o f R e s u l t s The  results  relationship  among  schizophrenic between  to  sample.  group  eye t r a c k i n g they  No  l a t e r a l  was  impaired,  accuracy  defined  i n the literature  control  group).  substance  found older  t o be  o f VBR,  performance. relative  from t h e c o n t r o l  p a t i e n t s had l a t e r a l  was f o u n d  of interest  None  s u b j e c t s tended Relationship conformed  WAIS-R  IQs and o t h e r  Although  the  controls,  the  above  respect  individual  enlargement t h e mean  as  of the  between d u r a t i o n o f h o s p i t a l i z a t i o n  with  WAIS-R  Full  measures. Scale  Age was  IQ s u c h  that  t o have h i g h e r IQ's.  among  battery  eye t r a c k i n g  group w i t h  of  a b u s e and any o f t h e p r i n c i p a l correlated  found  neuropsychological  ventricular  ( a VBR>_2 SD  i n the  were  to the  and on s e v e r a l  size.  the predicted  correlations  o f t h e measures  ventricle  No r e l a t i o n  t o show  measures  significant  d i d not d i f f e r  schizophrenic  or  failed  and n e u r o p s y c h o l o g i c a l  schizophrenic  tests,  study  the p r i n c i p a l  any c o m b i n a t i o n  accuracy  for  of this  the tests  to previous  i n the neuropsychological  findings of correlations  neuropsychological  measures,  between  indicating  that  the  neuropsychological  anomalous.  The  predicted  sensitive  to  frontal  supported:  of  15  frontal  lobe  relationship functioning  non-redundant  lobe tests,  only  finding  are among  not tests  was  correlations  not  entirely believed strongly  i n the matrix  t h r e e were s i g n i f i c a n t .  of  108 DISCUSSION  Group  Differences Before  three  principal  useful  measures  t o examine  control  the pattern  eye t r a c k i n g  significantly  Figure  2  impaired  This  literature  (e.g.  to the  of the distributions  r e p l i c a t e s many Holzman  group  t o t h e c o n t r o l group (see  f o r the schizophrenic previous  and  o f LRMS control  findings  e t a l . , 1974; I a c o n o  schizophrenic  significantly  less  schizophrenic  sample  made  tests  Card  abstracting  ability  these  have  trial  correct  i n the  e t a l . , 1982;  more  a memory  Card  on  Both  Sorting  group  The  these  Subjects  they  lobe Test  o f non-  schizophrenic  tasks  flexibility.  of items.  perform  on t h e C a t e g o r i e s  component.  the concept  to  s i x o u t o f t h e 10  9).  errors  Test.  sensitive to frontal  found  an age m a t c h e d  and c o n c e p t u a l  to t r i a l  Wisconsin  was  (see Table  Sorting  categorization  considered  than  significantly  Wisconsin  tasks  well  sample  psychiatric patients  neuropsychological  the  is  e t a l . , 1981). The  from  relative  i t  of the schizophrenic  relative  display  i n tracking  groups).  and  addressed,  o f impairments  performance  f o r graphic  deviation  Levin  c a n be m e a n i n g f u l l y  groups.  The was  t h e c e n t r a l i s s u e o f t h e r e l a t i o n s h i p s between t h e  must  these  function. has  been  assess  In addition,  are using  Both  Test  remember  to  obtain  tests are  P e r f o r m a n c e on repeatedly  demonstrated lesions  to  be  (Lezak,  impaired  1983).  in  patients  However,  p o o r p e r f o r m a n c e on  the Wisconsin  from  intellectual  a  variety  s a m p l e was the  slower  Trail  as  psychiatric task.  performance The  Tapping  Finger  controls and 8  groups  The  are  effort.  brain  in  completing  Lezak  damage,  (1983)  visual  and  involves The  relative  to  auditory  memory  an  significant  tests  tracking.  impaired  difference  schizophrenic  Verbal  did  IQ,  Further,  neither  not  Finger  Test  and  and  lack  patients  The  schizophrenic  which  visualmotor  group  Left.  and  attention  of  a  the  on  that  Fluency  trials.  of  patients  the  the  between  on  difference  would  simply finding  Word  WAIS-R  suggest  and  schizophrenics  Right  Left.  Test  cooperation between  that  the  to  note  or  the  to a normal  and  are  deficits  of  i n a t t e n t i o n or  that  schizophrenics  and  sample  Both  the  timed,  and  over  normals  the  Finger  interesting  artifacts the  from  Fluency,  Fluency  considerable  of  Word  differ  relative  Tapping  the  not  i t is  c o n t r o l s were i m p a i r e d  Tapping  require  was  a  result  neuropsychological  notably  both  there  The  can  out,  IQ.  Right  psychiatric  the  and  was on  Sorting Test  test,  lobe  (1983) p o i n t s  deficits.  presence  c o n t r o l s and  Table  Word  of  skills  controls  Card  This  schizophrenic  psychiatric  from  the  Lezak  frontal  psychiatric controls  one  sample  Finally,  psychiatric  areas  being  conceptual  schizophrenic  the  Test.  s e n s i t i v e to  visual  on  than  Making  characterizes most  of  as  with  repeated and in  both other  insufficient psychiatric  110 controls  do  Tapping, the  not  would  not  deficit Verbal  the  IQs  psychiatric  sample  groups  on  comprehend  other  patients  the  in  and  tests  general  respond  overview, shows  significantly  verbal  ability.  especially  (Categories  the  a  that not  fund  The  behavioral  similarities sample  to  be  knowledge  a  or  performance  on Test  pattern  The  from  the  of  sample  psychiatric controls the  schizophrenic  Retention the  (Benton  requiring  Wisconsin  visual  WAIS-R P e r f o r m a n c e IQ the  memory  Test  context  of  schizophrenic diffuse  tasks  of to  the  the  literature  patients  Rey  in  the  Auditory  would  be  in  Verbal  general  skills  are  and  Making T e s t ) ;  (Benton  this  characterized despite  d i f f e r e n c e s from p s y c h i a t r i c c o n t r o l .  in  subtests  Visual  Memory T e s t ) .  