Neuropsychological profile in patients with schizotypal personality disorder or schizophrenia

Neuropsychological impairments have been consistently reported in patients with schizophrenia. As little is known whether subjects with schizotypal personality disorder exhibit neurocognitive dysfunction similar to that in schizophrenia, we assessed the neuropsychological profile of 15 subjects with schizotypal personality disorder and compared it with that for 15 patients with schizophrenia and for 15 psychiatrically normal volunteers. All participants were administered a standard neuropsychological battery assessing language ability, spatial ability, visuomotor function, verbal memory, visual memory, auditory attention, visual attention, and executive function. Performance on most of the cognitive domains was impaired in patients with schizotypal personality disorder but less than patients with schizophrenia. Specifically, impairment in verbal memory and visuomotor ability in patients with schizotypal personality disorder and patients with schizophrenia were comparable, while patients with schizophrenia performed worse on the test of executive function than did patients with schizotypal personality disorder. As a whole, cognitive deficits in patients with schizotypal personality disorder were qualitatively similar to, but quantitatively milder than, those for patients with schizophrenia. The results suggest that cognitive abilities related to frontotemporal lobe function are disturbed across these schizophrenia-spectrum disorders.     

Contextual insensitivity in schizophrenic language processing: evidence from lexical ambiguity

The authors investigated whether contextual failures in schizophrenia are due to deficits in the detection of context or the inhibition of contextually irrelevant information. Eighteen schizophrenia patients and 24 nonpsychiatric controls were tested via a cross-modal semantic priming task. Participants heard sentences containing homonyms and made lexical decisions about visual targets related to the homonyms' dominant or subordinate meanings. When sentences moderately biased subordinate meanings (e.g., the animal enclosure meaning of pen), schizophrenia patients showed priming of dominant targets (e.g., paper) and subordinate targets (e.g., pig). In contrast, controls showed priming only of subordinate targets. When contexts strongly biased subordinate meanings, both groups showed priming only of subordinate targets. The results suggest that inhibitory deficits rather than context detection deficits underlie contextual failures in schizophrenia.     

The relationship between cognitive inhibition and psychotic symptoms

Cognitive models of schizophrenia have highlighted deficits of inhibitory attentional processes as central to the disorder. This has been investigated using "negative priming" (S. P. Tipper, 1985), with schizophrenia patients showing a reduction of negative priming in a number of studies. This study attempted to replicate these findings, but studied psychotic symptoms rather than the broad diagnostic category of schizophrenia. Psychotic individuals exhibiting positive symptoms were compared with asymptomatic psychiatric patients and with a normal control group. As predicted, the symptomatic group failed to show the usual negative priming effect, which was present in the asymptomatic and normal groups. A modest but significant correlation was found between negative priming and delusions. Neither diagnosis, nor affective or negative symptoms, nor chronicity, nor medication, was related to negative priming. These data replicate previous findings that positive symptoms are related to a reduction in cognitive inhibition, although considerable variability was observed among the psychotic patients.     

Mentalising, schizotypy, and schizophrenia.

Despite accumulating evidence that patients with schizophrenia perform poorly in mentalising tasks, doubts remain about the primacy of the role played by defective mentalising in schizophrenia. This study investigated the relationship between mentalising ability and self-reported schizotypal traits in non-clinical adults who reported no history of psychiatric illness in order to test two counter-proposals: (1) defective mentalising is a primary cause of psychotic symptoms in schizophrenia; and (2) defective mentalising in schizophrenia is a secondary consequence of the chronic asociality that is typical of general psychiatric illness. Mentalising ability was tested using a false-belief picture sequencing task that has been used elsewhere to demonstrate poor mentalising in patients with schizophrenia. Evidence of selective mentalising deficits in high schizotypal non-clinical subjects discounted the view that defective mentalising is restricted to psychiatric illness and strengthened the case for continuity models of psychosis-proneness. Furthermore, evidence that poor mentalisers in the normal population are more likely to self-report psychotic-like traits, as well as asocial or idiosyncratic behaviours, refuted suggestions that defective mentalising is linked solely to asocial symptomatology and supported the view that defective mentalising may have a fundamental role to play in the explanation of psychotic symptoms. In order to specify what that role might be, alternative theoretical accounts of defective mentalising were tested. Neither executive planning deficits nor failure to inhibit cognitively salient inappropriate information could adequately explain the pattern of selective mentalising deficits found in high schizotypal non-clinical subjects. Our findings suggest that there exists a domain-specific cognitive module that is dedicated to inferring and representing mental states which, when dysfunctional, causes defective mentalising that manifests phenomenologically in psychotic-like traits and impoverished social awareness of variable expression and ranging severity.     

