On the nature of Wisconsin Card Sorting Test performance in schizophrenia

Factors affecting cognition and emotion in patients with traumatic brain injury

BACKGROUND

Cognitive and emotional disturbances are common serious issues in patients with traumatic brain injury (TBI). However, predictors associated with neuropsychological functions were not consistent.

OBJECTIVE

To investigate factors affecting cognition and emotion in patients with TBI, we evaluated executive function, memory, and emotion based on injury severity and lesion location.

METHODS

Neuropsychological outcomes of 80 TBI patients were evaluated via Wisconsin Card Sorting Test (WCST), Color Trail Test (CTT), Controlled Oral Word Association Test (COWAT), Everyday Memory Questionnaire (EMQ), Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), and Agitated Behavior Scale (ABS). WCST, CTT, and COWAT assessed executive function; EMQ assessed everyday memory; and GDS, STAI, and ABS assessed emotion. Patients were categorized according to lateralization of lesion and existence of frontal lobe injury.

RESULTS

Patients with longer duration of loss of consciousness (LOC) showed more severe deficits in everyday memory and agitated behaviors. The frontal lesion group showed poorer performance in executive function and higher agitation than the non-frontal lesion group. Patients with bilateral frontal lesion showed greater deficits in executive function and were more depressed than unilateral frontal lesion groups. Especially in those unilateral frontal lesion groups, right side frontal lesion group was worse on executive function than left side frontal lesion group.

CONCLUSIONS

Duration of LOC and lesion location are main parameters affecting executive function, everyday memory, and emotion in neuropsychological outcomes following TBI, suggesting that these parameters need to be considered for cognitive rehabilitation interventions.

The psycho-periodic cube

The current diagnostic classification systems in psychiatry have been developed primarily for evidence-based clinical decision making with both categorical and dimensional approaches having their own advantages and disadvantages. Efforts have been made to improve these classification systems, and we are now at the point where we must expand beyond the one-dimensionality of these systems. In this paper, we propose that psychiatric disorders can be arranged in a three-dimensional classification system according to the degree of dysfunctions on three specific axes in a way that is similar to the arrangement of chemical elements according to their atomic weights in Mendeleyev's periodic table. For the three axes, we chose externalization, drive, and attention to represent the three-dimensional descriptions of mental health, namely, well-being in social, motivational, and cognitive areas, respectively. Throughout the paper, we explain our reasons for choosing these three axes and compare our hypothesis with categorical diagnostic systems as well as Cloninger's dimensional diagnostic system using personality disorders, affective disorders, and schizophrenia as the specific diagnostic samples.

Load-sensitive impairment of working memory for biological motion in schizophrenia

Impaired working memory (WM) is a core cognitive deficit in schizophrenia. Nevertheless, past studies have reported that patients may also benefit from increasing salience of memory stimuli. Such efficient encoding largely depends upon precise perception. Thus an investigation on the relationship between perceptual processing and WM would be worthwhile. Here, we used biological motion (BM), a socially relevant stimulus that schizophrenics have difficulty discriminating from similar meaningless motions, in a delayed-response task. Non-BM stimuli and static polygons were also used for comparison. In each trial, one of the three types of stimuli was presented followed by two probes, with a short delay in between. Participants were asked to indicate whether one of them was identical to the memory item or both were novel. The number of memory items was one or two. Healthy controls were more accurate in recognizing BM than non-BM regardless of memory loads. Patients with schizophrenia exhibited similar accuracy patterns to those of controls in the Load 1 condition only. These results suggest that information contained in BM could facilitate WM encoding in general, but the effect is vulnerable to the increase of cognitive load in schizophrenia, implying inefficient encoding driven by imprecise perception.

Optimization and pharmacological validation of a set-shifting procedure for assessing executive function in rats

BACKGROUND

Set-shifting tests represent a reliable paradigm to assess executive functions in humans and animals. In the rat, set-shifting in a cross-maze is a recognized method. In this test, rats must learn an egocentric rule to locate food reinforcement. Once acquired, a second rule, based on visual-cue strategy, allows the location of the food. Ability of rats to shift from the first to the second rule is considered to reflect cognitive flexibility.

NEW METHOD

This study aimed at optimizing the most currently used set-shifting protocol in a cross-maze for standardized drug testing by modulating the parameters related to caloric restriction, reward preference, and by redefining the notion of turn bias and classification of errors sub-types, i.e. perseverative vs. regressive. The new protocol has then been used to assess rats treated by sub-chronic phencyclidine administration and investigate the potential reversal effect of tolcapone, a brain penetrant catechol-O-methyl transferase inhibitor.

RESULTS

The new procedure resulted in a decreased total duration and a re-definition of turn bias and error subtypes. Despite preferences for sweet rewards, caloric restriction had to be maintained to motivate animals. Overall, sub-chronic PCP-treated rats made mostly perseverative errors compared to controls and required more trials to shift between the two rules. Tolcapone partly reversed impairments observed in PCP-treated rats.

CONCLUSION

The new protocol has improved the reliability of key parameters and has contributed to the decrease of the test duration. PCP-treated rats submitted to this protocol have been shown to have significant deficits that could be reversed by tolcapone.