for  not  reasoning  most  Trail  battery  impairments  does  Sorting Test);  Test,  the  reviewed  relative  abstract  Card  Retention  s c a l e and  and  neuropsychological  significant  the  patients  responses  on  the  schizophrenic  impairment  schizophrenic  tests and  of  motor  and  and  ability  which r e q u i r e c o o r d i n a t i o n of v i s u o p e r c e p t u a l  the  in  function  tasks  on  by  d i f f e r e n c e s between  likely  of  evidenced  generalized  the  Finger  psychiatric controls  schizophrenic  However,  impaired  deficits  sample.  interesting  differ  the  and  to verbal i n s t r u c t i o n s .  the  an  Word F l u e n c y ,  to  to  are  psychiatric controls.  ability  that  schizophrenic between  IQ,  relative  c o n t r o l s suggest  differences  to  suggest  a t t r i b u t a b l e simply in  In  for Verbal  again  schizophrenic  are  two  differ  study, as  the  showing  some As  In  a  nongroup,  Ill schizophrenic tests;  on  patients  WAIS-R with  (Kolb  Whishaw,  tasks  both  requiring  functioning The  third  ventricle controls Figure  which  did l ) .  although  The  ranges  forward  with  a  in  and  this  to  study  1980s.  previous  reports  schizophrenics small  by  may  the  Smith of  patient  (1986) groups  ventricle  enlargement  constructional  are for  lobe was  variable  the  several  and  findings  in  are  in that  artifact  the the  control mean  s t u d i e s which was  of  6.75,  put  in  the  the  late  consistent to  detect  that  A  some in  unrepresentatively  of  failed  while  lateral  enlargement  groups.  VBR  the  patients.  suggests  ventricular  of  to  studies  conducted  (1986)  the  hypotheses  in schizophrenic  Iacono  of  mean  respect  to  (see  identical,  scores the  with  lateral volunteer  virtually the  motor  function.  normal  this  above  the  and  study  on  are  functions  r e p o r t s which have f a i l e d  h a v e b e e n an  f o r seven  and  this  research  lateral  report  lobe  s a m p l e and  to  However,  ventricular size  Iacono  in  lobe  t e s t s which  parietal  counter  v e n t r i c u l a r enlargement  communication  with  finding,  and  frontal  perceptual  cluster  runs  a number o f p u b l i s h e d  lateral  of  scores  negative  particularly  early  spatial  tendency  group  memory  significantly of  several  parietal  on  measure  enlargement,  literature, 1970s  is  This  on  schizophrenic  differ  distribution.  and  associated  not  on  and  integration  The  schizophrenic  ventricle  1980);  are  there  IQ;  temporal  principal  size.  impaired  Performance  associated and  were  14  Smith  and  schizophrenic to  find  studies  lateral which  reported overall  v e n t r i c u l a r enlargement mean  enlarged  with  reporting  positive  a  i n their  mean  Thus,  VBR  which  schizophrenic of  6.34  failed  sizes  schizophrenic assessed  patients.  group  practically  t h e 14 with  several  The s a m p l e  study  has a  groups  find  studies  mean VBRs  studies  h a s a mean  mean  VBR  f o r studies  VBR  not  o f 6.75,  o f 6.53.  which  and  of schizophrenic  i n d i s t i n g u i s h a b l e from those  (1986)  to  an  with  f i n d i n g s a p p e a r s t o be a f u n c t i o n o f t h e  i n the control  i n this  had  s a m p l e s had c o n t r o l  whereas  t h e d i f f e r e n c e between  and n e g a t i v e  ventricle  control  The s t u d i e s  sample  p o s i t i v e f i n d i n g s had c o n t r o l g r o u p s  3.95.  Iacono  o f 6.86.  ventricles  groups  of  VBR  in their  failed  These  i n the subjects  while  values  the are  reported  by S m i t h and  to find  ventricular  enlargement. A  question  negative subjects  which  findings used  previous  virtue be  i n this  research.  the to  consists  This  literature similar  First,  way  from  intact  samples  used  t h e s a m p l e was f o u n d t o  accuracy  institution.  institutions,  schizophrenic  n o t be an u n u s u a l l y  relative  using  of  to the  seems an u n l i k e l y e x p l a n a t i o n i n  of consenting  report  i n response  t h e sample  i n some s y s t e m a t i c  tests,  p u b l i c mental  raised  might  f o r eye t r a c k i n g  neuropsychological  large,  study  o f a number o f i s s u e s .  impaired  sample  be  i s whether  group, which d i f f e r s in  might  a number o f  to controls.  consecutive  Second, t h e  admissions  As s e v e r a l o t h e r  consenting  subject  and on  consecutive  to a  studies i n admissions  s e l e c t i o n procedures  should  not  account  for differences  Third,  although  average  accumulated  was  two  2  percent  and of  4  the  abuse  dependence. exclude  not  abusers,  from  abuse the  only  would  reasons  inclusion  increase the is  the  that  unrepresentative Neither  of  smaller ventricle  impaired  effect  summary, smooth  this  this  would  of  Thus aspect  subject young  i s there  extensive provided  or  that of  alcohol to  abuse  a  sample  substance  I n any  be  ventricular  in  case,  expected  to  enlargement  in  overall, of  the  there sample  variables,  make  institutionalized any  particular  indication  sample  would  that bias  sizes. s c h i z o p h r e n i c group  pursuit  significantly  history  some  twenty  o f substance  suggest  at a l l .  or p a r t i c u l a r  schizophrenics.  In  perform  of finding  any  characteristics  toward  individuals  suspect  procedure,  sample  chronic  to  a  spent  t o attempt  u n r e p r e s e n t a t i v e sample.  these  i f i t has  reason  selection this  of  very  the l i k e l i h o o d  sample no  a  without  the  years  sample  be  good  and  of  f o r drug  high prevalence  of individuals  be  the  had  4  treated  among y o u n g c h r o n i c s c h i z o p h r e n i c s w o u l d composed  than  histories  excluded  35,  f o r t h e sample  subjects  more  others.  