Six Subclinical Spectrum Traits in Normal Creativity

In this article, I explore conceptual and empirical connections between schizophrenia, schizotypy, psychotic-like traits, affective symptoms, and creativity. The focus is on 6 symptom-like characteristics: (a) positive schizotypal cognitive symptoms, (b) negative schizotypal cognitive symptoms, (c) negative schizotypal affective symptoms (flat affect), (d) hypomania, (e) depression, and (f) impulsivity. Attention is directed at research differentiating the cognitive symptoms associated with the schizophrenia spectrum from those of the core affective disorders, as well as distinguishing schizophrenic-like flat affect from depression. I present data on relations between paper-and-pencil measures of creativity and scales of subclinical deviant traits. I also discuss the importance of distinguishing creativity and eminence in different professional fields, artistic media, and genres, as well as the conceptual relation between continuous trait views of genius and madness and the temporal dynamics of the creative process.     

Logical reasoning in schizotypal personality

It was examined whether psychotic-like personality traits in a sample of 205 college students could predict logical reasoning deficits, akin to those seen in schizophrenia. The participants were tested on their ability to assess the logical validity of premises (Logical Reasoning Task), and completed a multi-dimensional schizotypy inventory (O-LIFE). Low accuracy was associated with increased levels of disorganized schizotypy (‘Cognitive Disorganization’), while elevated errors were associated with increased levels of positive (‘Unusual Experiences’), negative (‘Introvertive Anhedonia’) and impulsive (‘Impulsivity Non-conformity’) schizotypy. Nevertheless, multiple regression analyses revealed that negative schizotypy was retained as the only significant predictor after performance was corrected for random guessing, and the contribution of the average amount of time spent on each premise was controlled. The results suggest that, although most schizotypy dimensions have a detrimental effect on reasoning performance, possibly due to disadvantageous test-taking strategies, negative schizotypy is the most reliable predictor of logical reasoning deficits. It is proposed that social/interpersonal schizotypal traits, like negative symptoms of schizophrenia, are accompanied by deficient executive functions of working memory, which appear to undermine, inter alia, logical reasoning processing.     

Cognitive inhibition in depression

Cognitive inhibition is a key mechanism in the regulation of emotion. There is emerging evidence that depression is characterized by deficits in the inhibition of mood-congruent material. These deficits could result in prolonged processing of negative, goal-irrelevant aspects of presented information thereby hindering recovery from negative mood and leading to the sustained negative affect that characterizes depressive episodes. Indeed, it has been suggested that deficits in cognitive inhibition lie at the heart of memory and attention biases in depression, and set the stage for ruminative responses to negative events and negative mood states. A ruminative response style results in a heightened vulnerability to experience episodes of major depression. Recent research has demonstrated that deficient inhibition of negative material is associated with heightened rumination. In this article, we review the depression literature with a focus on studies that investigate cognitive inhibition in depressed participants and in participants who report a history of major depressive episodes. In addition, we summarize neurobiological findings that indicate a strong relation between depression and deficits in inhibition and we take a closer look at the relation of inhibition, rumination and mood regulation.     

BRIEF REPORT

The effects of masking task load on latent inhibition (LI, poorer learning for a previously exposed irrelevant stimulus than for a novel stimulus) were examined as a function of levels of schizotypality. With low load, LI was present in low schizotypal but not high schizotypal participants. With high load, LI was abolished in low schizotypal, but was present in high schizotypal participants. The data support a distraction rather than a resource limitation model of attentional dysfunction in high schizotypal normals. Implications of the model for understanding the attentional dysfunction in schizophrenia are discussed.     

On the difference between response inhibition and negative priming: Evidence from simple and selective stopping

Negative priming is a commonly observed after-effect in studies concerning inhibition. Effects of the preceding trial are also found in other paradigms, like the stop signal paradigm. In the present study, stop signals were introduced in a negative priming paradigm and the relation between stop signal inhibition and negative priming was investigated. In Experiment 1, we used a simple stop signal task. Stopping data clearly suggest that stopping performance was not influenced by negative priming. Interestingly, on no-signal probes the negative priming effect disappeared after successful inhibition of the response on the prime trial. On the contrary, when inhibition failed, the negative priming effect remained. In Experiment 2, we used the selective stop signal task. As in Experiment 1, inhibition of motor responses was not influenced by negative priming. The hypothesis that negative priming disappeared due to a general nonspecific stop was confirmed in this experiment, as a negative priming effect was found after both successful and unsuccessful behavioral inhibition. The results of both experiments show that response inhibition is not influenced by negative priming, and that negative priming is only affected after a successful general stop.     