Attentional Set-Shifting Across Species

Attentional set-shifting, as a measure of executive flexibility, has been a staple of investigations into human cognition for over six decades. Mediated by the frontal cortex in mammals, the cognitive processes involved in forming, maintaining and shifting an attentional set are vulnerable to dysfunction arising from a number of human neurodegenerative diseases (such as Alzheimer's, Parkinson's and Huntington's diseases) and other neurological disorders (such as schizophrenia, depression, and attention deficit/hyperactivity disorder). Our understanding of these diseases and disorders, and the cognitive impairments induced by them, continues to advance, in tandem with an increasing number of tools at our disposal. In this chapter, we review and compare commonly used attentional set-shifting tasks (the Wisconsin Card Sorting Task and Intradimensional/Extradimensional tasks) and their applicability across species. In addition to humans, attentional set-shifting has been observed in a number of other animals, with a substantial body of literature describing performance in monkeys and rodents. We consider the task designs used to investigate attentional set-shifting in these species and the methods used to model human diseases and disorders, and ultimately the comparisons and differences between species-specific tasks, and between performance across species.

Schizophrenia and Depression Co-Morbidity: What We have Learned from Animal Models

Patients with schizophrenia are at an increased risk for the development of depression. Overlap in the symptoms and genetic risk factors between the two disorders suggests a common etiological mechanism may underlie the presentation of comorbid depression in schizophrenia. Understanding these shared mechanisms will be important in informing the development of new treatments. Rodent models are powerful tools for understanding gene function as it relates to behavior. Examining rodent models relevant to both schizophrenia and depression reveals a number of common mechanisms. Current models which demonstrate endophenotypes of both schizophrenia and depression are reviewed here, including models of CUB and SUSHI multiple domains 1, PDZ and LIM domain 5, glutamate Delta 1 receptor, diabetic db/db mice, neuropeptide Y, disrupted in schizophrenia 1, and its interacting partners, reelin, maternal immune activation, and social isolation. Neurotransmission, brain connectivity, the immune system, the environment, and metabolism emerge as potential common mechanisms linking these models and potentially explaining comorbid depression in schizophrenia.

Effects of tobacco smoking on neuropsychological function in schizophrenia in comparison to other psychiatric disorders and non-psychiatric controls

BACKGROUND AND OBJECTIVES

Compared to the general population cigarette smoking prevalence is elevated in psychiatric disorders such as schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD). These disorders are also associated with neurocognitive impairments. Cigarette smoking is associated with improved cognition in SZ. The effects of smoking on cognition in BD and MDD are less well studied.

METHODS

We used a cross-sectional design to study neuropsychological performance in these disorders as a function of smoking status. Subjects (N = 108) were SZ smokers (n = 32), SZ non-smokers (n = 15), BD smokers (n = 10), BD non-smokers (n = 6), MDD smokers (n = 6), MDD non-smokers (n = 10), control smokers (n = 12), and control non-smokers (n = 17). Participants completed a neuropsychological battery; smokers were non-deprived.

RESULTS

SZ subjects performed significantly worse than controls in select domains, while BD and MDD subjects did not differ from controls. Three verbal memory outcomes were improved in SZ smokers compared with non-smokers; smoking status did not alter performance in BD or MDD.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

These data suggest that smoking is associated with neurocognitive improvements in SZ, but not BD or MDD. Our data may suggest specificity of cigarette-smoking modulation of neurocognitive deficits in SZ.

In vitro and in vivo characterisation of Lu AF64280, a novel, brain penetrant phosphodiesterase (PDE) 2A inhibitor: potential relevance to cognitive deficits in schizophrenia

Here, we present the pharmacological characterisation of Lu AF64280, a novel, selective, brain penetrant phosphodiesterase (PDE) 2A inhibitor, in in vitro/in vivo assays indicative of PDE2A inhibition, and in vivo models/assays relevant to cognitive processing or antipsychotic-like activity. The in vitro selectivity of Lu AF64280 was determined against a panel of PDE enzymes and 3',5'-cyclic guanosine monophosphate (cGMP) levels in the hippocampus were determined using in vivo microdialysis. Lu AF64280 potently inhibited hPDE2A (Ki = 20 nM), 50-fold above moderate inhibition of both hPDE9A (Ki = 1,000 nM) and hPDE10A (Ki = 1,800 nM), and displayed a >250-fold selectivity over all other full-length human recombinant PDE family members (Ki above 5,000 nM). Lu AF64280 (20 mg/kg) significantly increased cGMP levels in the hippocampus (p < 0.01 versus vehicle-treated mice), attenuated sub-chronic phencyclidine-induced deficits in novel object exploration in rats (10 mg/kg, p < 0.001 versus vehicle-treated), blocked early postnatal phencyclidine-induced deficits in the intradimensional/extradimensional shift task in rats (1 and 10 mg/kg, p < 0.001 versus vehicle-treated) and attenuated spontaneous P20-N40 auditory gating deficits in DBA/2 mice (20 mg/kg, p < 0.05 versus vehicle-treated). In contrast, Lu AF64280 failed to attenuate phencyclidine-induced hyperactivity in mice, and was devoid of antipsychotic-like activity in the conditioned avoidance response paradigm in rats, at any dose tested. Lu AF64280 represents a novel tool compound for selective PDE2A inhibition that substantiates a critical role of this enzyme in cognitive processes under normal and pathological conditions.