of  institutions,  with  t h e r e may  and  t h e age  the  spent  specifically  Although  substance  had  individuals  were  been  Half  i n mental  sample  substance  not  months.  years  Finally,  had  study  duration of hospitalization  hospital.  they  this  a l l s u b j e c t s were u n d e r  years,' n i n e  between  between  less  eye  tracking  well  then  was  found  performance  psychiatric  to  have  and  to  controls  on  several  neuropsychological  consistent  with  hypothesized findings did  normal in  lateral  volunteer  controls.  both  ventricular that  positive  the present  Among  Neuropsychological principal  relationships  and n e g a t i v e was  VBR,  Test  that  measures such  negative  measures.  samples  None  finding i s  f i n d i n g s o f more  studies that  have  Thus,  while  n e i t h e r would  i t be  ventricles  than  many  of schizophrenic patients.  LRMS D e v i a t i o n  i n Eye T r a c k i n g ,  and  Performance  purpose o f t h i s  study  was t h e i n v e s t i g a t i o n ventricle  and n e u r o p s y c h o l o g i c a l t e s t  of chronic there  with  to the  and t o a p r o p o r t i o n  findings.  n o t found,  schizophrenic  would  t h a t low a t t a i n m e n t  associated  sample  relative  among t h e m e a s u r e s o f l a t e r a l  t h e group  research  f o r t h e sample o f p a t i e n t s i s  sample has s m a l l e r  t r a c k i n g accuracy,  hypothesized  be  this  are  impairment  previous  i t i s consistent with  enlargement  Relationships  within  greater  enlargement  hypothesis  T h e a v e r a g e VBR  findings  The s c h i z o p h r e n i c  Although  the previously reported  The  of  t o t h e mean VBRs f o r many c o n t r o l l e d  obtained  said  These  with  samples.  ventricular  literature,  studies.  similar  eye  and  c o n t r a d i c t i o n t o the study  recent  of  study,  i n schizophrenic  of previous  of  the predictions  i n this  n o t show  tests.  low  be  performance  patients.  correlations  of the predicted  on  each  of  relationships  I t was  between  on one m e a s u r e w o u l d  attainment  size,  the  tend t o  the  between  other VBR,  115 eye  tracking  in  this  found  study.  VBR found  o r any o f t h e n e u r o p s y c h o l o g i c a l t e s t s were  and eye t r a c k i n g .  between  variables  these  No  measures.  significant relationship The c o r r e l a t i o n  between  was  these  was l e s s t h a n z e r o and i n d i r e c t i o n o p p o s i t e t o t h a t  predicted. There  are  two  studies  relationship  between  (Weinberger  and W y a t t ,  findings a  between  Both  to  investigatory  project.  found  Wyatt  ventricles  while  had d i s o r d e r e d  the patients,  for  group.  each  sample  (n = 18)  64%  watching  which  respect  was  make  to the  size.  based selected  The on  an  on t h e  (a r a t i n g g r e a t e r  of the patients  nor give  and u s e d  pendulum.  Unfortunately  than  3 on a  with  large  t h e y do n o t  an i n d i c a t i o n o f t h e mean VBRs  et a l .  a rather  and l a t e r a l  a swinging  w i t h n o r m a l v e n t r i c l e s had  tracking.  The B a r t f a i  both eye t r a c k i n g  impaired  and " n o r m a l " v e n t r i c l e s , were g i v e n an  eye t r a c k i n g  describe  flaws  with  report  30% o f t h e p a t i e n t s  scale),  and  and v e n t r i c u l a r  (1982)  task which i n v o l v e d  that  size  Two g r o u p s o f p a t i e n t s  "large"  markedly disordered point  the data  eye t r a c k i n g  and  tracking  ventricle  have m e t h o d o l o g i c a l  interpret  between  o f having  large  studies  Weinberger  5  tracking  t o be s u g g e s t i v e o f  association  They  and e y e  the  were t h o u g h t by t h e i n v e s t i g a t o r s  d i f f i c u l t  eye  size  assessed  e t a l . , 1985); t h e  tracking.  basis  ventricle  have  1982; and B a r t f a i  relationship  it  lateral  which  (1985)  study  unsophisticated  ventricle size.  had a  small  measures o f  They  found  few  116 patients  with  horns, most  evidence  but they  impaired  than  concluded  trackers  patients  association  of enlarged  there  t o have  with  between  that  better  lateral  lateral was  a larger  a tendency  f o rthe  tracking.  ventricle  size  when  ventricle  size  horn  Their  s i g n i f i c a n t when t h e y  correlated  anterior  anterior  was n o t s t a t i s t i c a l l y they  ventricle  and  index  finding eye  of  tracking  compared  groups o r  and e y e t r a c k i n g  ratings  ( r = . 3 5 , d f = 1 5 , n o t s i g n i f i c a n t a t 0.05, o n e t a i l e d ) . The size  possibility  and e y e t r a c k i n g  cannot  be c o m p l e t e l y  schizophrenic relative  that  relationship  ruled  sample  out.  showed group.  enlargement  are associated  demonstrate  the relationship.  the schizophrenic  group  ventricular  size  samples  schizophrenic  of  that  then  having  The  i n this  ranges  and  approximately believe to  that  demonstrate  study  i n this  a true  ventricular f a i l  however, study  who,  enlargement.  did exhibit  found by  to  be  noted  a  mean  has  i n other  virtue  sample  relationship  The  eye t r a c k i n g f o r VBR  Therefore,  particular  i m p a i r m e n t and  would  to that  i n the  of  samples have been l a b e l e d  d i s t r i b u t i o n s  normal.  