Context-processing deficits in schizotypal personality disorder

Research suggests that schizotypal personality disorder (SPD) is a part of the spectrum of schizophrenia-related illnesses. This article hypothesizes that a deficit in the representation and maintenance of context is a core cognitive disturbance in schizophrenia and that SPD individuals should demonstrate context-processing deficits. To test this hypothesis, the authors administered 3 versions of their AX-CPT task, designed to assess context processing, to 35 healthy controls and 26 individuals with DSM-IV SPD. They also administered working memory and selective attention tasks. SPD individuals displayed context representation deficits similar to those found in schizophrenia but did not show the same additional deficits in context maintenance. Context processing was strongly associated with working memory and selective attention performance in the SPD individuals.     

Religiosity, schizotypal thinking, and schizophrenia

The relationship between religiosity and the incidence of schizotypal thinking was investigated in a normal sample and in acute and chronic schizophrenic samples. The Rust Inventory of Schizotypal Cognitions was administered to measure schizotypal thinking, and two religiosity measures were developed. Religiosity had a significantly negative relationship with schizotypal thinking in normal subjects, while in schizophrenic patients the relationship was positive and significantly different. It is suggested that the process of existential growth of awareness in the normal development of religious belief, which is thought to be associated with schizotypal thinking, may have proceeded differently in persons suffering from schizophrenia.     

P50 sensory gating deficits in schizotypy

Sensory gating is the ability to filter out irrelevant stimuli from the environment. Individuals with schizophrenia consistently demonstrate deficits in this ability leading to sensory overload and cognitive fragmentation. This dysfunction has also been found in schizotypy, which is defined as a manifestation of nonclinical symptoms qualitatively similar to those found in schizophrenia. In the present study, auditory sensory gating was assessed in healthy individuals by testing the attenuation of the P50 event-related potential. The degree of suppression was then correlated with schizotypy by using the O-LIFE questionnaire. Relative to the low-scoring individuals, P50 suppression was significantly reduced in those with high levels of schizotypy. Furthermore, the degree of deficit in P50 gating correlated with both cognitive disorganisation and impulsive nonconformity dimensions of schizotypy. These results suggest that schizotypal individuals may have early sensory gating deficits similar to schizophrenia patients, especially if they display a disorganised or impulsive profile. As they do not exhibit overt psychotic symptoms, it is likely that such deficits represent an underlying core cognitive dysfunction within the schizophrenia spectrum.     

Sex differences in schizotypal personality in a nonclinical population.

This study tests the hypothesis that normal women will score higher on the more "positive" features of schizotypal personality and normal men will score higher on more "negative" schizotypal features. Two samples (n = 393, 394) were administered the Schizotypal Personality Questionnaire, which contains subscales corresponding to the 9 schizotypal personality traits outlined in the Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; American Psychiatric Association, 1987). Women scored significantly higher on the positive subscales of Ideas of Reference and Odd Beliefs/Magical Thinking, and men scored significantly higher on the negative subscales of No Close Friends and Constricted Affect. These findings replicated from one sample to another. These results are broadly consistent with previous findings on schizotypal personality and schizophrenia. It is hypothesized that sex differences in schizophrenic symptomatology may in part reflect an exaggeration of normal sex differences in the general population.     

Schizotypal traits are not related to multisensory integration or audiovisual speech perception

Multisensory integration, the binding of sensory information from different sensory modalities, may contribute to perceptual symptomatology in schizophrenia, including hallucinations and aberrant speech perception. Differences in multisensory integration and temporal processing, an important component of multisensory integration, are consistently found in schizophrenia. Evidence is emerging that these differences extend across the schizophrenia spectrum, including individuals in the general population with higher schizotypal traits. In the current study, we investigated the relationship between schizotypal traits and perceptual functioning, using audiovisual speech-in-noise, McGurk, and ternary synchrony judgment tasks. We measured schizotypal traits using the Schizotypal Personality Questionnaire (SPQ), hypothesizing that higher scores on Unusual Perceptual Experiences and Odd Speech subscales would be associated with decreased multisensory integration, increased susceptibility to distracting auditory speech, and less precise temporal processing. Surprisingly, these measures were not associated with the predicted subscales, suggesting that these perceptual differences may not be present across the schizophrenia spectrum.     

Schizophrenia, ketamine and cannabis: evidence of overlapping memory deficits

Drug models of mental illness are considered useful if they provoke its characteristic symptoms. In this respect, ketamine and tetrahydrocannabinol (cannabis) are coming under increasing scrutiny as models for schizophrenia. However, although both undoubtedly produce psychotic symptoms characteristic of the disorder, we argue here that, because schizophrenia is also accompanied by cognitive deficits, a full understanding of the impact of these drugs on cognition will be crucial in taking these models further. Memory deficits are pronounced in schizophrenia and we focus upon patterns of working and episodic memory impairment produced by ketamine and cannabis, identifying overlaps between drug and illness. We suggest that close attention to these deficits can offer insights into core pathophysiology of schizophrenia.     