PNU-120596, a positive allosteric modulator of α7 nicotinic acetylcholine receptors, reverses a sub-chronic phencyclidine-induced cognitive deficit in the attentional set-shifting task in female rats

The α7 nicotinic acetylcholine receptors (nAChRs) have been highlighted as a target for cognitive enhancement in schizophrenia. Adult female hooded Lister rats received sub-chronic phencyclidine (PCP) (2 mg/kg) or vehicle i.p. twice daily for 7 days, followed by 7 days' washout. PCP-treated rats then received PNU-120596 (10 mg/kg; s.c.) or saline and were tested in the attentional set-shifting task. Sub-chronic PCP produced a significant cognitive deficit in the extra-dimensional shift (EDS) phase of the task (p < 0.001, compared with vehicle). PNU-120596 significantly improved performance of PCP-treated rats in the EDS phase of the attentional set-shifting task (p < 0.001). In conclusion, these data demonstrate that PNU-120596 improves cognitive dysfunction in our animal model of cognitive dysfunction in schizophrenia, most likely via modulation of α7 nACh receptors.

Negative modulation of GABAA α5 receptors by RO4938581 attenuates discrete sub-chronic and early postnatal phencyclidine (PCP)-induced cognitive deficits in rats

RATIONALE

A growing body of evidence suggests that negative modulation of γ-aminobutyric acid (GABA) GABA(A) α5 receptors may be a promising strategy for the treatment of certain facets of cognitive impairment; however, selective modulators of GABA(A) α5 receptors have not yet been tested in "schizophrenia-relevant" cognitive assay/model systems in animals.

OBJECTIVES

The objectives of this study were to investigate the potential of RO4938581, a negative modulator of GABA(A) α5 receptors, and to attenuate cognitive impairments induced following sub-chronic (sub-PCP) and early postnatal PCP (neo-PCP) administration in the novel object recognition (NOR) and intra-extradimensional shift (ID/ED) paradigms in rats. Complementary in vitro, ex vivo and in vivo studies were performed to confirm negative modulatory activity of RO4938581 and to investigate animal model validity, concept validity and potential side effect issues, respectively.

RESULTS

In vitro studies confirmed the reported negative modulatory activity of RO4938581, whilst immunohistochemical analyses revealed significantly reduced parvalbumin-positive cells in the prefrontal cortex of sub-PCP- and neo-PCP-treated rats. RO4938581 (1 mg/kg) ameliorated both sub-PCP- and neo-PCP-induced cognitive deficits in NOR and ID/ED performance, respectively. In contrast, QH-II-066 (1 and 3 mg/kg), a GABA(A) α5 receptor positive modulator, impaired cognitive performance in the NOR task when administered to vehicle-treated animals. Additional studies revealed that both RO4938581 (1 mg/kg) and QH-II-066 (1 and 3 mg/kg) attenuated amphetamine-induced hyperactivity in rats.

CONCLUSIONS

Taken together, these novel findings suggest that negative modulation of GABA(A) α5 receptors may represent an attractive treatment option for the cognitive impairments, and potentially positive symptoms, associated with schizophrenia.

Declarative memory and WCST-64 performance in subjects with schizophrenia and healthy controls

The Wisconsin Card Sorting Test (WCST) is a set-switching task used extensively to study impaired executive functioning in schizophrenia. Declarative memory deficits have also been associated with schizophrenia and may affect WCST performance because continued correct responding depends on remembering the outcome of previous responses. This study examined whether performance in visual and verbal declarative memory tasks were associated with WCST performance. Subjects comprised 30 patients with schizophrenia or schizoaffective disorder (SCZ) and 30 demographically matched healthy controls (CON) who were tested on the WCST, the Benton Visual Retention Test (BVRT), the California Verbal Learning Test (CVLT), and the Continuous Performance Test (CPT). SCZ subjects showed significant correlations between visual and verbal declarative memory and performance on the WCST-64 that were in the hypothesized direction such that worse memory performance was associated with worse performance on the WCST. CON subjects did not show a significant relationship between visual or verbal memory and WCST-64 performance. Fisher's r to z transformations indicated that the associations between declarative memory and WCST-64 performance in the SCZ subjects differed significantly from those of CON subjects. The findings suggest that interpretations of WCST-64 scores for subjects with schizophrenia should be considered in light of their declarative memory functioning.

Prefrontal cortex dysfunction and 'Jumping to Conclusions': bias or deficit?

The 'beads task' is used to measure the cognitive basis of delusions, namely the 'Jumping to Conclusions' (JTC) reasoning bias. However, it is not clear whether the task merely taps executive dysfunction - known to be impaired in patients with schizophrenia - such as planning and resistance to impulse. To study this, 19 individuals with neurosurgical excisions to the prefrontal cortex, 21 unmedicated adults with Attention Deficit Hyperactivity Disorder (ADHD), and 25 healthy controls completed two conditions of the beads task, in addition to tests of memory and executive function as well as control tests of probabilistic reasoning ability. The results indicated that the prefrontal lobe group (in particular, those with left-sided lesions) demonstrated a JTC bias relative to the ADHD and control groups. Further exploratory analyses indicated that JTC on the beads task was associated with poorer performance in certain executive domains. The results are discussed in terms of the executive demands of the beads task and possible implications for the model of psychotic delusions based on the JTC bias.