this  I t should,  study  enlargement  when  study  patients,  significant ventricular  patients  only  this  i s comparable  comparison with d i f f e r e n t c o n t r o l  by t h i s  ventricular  I f eye t r a c k i n g  i s extreme,  ventricle  None o f t h e s u b j e c t s  lateral  enlargement  that  between  e x i s t s , b u t was u n d e t e c t e d  to the control  ventricular  a  there would  and i s no  group  as of  impairment. LRMS reason  be any l e s s  are to  likely  between v e n t r i c l e s i z e and  117 eye t r a c k i n g  than  whom m e a s u r e s In larger  other  samples  of ventricular  summary, t h e r e was lateral  relevant  found  more p a t i e n t s  than  that  did patients  failed  to  Although  show  with  a  felt  a  do  not  strong  as a p p l i e d show  concluded  that,  any  very  this  on  ventricles  the  two.  find  the  of  extreme  argument  i s not  of the  present  who,  as a  enlargement.  It  in a  group, can  sample  be with  emerge, i t i s c l e a r l y n o t t h e c a s e t h a t  bad  eye  associated  relationships  involved  with ventricular Test  was  relative  not  between  to  VBR  the  and  (see Table of  There  to  control  have  and  on  10).  this  finding  eye  this  are  previous  tracking.  abnormally  group,  were  performance  i n some d e t a i l i n t h e  between VBR  found  enlargement.  Performance.  in discussion  the r e l a t i o n s h i p  sample  study  eye  s i m i l a r to those discussed  section  to  absence  a correlation  Neuropsychological  issues  failed  that  poorly  other  between  patients  i t i s possible  of the neuropsychological tests The  The  this  study  and  i s causally  significant  One  between VBR  tracking  no  the  The  tracked  to the v a l i d i t y  ventricular  enlargement  might  and  to  to schizophrenic  tracking  VBR  due  i n the p a t i e n t s ,  although  more v e n t r i c u l a r  ventricles  study  between  tracking.  i s small.  relationship  this  challenge  extreme  eye  ventricles.  that  enlargement  impaired  large  for  available.  relationship  significant  ventricular  findings  and  small  relationship  patients  significant relationship  with  i t i s possible  be  no  to t h i s  predicted  to  s i z e are  ventricles  literature  of schizophrenic  As  enlarged  investigation  118 is  not  large as  able  to  address  v e n t r i c l e s on  was  pointed  sample  showed  several  other  reported that  out  in discussion  lateral studies  sample  span  the  tests.  means  it  seem  that  study  to  particular true  for  in  the  8)  no  than  in  range  have  number  ranges of  of  scores a l l the  controls  into  as  indications  show t h a t  reason  between  performance  a  psychiatric  this  which  clear  the  However,  same  on  above i s s u e s is  abnormally  tracking,  patients  Table  less likely  r e l a t i o n s h i p  eye  There are  both  there  be  and  Examination of  Taking the  neuropsychological one  o f VBR  (see  of  performance.  impairment  patients  norms.  effect  schizophrenic  exhibits  literature would  the  ventricle sizes of  schizophrenic  ranges  a  of  v e n t r i c u l a r enlargement.  the  the  issue  neuropsychological  neuropsychological for  the  and  consideration,  to  others  expect to  v e n t r i c l e  schizophrenic  this  demonstrate s i z e  and  patients,  i f  exists. Examining  between  the  lateral  performance  ventricle  suggests  between c o g n i t i v e studies  only  size  which report functioning  Golden  et  al.  in  Johnstone  the are  (1980a and et  al.  related and  and  support  lateral  strongest  1982). (1976)  The  which  content  a  to  association  an  association The  b e t w e e n VBR  and  a l . (1976)  a v e r a g e VBR  the  test  ventricle size.  (n=18) s t u d y was  in  for  those of Johnstone et  functioning  similar  the  association  measure o f c o g n i t i v e is  to  neuropsychological  moderate  functioning  cognitive  the  literature  was  for  and  patients  18.7.  The  Withers-Hinton  scale,  neurological  mental  state  exam.  These i n v e s t i g a t o r s  ventricle report much  size  by  sample  on  described  in  in  1976  1985  scores.  (Owen e t  (although  the  the  a c o r r e l a t i o n of  Withers-Hinton  t h i s r e s e a r c h group  larger  reported  and  found  i t  study  paper)  a  relationship  between W i t h e r s - H i n t o n  size.  papers  other  Both  research.  reported  in  techniques The  It  their  which  Withers-Hinton show  a  functioning report  are  from the  Luria  method, using  only  VBR.  and  and  found  of  Nebraska),  those  a sizable  between  reports lateral  and  which  VBR  which  VBR  studies. size  other  between and  the  Luria  eight  and  14  They  scales  scales of  from their  calculated  significantly correlated the  There  failed size  to  and  and  studies  1982).  c o e f f i c i e n t s were  functioning.  ventricular  sizes  measurement  description  study,  to  neuropsychological  ( f o r VBR  present  have  curvilinear  from  two  VBR  the  group  ventricle  (1980a and  (for  to  the  compared  most  and  al.  0.76  subjects  ventricular  The  a  ventricular  Golden  correlational relationship  neuropsychological  published  0.72  correlation  the  in  coefficients  According  scales  unlike  between  Golden et  VBR  the  used  between  and  derived  puzzling.  correlation  multiple  Thus,  studies  is  are  of  findings  that  those  relationship  Nebraska).  the  from  those of  Battery  likely  the  significant  anomalous  study  relationship  multiple  Luria  first  scores  Nebraska  the  seems  differ  curvilinear  which  present  recent  which uses  part  scores  between  more  that  also  found  A  a l . , 1985)  appears  are  -.70  are  find various  with  et  between  at  least  al. VBR six  relationships measures  of  120 cognitive  functioning.  consistent  with  size  the majority  and c o g n i t i v e  would  The  benefit  from  replicated  i t may  author,  variations Battery  have  used  sensitive  some  to  size,  special  the effects  Tracking  performance  an  would  between  for this  study  findings  be  make  to  Nebraska i t very  enlargement  on  suggest  involve  that  an  indicant  of  schizophrenics.  