Context processing in schizotypal personality disorder: evidence of specificity of impairment to the schizophrenia spectrum

Working memory abnormalities, which are particularly pronounced on context processing tasks, appear relatively specific to schizophrenia spectrum illnesses compared with other psychotic disorders. However, the specificity of context processing deficits to schizotypal personality disorder (SPD), a prototype of schizophrenia, has not been studied. The authors administered 3 versions of the modified AX Continuous Performance Test and an N-back working memory test to 63 individuals with SPD and 25 with other personality disorders, as well as 42 healthy controls. For the AX Continuous Performance Test standard and degraded versions, there was a significant Trial Type x Delay x Group interaction, as SPDs made significantly more errors reflecting poor maintenance of context and fewer errors reflecting good maintenance of context. SPDs also demonstrated poor performance on the N-back, especially at the 2-back condition. Context processing errors and N-back accuracy scores were related to disorganization symptoms. These findings, which are quite similar to those previously reported in patients with schizophrenia, suggest that context processing deficits are specific to the schizophrenia spectrum and are not a reflection of overall psychopathology.     

Schizotypy and sustained attention: confirming evidence from an adult community sample

Sustained attention deficits represent one of the most robust findings in the study of schizophrenia and schizotypy. However, very little is known about the nature of sustained attention performance and schizotypy in the general adult population. The present study assessed sustained attention performance in a large, normative adult community sample (N = 305) with no history of psychosis using the Continuous Performance Test-identical pairs version (CPT-IP). Associations between overall CPT-IP performance and schizotypal personality disorder features, controlling for the effects of age, sex, and educational level, revealed diminished sensitivity (d', discriminability), and increased random errors were related to increased reality distortion features. These data, drawn from a general population sample, provided support for overall sustained attention deficits as an endophenotype for schizophrenia liability.     

Adult age differences in inhibitory processes and their predictive validity for fluid intelligence

According to the inhibition-deficit hypothesis age differences in working memory capacity and fluid intelligence have been attributed to a decline in inhibitory efficiency. Conceptualizing inhibition as multifaceted, 88 participants (49 younger and 39 elderly) completed two versions of the negative priming paradigm (identification and localization), and two variants of the directed forgetting paradigm (listwise and itemwise). Two tasks of the Wechsler Intelligence Test with high loadings on general fluid intelligence (Gf) served as validation criteria. Results revealed task-specific and speed-independent inhibitory deficits in the elderly (lower negative priming in both paradigms; more intrusions in the directed forgetting tasks), as well as higher levels of repetition priming. Significant correlations between measures of inhibition and the Wechsler scores were found in both age groups. Results support the view of multiple inhibitory-like capabilities that play a central role in the decline of higher-order cognitive functions in old age.     

Schizotypy,cognitive performance,and genetic risk for schizophrenia in a non-clinical population

Schizophrenia risk alleles are expected to mediate effects on cognitive task performance, and aspects of personality including schizotypy, in nonclinical populations. We investigated how 32 of the best-validated schizophrenia risk alleles, singly and as summed genetic risk, were related to measures of schizotypal personality and measures of two aspects of cognitive performance, verbal skills (vocabulary) and visual-spatial skills (mental rotation), in healthy individuals. Summed genetic risk score was not associated with levels of total schizotypy or its three main subscales. Similarly, genotypic variation at none of the individual risk loci was related to cognitive performance measures, after correction for multiple tests. Higher overall genetic risk score was, however, associated with lower performance on the mental rotation test in males, with a broad set of loci contributing to this effect. These results imply that there is a lack of linear, genetically-based continuity connecting schizotypal cognition with the expression of schizophrenia itself, and indicate that, for males, higher genetic risk of schizophrenia exerts negative effects on visual-spatial skills, as measured by mental rotation.     

The timing of neurodevelopmental abnormality in schizophrenia: an integrative review of the neuroimaging literature

In this paper we will review recent neuroimaging research in schizophrenia, with an aim to critically evaluate several recent proposals concerning the nature and the timing of the neuroanatomic abnormalities underlying the disorder. Specifically, enlargement of cerebrospinal fluid spaces, deficits in cortical gray matter, and reduced volume of mesiotemporal structures have all been reported in patients in the first episode of schizophrenia, their first-degree relatives, and individuals with schizotypal personality disorder, supporting the possibility that these abnormalities reflect a genetically mediated neurodevelopmental disorder. These findings from the empirical literature will be synthesized from the perspective of dual cytoarchitectonic trends theory of neurodevelopment, as well as in relation to current conceptions of the schizophrenia prodrome. We believe that the evidence shows that sufficient groundwork has been laid to begin longitudinal neuroimaging studies of adolescents at clinical risk for schizophrenia, in order to more definitively determine the pathophysiology of the disorder. Such information could have significant implications in terms of understanding the prediction, treatment, and ultimately the prevention of schizophrenia.