Prestimulus top-down reflection of obsessive-compulsive disorder in EEG frontal theta and occipital alpha oscillations

It has recently been reported that prestimulus electroencephalogram (EEG) frontal theta and occipital alpha oscillations of healthy controls were modulated by the type of upcoming tasks, reflecting prestimulus top-down preparation. The present study explored the differences in dynamics of frontal theta and occipital alpha activities between obsessive-compulsive disorder (OCD) patients and healthy participants in terms of reflection of prestimulus top-down regulation. EEGs were recorded from 16 OCD patients and 16 healthy controls using a color and a shape discrimination task. The power and time course of oscillatory activity were calculated by convolving the EEG signals with Morlet wavelets. Although OCD patients yielded significantly lower total alpha and total theta power results than the normal controls, they demonstrated that significantly higher total alpha and total theta power preceded the difficult task (shape-task) as compared to the easy task (color-task). Furthermore, the frontal region, where OCD patients usually revealed abnormalities, showed significant differences in the prestimulus total theta power between the normal and OCD groups. Taken together, frontal theta and occipital alpha oscillations seem to be potent electrophysiological correlates reflecting impairment in the prestimulus top-down processing of OCD patients.

Instinctual impulses in obsessive compulsive disorder: A neuropsychological and psychoanalytic interface

Psychopathology of obsessive compulsive disorder (OCD) that has been characterized by a conflict between the ego and superego on one hand, and aggressive and sexual impulses emerging from the id on the other, and employment of characteristic defenses to combat intense conflicts being connected with ones' biological disposition from the psychoanalytic school of thought now gets empirical foundation from neuroimaging research. The findings disregard the psychological construct, exclusively establishing the neurobiology of the disorder. With the objective to study the impact of sexual and aggressive impulses on the executive functions and processing speed in the patient group, 20 OCD patients (11 males, 9 females) and 20 normal control subjects, matched for all relevant variables including age, sex, educational level and handedness were studied. Sexual impulse and guilt was assessed on the Sex Guilt Rating Scale (SGRS), aggressive impulses were tested using State-Trait Anger Expression Inventory (STAXI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess symptom severity, executive functions were assessed through Wisconsin Card Sorting Test (WCST), and processing speed was assessed by employing the Processing Speed Index (PSI) - from WAIS III. It was found that the OCD group differed significantly from the controls, attaining significantly lower percentiles on Processing Speed Index and for all variables of WCST under consideration, namely, perseverative response, perseverative error, non-perseverative error, conceptual level response and number of categories completed. They reported higher scores on subscales of STAXI, specifically related to trait anger and lower scores on anger expression. On the items of SGRS, the OCD group significantly differed with the controls, expressing greater sexual inhibition. In conclusion, we propose an explanation of psychopathology of OCD, which addresses instinctual impulses, executive functions and neural substrates. Our findings contribute to understanding instinctual impulses from the neuropsychological perspective. The findings have implications for better eclectic understanding of the pathogenesis of OCD.

Erythropoietin reverses the attentional set-shifting impairment in a rodent schizophrenia disease-like model

RATIONALE

Executive function impairment, as classically assessed using the Wisconsin Card Sort Test or intradimensional/extradimensional tests, is a key feature of schizophrenia but remains inadequately treated by existing therapies. Recently, however, erythropoietin has been shown to improve attentional set-shifting performance in schizophrenic patients.

OBJECTIVE

The present study utilized the rat intradimensional/extradimensional task to investigate the potential of erythropoietin to reverse a phencyclidine-induced extradimensional shift impairment when given alone or in combination with subchronic haloperidol treatment.

METHODS

Rats were subjected to a subchronic systemic administration (7 days, b.i.d) of either saline vehicle or phencyclidine (5 mg/kg) followed by a 7-day washout period during which haloperidol was given. Subsequently, rats were trained to dig in baited bowls for a food reward and to discriminate on the basis of digging media or bowl odor. In experiment 1, rats performed a series of discriminations following acute administration of vehicle, erythropoietin, or modafinil. In a second experiment, rats receiving either haloperidol in the drinking water or just normal drinking water were run in the attentional set-shifting task after acute administration of erythropoietin (1,000 or 10,000 IU/ml  i.p., selected from experiment 1).

RESULTS

The subchronic phencyclidine-induced extradimensional deficit was ameliorated by both erythropoietin and modafinil. When combined with subchronic haloperidol, the higher dose of erythropoietin tested was able to reverse the extradimensional shift impairment.

CONCLUSIONS

Overall, these findings further support the use of erythropoietin as an adjunct to antipsychotic therapy in order to address, at least part of, the cognitive dysfunction associated with schizophrenia.

Animal models of cognitive dysfunction and negative symptoms of schizophrenia: focus on NMDA receptor antagonism

Cognitive deficits in schizophrenia remain an unmet clinical need. Improved understanding of the neuro- and psychopathology of these deficits depends on the availability of carefully validated animal models which will assist the development of novel therapies. There is much evidence that at least some of the pathology and symptomatology (particularly cognitive and negative symptoms) of schizophrenia results from a dysfunction of the glutamatergic system which may be modelled in animals through the use of NMDA receptor antagonists. The current review examines the validity of this model in rodents. We review the ability of acute and sub-chronic treatment with three non-competitive NMDA antagonists; phencyclidine (PCP), ketamine and MK801 (dizocilpine) to produce cognitive deficits of relevance to schizophrenia in rodents and their subsequent reversal by first- and second-generation antipsychotic drugs. Effects of NMDA receptor antagonists on the performance of rodents in behavioural tests assessing the various domains of cognition and negative symptoms are examined: novel object recognition for visual memory, reversal learning and attentional set shifting for problem solving and reasoning, 5-Choice Serial Reaction Time for attention and speed of processing; in addition to effects on social behaviour and neuropathology. The evidence strongly supports the use of NMDA receptor antagonists to model cognitive deficit and negative symptoms of schizophrenia as well as certain pathological disturbances seen in the illness. This will facilitate the evaluation of much-needed novel pharmacological agents for improved therapy of cognitive deficits and negative symptoms in schizophrenia.