disruptions  Performance.  eye t r a c k i n g  a c c u r a c y and  tests  proposed eye  One p a t t e r n  association  two  eye t r a c k i n g  "diffuse"  believe  brain  alternative and  which might  have  o f eye tracking  with  tests.  impairment might  deficits,  (see Table  tracking  of the neuropsychological  neuropsychological  both  Test  between  performance.  on many  investigators  that  group  including the  which  of ventricular  f o r relationships  impairment  global  a  the Luria  on any o f t h e n e u r o p s y c h o l o g i c a l  neuropsychological  would  their  and N e u r o p s y c h o l o g i c a l  The h y p o t h e s e s  emerged  by  are insensitive  and t h a t  qualities  T h e r e were no r e l a t i o n s h i p s  forms  which  ventricle  functioning.  Eye  10).  Should  are  o f Golden e t a l .  investigators,  tests  study  on l a t e r a l  replication  group.  that  in ventricle  has  cognitive  imply  this  The f i n d i n g s  systematic  o f t h e Nebraska  of  of research  functioning.  independent  present  results  and h e n c e ,  This  be r e l a t e d t o  might  dysfunction,  s e r v e as  which  some  t o be a c h a r a c t e r i s t i c o f a s u b g r o u p o f  On t h e o t h e r hand, some i n v e s t i g a t o r s  eye t r a c k i n g of frontal  impairment lobe  and s c h i z o p h r e n i a  functioning.  I f this  believe involve  were  t o be  121 the  case,  one  might  have  be  particularly related  in  the  expected to d e f i c i t s  neuropsychological  patterns  eye  test  tracking  on  the  battery.  is  little  previous  and  al.  between  in  ( 1985)  found  which  1982)  study.  not  Holzman to  m e a s u r e s and  would  eye  the  measure  on  of  relative  to  approximately  the  Subject The duration  —  and  the  tests  of  these  relationship  tracking. eye the  B a r t f a i et  tracking Trail  were n o t  Cegalis  and  and  Making  two Test  replicated  Sweeny  significant correlations  (1979,  between  IQ  proficiency.  hypothesis  that  impaired  tracking,  eye  tracking  on n e u r o p s y c h o l o g i c a l t e s t s there  was  neuropsychological  controls.  subjects Given  no  concordance  measures  were  the  and  impaired  score  on on  ranges  was for the both and  n o r m a l d i s t r i b u t i o n s f o r most o f t h e m e a s u r e s i t  seems i m p r o b a b l e systematic  (1974)  Although  eye  study  to impairment  confirmed.  eye  on  These f i n d i n g s  tracking  related  impairment  the  find  summary,  be  in this  Tapping-Right.  failed  In  correlations  were u s e d  Finger this  Neither  research  between n e u r o p s y c h o l o g i c a l t e s t s  and  f r o n t a l lobe  to  emerged.  There  tests  impairment  that  the  relationships  data  analyses  i f they  were  would  fail  to  uncover  present.  variables possibility  of  confounding  of i n s t i t u t i o n a l i z a t i o n ,  principal  measures  was  relationships  substance  a b u s e , and  examined.  There  between age were  and no  122 s i g n i f i c a n t  c o r r e l a t i o n s  institutionalization neuropsychological for  approximately  a n d VBR,  tests.  Past  one t h i r d  group  with  of substance  little  o r no d r u g  o r WAIS-R F u l l in  Scale  t h e study;  .40.  particular  tracking is  was  impaired  patients  sample  the older  IQ's measured  test  This  performance.  suggests slowed  (ie.  patients  both  significant  were  s p e e d and  test  of verbal  the schizophrenic  i n e i t h e r motor -  on e y e  However, i t  o f motor  that  responses  o f which sedation  occur i f (Heaton  &  1981).  Correlations within the Neuropsychological  the  tended t o  effects  o r on a t i m e d  responses  are causing  one v a r i a b l e  i n t h e group.  the schizophrenic  Tapping),  of verbal  eye t r a c k i n g ,  subjects  f o r medication  that  were n o t a b n o r m a l l y  medications  of ten patients  IQ and a g e were c o r r e l a t e d  t o n o r m a l s on a t e s t  (Word F l u e n c y ) .  production  Crowley,  t o note  (Finger  and a g r o u p  Scale  control  relative  coordination fluency  T h e r e were no d i f f e r e n c e s between  or neuropsychological  interesting  not  or  no  abuse,  i s not believed to  Age was r e l a t e d t o o n l y  Full  o f  age o r any o f t h e  history of substance  abusers  IQ.  h a v e some o f t h e h i g h e r There  d u r a t i o n  o r a l c o h o l u s e f o r VBR,  WAIS-R  In this  LRMS,  o f t h e sample,  have a f f e c t e d t h e f i n d i n g s . the  between  The  pattern  o f p o s i t i v e and n e g a t i v e  test  battery  are d i r e c t i o n a l l y  attainment  v s . e r r o r scored  Test  Battery  correlations within  consistent  with  scoring  t e s t s produce c o r r e l a t i o n s i n  123 the  expected  between  directions).  five  individual scales  T h e r e were s i g n i f i c a n t  o f t h e non-IQ  tests  tests  consistent  abilities  t h e s e t e s t s measure.  Retention  Test  and t h e T r a i l  both  IQ.  These  two  which  to the Performance  Test)  Verbal  IQ.  correlate  performance,  (Categories  and t h e v e r b a l  with not  tests  with  Tests  fluency  The f a c t IQ  theories  Test  and m o t o r  of the  that  tasks  IQ  score.  (Word  a  tasks  Conceptual Card  Fluency)  which  Sorting  correlated  Tapping  finding  with  involve  a s do s e v e r a l  the Finger  i s also  Visual  correlate  and W i s c o n s i n  test  The  w i t h t h e two IQ  Making  IQ and n o t V e r b a l  contribute  with  scales.  