Activation of type 5 metabotropic glutamate receptors attenuates deficits in cognitive flexibility induced by NMDA receptor blockade

Metabotropic glutamate (mGlu) receptors provide a mechanism by which the function of NMDA glutamate receptors can be modulated. As NMDA receptor hypofunction is implicated in the etiology of psychiatric disorders, including schizophrenia, the pharmacological regulation of mGlu receptor activity represents a promising therapeutic approach. We examined the effects of the positive allosteric mGlu(5) receptor modulator 3-cyano-N-(1,3-diphenyl-1H-pyrazol-5-yl)benzamide (CDPPB), alone and in combination with the NMDA receptor antagonist MK-801, on a task measuring cognitive set-shifting ability. This task measures NMDA receptor-dependent cognitive abilities analogous to those impaired in schizophrenia. Systemic administration of CDPPB (10 and 30 mg/kg i.p) blocked MK-801 (0.1mg/kg, i.p.)-induced impairments in set-shifting ability. The effect on learning was dose-dependent, with the 30 mg/kg dose having a greater effect than the 10mg/kg dose across all trials. This ameliorative effect of CDPPB reflected a reduction in MK-801-induced perseverative responding. These results add to the evidence that mGlu(5) receptors interact functionally with NMDA receptors to regulate behavior, and suggest that positive modulators of mGlu(5) receptors may have therapeutic potential in the treatment of disorders, like schizophrenia, characterized by impairments in cognitive flexibility and memory.

Isolation rearing impairs novel object recognition and attentional set shifting performance in female rats

It has been suggested that the isolation rearing paradigm models certain aspects of schizophrenia symptomatology. This study aimed to investigate whether isolation rearing impairs rats' performance in two models of cognition: the novel object recognition (NOR) and attentional set-shifting tasks, tests of episodic memory and executive function, respectively. Two cohorts of female Hooded-Lister rats were used in these experiments. Animals were housed in social isolation or in groups of five from weaning, post-natal day 28. The first cohort was tested in the NOR test with inter-trial intervals (ITIs) of 1 min up to 6 h. The second cohort was trained and tested in the attentional set-shifting task. In the NOR test, isolates were only able to discriminate between the novel and familiar objects up to 1-h ITI, whereas socially reared animals remembered the familiar object up to a 4-h ITI. In the attentional set-shifting task, isolates were significantly and selectively impaired in the extra-dimensional shift phase of the task (P < 0.01). Rats reared in isolation show impaired episodic memory in the NOR task and reduced ability to shift attention between stimulus dimensions in the attentional set-shifting task. Because schizophrenic patients show similar deficits in performance in these cognitive domains, these data further support isolation rearing as a putative preclinical model of the cognitive deficits associated with schizophrenia.

Impairment in flexible emotion-based learning in hallucination- and delusion-prone individuals

Deficits in emotion-based learning are implicated in many psychiatric disorders. Research conducted with patients with schizophrenia using one of the most popular tasks for the investigation of emotion-based learning, the Iowa Gambling Task (IGT), has largely been inconclusive. The present study employed a novel, contingency-shifting variant IGT with hallucination- and delusion-prone university students to determine whether previous findings were due merely to the presence of psychosis. Following initial screening of a sample of 253 students (mean age = 20.13 years, S.D. = 3.27), 28 high (10 male, 18 female) and 27 low (12 male, 15 female) hallucination-prone and 27 high (7 male, 20 female) and 26 low (11 male, 15 female) delusion-prone individuals completed the contingency-shifting variant IGT. Results showed no significant differences between the performances of high and low hallucination- and delusion-prone individuals during the original phase of the task. Differences only emerged following the onset of the contingency-shift phases, with individuals high in hallucination- and delusion-proneness having impaired performance compared with low hallucination- and delusion-prone individuals. Overall, the present findings demonstrate that impairments associated with hallucination- and delusion-proneness are specific to the shift phase of the contingency-shifting variant IGT, which supports previous findings with patients with schizophrenia.

Role of 5-HT receptor mechanisms in sub-chronic PCP-induced reversal learning deficits in the rat

RATIONALE

5-HT receptor mechanisms have been suggested to mediate improvements in cognition in schizophrenia.

AIM

The aim of this study was to investigate the involvement of 5-HT receptor mechanisms in sub-chronic phencyclidine (PCP)-induced reversal learning deficits in female rats, a task of relevance to schizophrenia.