F o r i n s t a n c e t h e Benton  visuoperceptual  reasoning  t h e IQ  w h i c h do and do n o t c o r r e l a t e  a r e , i n t h e main,  Performance  and  correlations  Test  does  would  be  expected. Demonstrating useful, of  indicating  t h e expected  tests  that  were  actively  the subjects'  performance  samples.  a t the time  precluding  relationships  tests  i t unlikely  that  failure  other  m i g h t be  some these  i n this were  highly  between t h e  measures.  i n the battery  o f the c o r r e l a t i o n to find  among  o f whom  relationship  tests  shows  I t i s conceivable  individuals  and  between t h e v a r i o u s  o f the directions  many  of testing.  any s y s t e m a t i c  neuropsychological  found  sample i s  The s u b j e c t s  i n s t i t u t i o n a l i z e d patients  psychotic  consistency  i n this  inter-correlation typically  the t e s t performance o f these  erratic,  makes  relationships  i n many d i f f e r e n t p a t i e n t  study  that  these  The and t h e  coefficients  relationships  between  124 neuropsychological to  erratic  sufficient  the consistency  to rule  behavior,  More  lobe  the  frontal  The f a c t  between  these  First,  several  i n these  is  possible  dysfunction hence,  that  lobe  integrity  possible  not  be  involve  the result  of  designated  as  complex  to the frontal  there  measuring  are sensitive  tests.  a  to d i f f e r e n t  lobes,  specific  covergence  As no o b j e c t i v e  i s available  f o r these  frontal  sensitive to  and  therefore  Finally, i t frontal  who p a r t i c i p a t e d i n t h i s t o expect  hence,  i t i s highly  are not equally  i s not  cognitive  lobes;  Second,  of the frontal  stronger  lobe  s t u d y and  o f performance  criterion  of frontal  subjects,  i t i s not  t o c h o o s e between t h e above a l t e r n a t i v e s .  Finally are  i s not a  to intercorrelate highly.  i s no r e a s o n  among t h e f r o n t a l  or  sensitive to  of the tests  to  tests'  i n the subjects  there  there might  patients.  functioning,  n o t be e x p e c t e d  tests  n o t be s p e c i f i c a l l y  aspects o f the functioning should  that  tasks  a r e known  the 'frontal  lobe  invalid  function.  t e s t s ' may  that  or  t o be  between  functioning  likely  i s thought  expected  which a r e not e x c l u s i v e  'frontal  lobe  i n responses  was  tests'  functions  by t h e p a t i e n t s .  c o r r e l a t i o n s d i d n o t emerge.  factors.  'frontal  i s due  expected  relationship numerous  measures  o u t t h e l i k e l i h o o d o f random  several  covariation  frontal  and t h e o t h e r  o r random t e s t b e h a v i o r  Although  test  performance  i t i s noteworthy  s i g n i f i c a n t l y  standardization  sample  that  Verbal  and P e r f o r m a n c e IQs  correlated. of  300  subjects  In  the  age  WAIS-R  25-34,  the  125 correlation this  sample  control Verbal The  between i t is  group IQ  low  .25.  comparison  did  signrficantly between  impairment  of  Performance  consistent  In  Performance  schizophrenic  correlation  depression  and  the  but  selective WAIS-R  Verbal  of  Scale.  with  the  sort of  less  the  IQ  was  not  on  pattern  in IQ.  reflect  assessed of  by  a the  significant  to  found  differ  may  abilities  impairment  In  Performance  scales  relative  .76.  the p s y c h i a t r i c  do  well  two  The  Performance  with  patients  the  some o f  IQ  Verbal  IQ  in diffuse  is  brain  damage.  Statistical The using  Issues  analyses  multiple  examination test  Bonferroni the  most  other  appropriate  relationships  in  literature  the  relatively a  well  In  approach any  small,  developed  accord  with to  a  and  in  this  correlations. the  for  a  relatively  values. study  were  measures.  base  i t seems error.  for  advisable  This  This  significant Examining the  study  the  many  the  linking use  failed  seems inter-  Further,  the  measures  is  does not the  have  measures.  a  conservative  to  demonstrate  relationships correlation  against  approach  sample.  to  for  done  examining  small  conducted  Except  i n c o n s i s t e n c i e s , and  theoretical  I  were  neuropsychological  comparisons  probability  contains  this  Type  multiple  one  study  r e l a t i o n s h i p s between  statistically  principal  data  inter-correlations in  corrected  on  the  t-tests  of  battery,  of  among  the  t a b l e s makes i t  126 clear  that  data  there  are related  s l i m margin. the  VBR  In fact,  eye  p-value  correlated  -.3 3  correlated  .37  investigation tracking sort  of battery  eye  do  would  significance  by a  Of t h e twenty  the neuropsychological  two  one  would  tailed  be  significant  The  and n e u r o p s y c h o l o g i c a l  test  provide  be p a r t i c u l a r l y  eye  related  patients.  convincing  measures s h a r e  of the  p e r f o r m a n c e , as  The  two o f t h e n e u r o p s y c h o l o g i c a l  not  i s  Test i n  o f u s i n g VBR,  o f hypotheses  of schizophrenic  at a IQ  purpose  the p o s s i b i l i t y  for investigation  tests  (Performance  tracking).  t o assess  p e r f o r m a n c e on t h e s e either  eye  between  tracking  that the  e y e t r a c k i n g and t h e C a t e g o r i e s  subgrouping  relationships  between  .05  with  was  but miss  would n o t change.  tracking, of  accuracy,  biological  of results  with  t o suggest  were t h e B o n f e r r o n i p r o c e d u r e n o t u s e d ,  coefficients  and  liberal  a  as h y p o t h e s i z e d ,  interpretation  correlation and  a r e no c o n s i s t e n t t r e n d s  to  weak  t e s t s and  evidence  that  a common e t i o l o g y , o r t h a t  useful to p r e d i c t the  occurrence  of the other. Conclusion. study  that  There  lateral  i s no  indication  ventricular  enlargement,  impairment,  and n e u r o p s y c h o l o g i c a l  group,  a useful  form  subgroup  of chronic  from  test  s e t o f measures schizophrenic  the  present  eye t r a c k i n g  deficits  would,  as a  for identification  of a  patients  for further  research. The as  sample  predicted.  