METHODS

Adult female hooded Lister rats were trained to perform an operant reversal learning task and then received sub-chronic PCP (2 mg/kg) or vehicle intraperitoneally (i.p.) twice daily for 7 days, followed by 7-day washout. Rats then received an acute dose of the 5-HT(7) receptor antagonist SB-269970A (1.0, 3.0, and 10.0 mg/kg, i.p.) or vehicle. In experiment 2, PCP-treated rats received the selective 5-HT(2C) receptor antagonist, SB-243213A acutely (1.0, 3.0, and 10.0 mg/kg, i.p.) or vehicle. In experiment 3, PCP-treated rats received the 5-HT(1A) receptor partial agonist, buspirone (0.15625, 0.3125, and 0.625 mg/kg, i.p.) in combination with the selective 5-HT(1A) receptor antagonist WAY-100635 (0.3 and 1.0 mg/kg).

RESULTS

In all experiments, sub-chronic PCP significantly impaired reversal phase performance (P < 0.01-0.001), with no effect in the initial phase. SB-269970A at 3.0 and 10.0 mg/kg significantly improved the PCP-induced deficit (P < 0.05). SB-243213A also significantly attenuated the deficit at 10 mg/kg (P < 0.05). In experiment 3, buspirone attenuated the deficit with significant effects at 0.3125 and 0.625 mg/kg (P < 0.05). WAY-100635 at 0.3 and 1.0 mg/kg produced a partial attenuation of buspirone's effect as buspirone (0.3125 mg/kg) in the presence of WAY-100635 did not significantly reverse the PCP-induced deficit.

CONCLUSIONS

These studies implicate the role of 5-HT(7), 5-HT(2C), and 5-HT(1A) receptors in the improvement of cognitive dysfunction of relevance to schizophrenia.

Downregulation of oligodendrocyte transcripts is associated with impaired prefrontal cortex function in rats

Abnormalities of brain white matter and oligodendroglia are among the most consistent findings in schizophrenia (Sz) research. Various gene expression microarray studies of post-mortem Sz brains showed a downregulation of myelin transcripts, while imaging and microscopy studies demonstrated decreases in prefrontal cortical (PFC) white matter volume and oligodendroglia density. Currently, the extent to which reduced oligodendrocyte markers contribute to pathophysiological domains of Sz is unknown. We exposed adolescent rats to cuprizone (CPZ), a copper chelator known to cause demyelination in mice, and examined expression of oligodendrocyte mRNA transcripts and PFC-mediated behavior. Rats on the CPZ diet showed decreased expression of mRNA transcripts encoding oligodendroglial proteins within the medial PFC, but not in the hippocampus or the striatum. These rats also displayed a specific deficit in the ability to shift between perceptual dimensions in the attentional set-shifting task, a PFC-mediated behavioral paradigm modeled after the Wisconsin Card Sorting Test (WCST). The inability to shift strategies corresponds to the deficits exhibited by Sz patients in the WCST. The results demonstrate that a reduction in oligodendrocyte markers is associated with impaired PFC-mediated behaviors. Thus, CPZ exposure of rats can serve as a model to examine the contribution of oligodendrocyte perturbation to cognitive deficits observed in Sz.

D(1)-like receptor activation improves PCP-induced cognitive deficits in animal models: Implications for mechanisms of improved cognitive function in schizophrenia

Phencyclidine (PCP) produces cognitive deficits of relevance to schizophrenia in animal models. The aim was to investigate the efficacy of the D(1)-like receptor agonist, SKF-38393, to improve PCP-induced deficits in the novel object recognition (NOR) and operant reversal learning (RL) tasks. Rats received either sub-chronic PCP (2 mg/kg) or vehicle for 7 days, followed by a 7-day washout. Rats were either tested in NOR or the RL tasks. In NOR, vehicle rats successfully discriminated between novel and familiar objects, an effect abolished in PCP-treated rats. SKF-38393 (6 mg/kg) significantly ameliorated the PCP-induced deficit (P<0.01) an effect significantly antagonised by SCH-23390 (0.05 mg/kg), a D(1)-like receptor antagonist (P<0.01). In the RL task sub-chronic PCP significantly reduced performance in the reversal phase (P<0.001); SKF-38393 (6.0 mg/kg) improved this PCP-induced deficit, an effect antagonised by SCH-23390 (P<0.05). These results suggest a role for D(1)-like receptors in improvement of cognitive function in paradigms of relevance to schizophrenia.

Endophenotypes in schizophrenia: a selective review

BACKGROUND

Given the wealth of data in the literature on schizophrenia endophenotypes, it is useful to have one source to reference their frequency data. We reviewed the literature on disease-liability associated variants in structural and functional magnetic resonance images (MRI), sensory processing measures, neuromotor abilities, neuropsychological measures, and physical characteristics in schizophrenia patients (SCZ), their first-degree relatives (REL), and healthy controls (HC). The purpose of this review was to provide a summary of the existing data on the most extensively published endophenotypes for schizophrenia.

METHODS

We searched PubMed and MedLine for all studies on schizophrenia endophenotypes comparing SCZ to HC and/or REL to HC groups. Percent abnormal values, generally defined as >2 SD from the mean (in the direction of abnormality) and/or associated effect sizes (Cohen's d) were calculated for each study.

RESULTS

Combined, the articles reported an average 39.4% (SD=20.7%; range=2.2-100%) of abnormal values in SCZ, 28.1% (SD=16.6%; range=1.6-67.0%) abnormal values in REL, and 10.2% (SD=6.7%; range=0.0-34.6%) in HC groups.

CONCLUSIONS

These findings are reviewed in the context of emerging hypotheses on schizophrenia endophenotypes, as well as a discussion of clustering trends among the various intermediate phenotypes. In addition, programs for future research are discussed, as instantiated in a few recent large-scale studies on multiple endophenotypes across patients, relatives, and healthy controls.

Comparison of haloperidol, risperidone, sertindole, and modafinil to reverse an attentional set-shifting impairment following subchronic PCP administration in the rat--a back translational study

RATIONALE

Selective cognitive impairments, including those of executive function as assessed using the Wisconsin Card Sort Test or intradimensional-extradimensional (ID-ED) tests, are a key feature of schizophrenia but remain inadequately treated by existing therapies. Recently, however, modafinil has been shown to improve attentional set-shifting performance in patients with schizophrenia.

OBJECTIVE

The present study evaluated the recently described analogous rat ID-ED attentional set-shifting task by investigating the effects of various pharmacological challenges to a phencyclidine (PCP)-induced ED shift impairment, namely, haloperidol, risperidone, sertindole, and modafinil.

MATERIALS AND METHODS

Rats were subjected to a subchronic systemic administration of either saline vehicle or PCP (5 mg/kg i.p. b.i.d. for 7 days) followed by a 7-day washout period. During this period, rats were trained to dig in baited bowls for a food reward and to discriminate based on odor or digging media. In a single test session conducted the day after the washout period (day 8), rats performed a series of discriminations following acute administration of either vehicle, or haloperidol (0.1 mg/kg s.c.), or risperidone (0.2 mg/kg i.p.), or sertindole (1.25 mg/kg p.o.) or modafinil (64 mg/kg p.o.).

RESULTS

The subchronic PCP-induced ED deficit was ameliorated by sertindole and modafinil but not by haloperidol or risperidone.

CONCLUSIONS

Overall, these findings further support that the rat ID-ED test in subchronic PCP-treated rats has utility and validity as a preclinical model of the cognitive symptoms of schizophrenia and demonstrates back-translational potential.

Asenapine restores cognitive flexibility in rats with medial prefrontal cortex lesions

RATIONALE

Cognitive inflexibility in schizophrenia is treatment-resistant and predictive of poor outcome. This study examined the effect of asenapine, a novel psychopharmacologic agent being developed for schizophrenia and bipolar disorder, on cognitive dysfunction in the rat.

OBJECTIVES

The objective of this paper was to establish whether asenapine has a beneficial effect on the performance of rats with ibotenic acid-induced lesion of the medial prefrontal cortex (mPFC) in an intradimensional/extradimensional (ID/ED) test of cognitive flexibility.

METHODS

The effect of subcutaneously administered asenapine (0.75, 7.5, 75 microg/kg) on ID/ED performance of controls or mPFC-lesioned rats was examined using a within-subjects, repeated-measures design. In a second experiment, lesioned and control rats were tested with or without asenapine in a modified version of the task, with multiple set-shifts, before brains were processed for Fos-immunoreactivity in the mPFC.

RESULTS

The mPFC lesion-induced deficit in the ID/ED task was stable with repeated testing over more than two months. Asenapine (75 microg/kg s.c., p < 0.05) completely restored the performance of lesioned rats. Experiment 2 replicated both lesion and asenapine effects and demonstrated that it is possible to measure set-shifting multiple times within a test session. Asenapine (75 microg/kg s.c.) was associated with differential activation of the neurons in the anterior mPFC of lesioned animals, but was without effect in controls.

CONCLUSION

Asenapine can ameliorate mPFC lesion-induced impairment in attentional set-shifting, and is associated with a greater activation of the spared neurons in the anterior mPFC. These data suggest that asenapine may benefit impaired cognitive flexibility in disorders such as schizophrenia.

The Wisconsin Card Sorting impairment in schizophrenia is evident in the first four trials

BACKGROUND

Schizophrenia (SZ) patients' low scores on the Wisconsin Card Sorting Test (WCST) are often attributed to frequent perseverative errors, a pattern typically interpreted as a failure to shift from previously rewarded behavior in response to negative feedback. In this study we tested the hypothesis that SZ patients, due to dysregulated error-processing mechanisms, are more fundamentally impaired in their on-line, trial-to-trial use of feedback to guide behavior.

METHODS

Analysis of archival WCST data from 145 adults with schizophrenia and 80 healthy comparison subjects.

RESULTS

Schizophrenia patients' impaired use of negative feedback was evident on the first four WCST cards, where they were significantly less accurate than comparison subjects. Performance on these early cards significantly predicted overall task success as indexed by categories completed and proportion of perseverative errors.

CONCLUSIONS

Patients' poor performance on pre-shift WCST trials likely reflects a fundamental impairment in the ability to use feedback to guide behavior. Recent data from both humans and primates suggest that reward-based learning processes like those employed in the WCST are driven by phasic changes in midbrain dopamine activity. It might, therefore, be possible to interpret higher order executive dysfunction in schizophrenia as a manifestation of altered DA signaling.

Subchronic and chronic PCP treatment produces temporally distinct deficits in attentional set shifting and prepulse inhibition in rats

RATIONALE

We have previously demonstrated that subchronic (five daily administrations of 2.6 mg/kg PCP) and chronic intermittent administration of 2.6 mg/kg PCP to rats produces hypofrontality and other neurochemical changes akin to schizophrenia pathology (Cochran et al., Neuropsychopharmacology, 28:265-275, 2003).