d i d n o t show In  light  lateral of  ventricular  t h e most  recent  enlargement research  127 literature,  significant  schizophrenics suggested. third  ventricle,  ventricle  were  not  group scores a  was  so  on  The  that  in  measures  in  Third  i n both  impairments  hampered  on  of  This  impairment  of  is the of  to preclude the demonstration  of  and  the  a  by u s i n g  both.  that  eye  ranges  interpretation  neuropsychological  these  i t may  of  be  and  hence  their  exists,  that  variables  t h e sample the  of  the  performance  i s unrelated in  that  had  sample  with  of  these  be  in  this  measures been  are  of  attainment  found  to  be  on  both  related.  study  is a  related group.  eye  applied  schizophrenic patients,  abnormal  would  in this  measures  co-occurrence  n e u r o p s y c h o l o g i c a l performance  individuals  1985).  these  was  appear  parsimonious  on  the  patients.  virtue  heterogeneous  the  most  performance  itself,  possibility  as  that  measurement  impaired  i t does n o t  findings  abnormal  deficits  that  variables  in  report.  showed  be  are  al. ,  Despite the o v e r a l l  tracking  Nonetheless,  and  might  restricted  eye  schizophrenic  subgroup  earlier  suggesting  et  in this  excessively  both measures,  were  be  are  enlargement  ventricles,  sample  It  t o be u n l i k e l y .  findings  simple  analyzed  present  than  Boronow  b e t w e e n t h e s e two  relationship.  would  lateral  (e.g.  related.  which  on  common  n e u r o p s y c h o l o g i c a l performance,  relationship  thought  the  not  the  and  sample  not  s i z e was  less  ventricular  investigators  patients  Although tracking  be  Several  schizophrenic  a  may  lateral  would  The  tracking  to a  by  a  broadly  subgroup emerge  Further  of and  research  128 along  these  it  would  of  clinical  may  be  l i n e s m i g h t be u s e f u l .  be a d v i s a b l e  parameters than  that  subject  links  factors  which  schizophrenia. patient  group  covary  with  These  l i t e r a t u r e .  illness. change be  study,  L o n g i t u d i n a l  deficits  interesting  to  deficits  assessments  earlier  i t appeared  performance  neuropsychological follow-up  participated  others  over  i n this  investigate  o f both  f u n c t i o n i n g were c a r r i e d o u t .  deficits  reported  study  clinical  of  of  their little  I t would  the prevalence  and  in  had b e e n  had b e e n  o f years.  episode  in  interesting.  i n the course  a period  in first  about  i n v e s t i g a t i o n  that there  by  i n the chronic  w o u l d be p a r t i c u l a r l y  assessed  I n some c a s e s  i n their  very  who  It  study.  i s known  exist  and i n many  study.  i n this  information  clearly  range  are mediated  neuropsychological  deficits  i n this  neuropsychological^  i n this  w h i c h went u n m e a s u r e d specific  Some o f t h e p a t i e n t s  on a w i d e r  the variables  little  neuropsychological  information  were c o n s i d e r e d  between  characteristics  Finally,  the  to collect  Were s u c h work t o be done,  patients  of  on whom  neuropsychological  129 REFERENCES Adams, R.L., B o a k e , C , & C r a i n , C. 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Changes on computed c r a n i a l t o m o g r a p h y w i t h a g i n g : Intracranial f l u i d volume. A m e r i c a n J o u r n a l o f N e u r o r a d i o l o g y , 3, 111.  138 APPENDIX A Testing the Identity Matrix The overall  calculation null  identity  of  hypothesis  matrix  the  X  that  value  2  a matrix  i s done w i t h t h e X  =  2  Hypothesis used of  in  testing  correlations  the  is  an  f o l l o w i n g formula:  (N-3)  Zij  2  j<i where Z i j  are the  2  the  non-redundant  N-3  corresponds  freedom  for  squares  correlation  to  the  the  the  case  of  value  f o r the X  of  with  X  2  45  2  are  This obtaining  method  of the squared  i s 100.7.  t h e r e f o r e the n u l l  is  of  The  and  degrees  number  of  45  of non-  When  this  freedom can  i s proposed wise e r r o r  by  for  transformations this  sample)  value  the  is  obtained  to a tabled  (p=.05) w h i c h e q u a l s be  the  non-redundant  Fisher Z  3.73. in  coefficients  T h i s i s compared  hypothesis  experiment  the  matrix  matrix.  (N-3 = 3 0 - 3 ,  degrees  are  there  sum  N-3  value  battery,  correlations  by  3.  of  for  multiplied  minus  matrix  The  45  2  i n the  size  10x10  correlations. these  X  i n the  the  neuropsychological  coefficients  sample  critical  redundant c o r r e l a t i o n s In  of the F i s h e r Z transformations f o r  value  61.656,  rejected.  Steiger  (1980)  rate protection.  as  a  way  of  APPENDIX B l MARKERS AND PREDICTORS  (MAP) PROJECT CONSENT FORM  Investigators: William  G. I a c o n o , Ph.D.  Karen Tallman, B.Sc.  C o n s e n t t o be A  interviewed:  research  project  physiological  records  I  that  understand  study  they  because with  t o my  treatment  the  purposes  $5.00 the  project  will  interview  i s c a r r i e d out  needs t o c a r e f u l l y  of this  withdraw present In  from  project  study.  the interview  signing  this  t o my  I understand  that  whether  I also  will  only f o r be p a i d  I am s e l e c t e d f o r  without  that  I may  prejudice to  and t r e a t m e n t . form  I hereby  acknowledge  receiving a  c o p y o f my own u s e .  Witness  be  obtained  I will  understand  a t any t i m e  people  t h e r a p i s t (or  c o n f i d e n t i a l and u s e d  or not.  and f u t u r e c a r e  that  Otherwise a l l the information  a t t h e end o f t h e i n t e r v i e w  research  select  Information  may be c o n v e y e d  be k e p t  t o me.  i n the research  o f problems. ).  this  testing,  i s included  This  project  to in  anyone  are interviewed.  the research  psychological  and a CAT s c a n h a s b e e n d e s c r i b e d  before  c e r t a i n types  helpful  involving  Signature  Print  Name  Date  140 APPENDIX MARKERS AND PREDICTORS  B2  (MAP)  PROJECT CONSENT FORM  Investigators: W i l l i a m G.  Iacono,  Ph.D.  Karen Tallman,  The in  has  cause  research project  three parts. you  any  and  University  of  university project during will day  staff the  be you  go  in  the  will from  drive and the  and  you  then  read  what you  will  rest  to be  will  take  you  testing  hours. back  f o r about  for  testing.  of  this  be d o i n g  i f you  will  place at  done  at  the  at  the  A member o f  the  stay with  to Riverview. 5  form  doing  happen  to the U n i v e r s i t y , drive  participate  will  will  The  a half  hospital  the  study  parts  Columbia. two  asked  t h i n g s we  two  to the U n i v e r s i t y  Please understand  other  about  been  p a r t of the  British  testing  away  One  the  takes  have  None o f t h e  pain.  Riverview  you  B.Sc.  or  6 yours  carefully  decide to  You  on so  you the you  participate  study.  PART ONE:  P s y c h o l o g i c a l T e s t i n g at Riverview:  about  3  hours  I n t h i s p a r t o f t h e s t u d y , you w i l l be g i v e n t e s t s o f memory, w o r d d e f i n i t i o n s , c o n c e p t p u z z l e s , had c o o r d i n a t i o n t a s k s and o t h e r more d i f f i c u l t f o r y o u . You w i l l be a s k e d t o c o n c e n t r a t e a n d t r y y o u r b e s t t o answer e a c h q u e s t i o n . We w i l l t a k e a r e s t a t t h e end o f e a c h h o u r . PART TWO:  P h y s i o l o g i c a l Recording  a t U.B.C.:  about  2  hours  I n t h i s p a r t o f t h e s t u d y y o u r body r e s p o n s e s s u c h as eye m o v e m e n t s , h e a r t b e a t , b r a i n waves and t h e a c t i v i t y o f y o u r sweat g l a n d s w i l l be m e a s u r e d w h i l e you p e r f o r m s e v e r a l s i m p l e tasks. These tasks i n c l u d e comfortably relaxing while l i s t e n i n g to b e l i e f tones, watching b r i e f f l a s h e s o f l i g h t , w a t c h i n g a s p o t o f l i g h t move b a c k and f o r t h on a s c r e e n and a t t e m p t i n g t o p r o d u c e s i m i l a r movements by t u r n i n g a knob back and f o r t h . To make t h e s e r e c o r d i n g s , s e n s o r s w i l l be a t t a c h e d t o y o u r arms, l e g s , and head b u t no d i s c o m f o r t o r d a n g e r t o you i s i n v o l v e d . In another p a r t o f t h i s study a drop o f o i l s i m i l a r t o c o o k i n g o i l w i l l be p l a c e d on y o u r s k i n n e a r y o u r f i n g e r n a i l s and a p h o t o g r a p h o f y o u r s k i n w i l l be made.  141 PART THREE:  CAT S c a n a t U.B.C.  about  1/2  hour  In t h i s p a r t o f t h e s t u d y , p i c t u r e s o f y o u r h e a d w i l l be made w i t h a m a c h i n e c a l l e d a CAT o r b o d y i m a g e scanner. H a v i n g a CAT s c a n made i s a r o u t i n e h o s p i t a l p r o c e d u r e that t a k e s a b o u t 20 m i n u t e s . There i s n o t h i n g u n p l e a s a n t about a CAT s c a n ; a l l y o u h a v e t o do i s l i e s t i l l on a bed w h i l e t h e machine takes the p i c t u r e . A CAT s c a n i s v e r y much l i k e an Xray and makes i t p o s s i b l e t o l o o k a t t h e s t r u c t u r e s o f b r a i n s t r u c t u r e s t h a t a r e r e l a t e d t o t h e k i n d s o f p r o b l e m s y o u had been h a v i n g or t h a t a r e r e l a t e d t o t h e m e a s u r e s o f e y e movements, sweat g l a n d , and b r a i n wave a c t i v i t y . We hope you h a v e c a r e f u l l y r e a d t h e d e s c r i p t i o n o f t h e three parts of the study. T h i s i s a good t i m e t o ask q u e s t i o n s i f t h e r e i s a n y t h i n g you don't u n d e r s t a n d . I f you f e e l y o u u n d e r s t a n d what y o u w i l l be d o i n g , and i f y o u s t i l l wish t o t a k e p a r t i n t h e p r o j e c t p l e a s r e a d and s i g n t h e f o l l o w i n g consent form. I have read t h e above e x p l a n a t i o n o f a r e s e a r c h p r o j e c t and b e e n g i v e n a c o p y o f t h i s c o n s e n t f o r m f o r my own u s e . I understand the project w i l l involve psychological testing, p h y s i o l o g i c a l r e c o r d i n g s and a CAT s c a n . I am aware t h a t I w i l l t r a v e l by c a r t o t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a with one o f t h e r e s e a r c h s t a f f . I n f o r m a t i o n t h a t w i l l be h e l p f u l to my treatment may b e c o n v e y e d t o my therapist (or to ). Otherwise, a l l t h e i n f o r m a t i o n obtained i n t h i s p r o j e c t w i l l be k e p t c o n f i d e n t i a l and u s e d o n l y f o r t h e purposes of t h i s study. I understand I am f r e e t o a s k q u e s t i o n s a b o u t t h e p r o c e d u r e a t any t i m e . By s i g n i n g t h i s f o r m , I a g r e e t o p a r t i c i p a t e , a l t h o u g h I . r e a l i z e I am f r e e t o w i t h d r a w from t h i s s t u d y a t any t i m e w i t h o u t p r e j u d i c e t o p r e s e n t and f u t u r e c a r e a n d t r e a t m e n t . when I f i n i s h a l l p a r t s o f t h e s t u d y I w i l l be p a i d $35.00.  Witness  Signature  Print  Name  Date  

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