OBJECTIVES

We sought to determine whether behavioral alterations related to discrete aspects of schizophrenia are also induced by these PCP treatment regimes.

MATERIALS AND METHODS

Following administration of vehicle or PCP according to the protocols described above, rats were assessed for attentional set shifting ability, prepulse inhibition (PPI), or social interaction and the locomotor response to a challenge dose of amphetamine.

RESULTS

Ability to shift attentional set was impaired 72 h after the last PCP administration following the subchronic and chronic intermittent treatment regimes. PPI was disrupted after each acute administration of PCP in animals under the subchronic treatment regime. However, PPI deficits were not sustained 72 h after the last of five daily administrations. In subchronic and chronic PCP treated animals, no change was found in social interaction behavior, and there was little change in baseline or amphetamine-stimulated locomotor activity, employed as an indicator of dopaminergic hyperfunction.

CONCLUSIONS

The temporally distinct behavioral effects of these PCP treatment regimes suggest that PPI deficits relate directly to acute NMDA receptor antagonism, whereas the more enduring set shifting deficits relate to the longer term consequences of NMDA receptor blockade. Therefore, these subchronic and chronic PCP treatment regimes produce hypofrontality (Cochran et al., Neuropsychopharmacology, 28:265-275, 2003) and associated prefrontal cortex-dependent deficits in behavioral flexibility which mirror core deficits in schizophrenia.

Behavioural and neurochemical effects of post-weaning social isolation in rodents-relevance to developmental neuropsychiatric disorders

Exposing mammals to early-life adverse events, including maternal separation or social isolation, profoundly affects brain development and adult behaviour and may contribute to the occurrence of psychiatric disorders, such as depression and schizophrenia in genetically predisposed humans. The molecular mechanisms underlying these environmentally induced developmental adaptations are unclear and best evaluated in animal paradigms with translational salience. Rearing rat pups from weaning in isolation, to prevent social contact with conspecifics, produces reproducible, long-term changes including; neophobia, impaired sensorimotor gating, aggression, cognitive rigidity, reduced prefrontal cortical volume and decreased cortical and hippocampal synaptic plasticity. These alterations are associated with hyperfunction of mesolimbic dopaminergic systems, enhanced presynaptic dopamine (DA) and serotonergic (5-HT) function in the nucleus accumbens (NAcc), hypofunction of mesocortical DA and attenuated 5-HT function in the prefrontal cortex and hippocampus. These behavioural, morphological and neurochemical abnormalities, as reviewed herein, strongly resemble core features of schizophrenia. Therefore unravelling the mechanisms that trigger these sequelae will improve our knowledge of the aetiology of neurodevelopmental psychiatric disorders, enable identification of longitudinal biomarkers of dysfunction and permit predictive screening for novel compounds with potential antipsychotic efficacy.

Neurobiological underpinnings of insight deficits in schizophrenia

Impaired insight into illness is commonly observed across various psychiatric illnesses, but is most frequent in patients with schizophrenia. The clinical relevance and public health impact of poor insight is reflected by its close association with important clinical outcome measures, such as treatment non-adherence, lower psychosocial functioning, poor prognosis, involuntary hospitalization, and higher utilization of emergency services. Although the neurobiology of insight has not been determined, data from neurocognitive and a few structural imaging studies provide some understanding of the neurobiological underpinnings of insight function in schizophrenia. Using published and preliminary data, we propose a hypothetical model of insight that may help initiate neurobiological investigations in this complex area.

Cognitive deficits and functional outcome in schizophrenia

Cognitive dysfunction is a core feature of schizophrenia. Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits pre-date the onset of frank psychosis and are stable throughout the course of the illness in most patients. Over the past decade, the focus on these deficits has increased dramatically with the recognition that they are consistently the best predictor of functional outcomes across outcome domains and patient samples. Recent treatment studies, both pharmacological and behavioral, suggest that cognitive deficits are malleable. Other research calls into question the meaningfulness of cognitive change in schizophrenia. In this article, we review cognitive deficits in schizophrenia and focus on their treatment and relationship to functional outcome.

Insight and frontal cortical function in schizophrenia: a review

Insight into illness has been identified as a clinically important phenomenon, in no small part due to an association with treatment-adherence. An increasing number of studies, but not all, have observed poor insight to be a reflection of cognitive dysfunction in schizophrenia. A review of 34 published English-language studies found a significant number (i.e., 21) reporting a relationship between insight deficits and impaired performance on cognitive tasks primarily mediated by frontal cortex. A significant number of reviewed studies examined insight function in more than one psychiatric population, including bipolar and schizoaffective disorder. The most replicated findings from these studies were the correlations between insight deficits and impaired performance on the Wisconsin Card Sorting Test (WCST). More specifically, WCST perseverative errors correlated positively and the number of categories completed correlated negatively with poor insight, suggesting that impaired insight may be mediated by deficiencies in conceptual organization and flexibility in abstract thinking. Since the WCST requires the ability to demonstrate conceptual flexibility through the generation, maintenance and switching of mental sets along with the capacity to use verbal feedback to correct errors, it would appear that such 'executive' functions are most related to insight. In addition, recently identified structural correlates of poor insight in schizophrenia show some association with anosognosia in neurological patients. This review will discuss the implications of these findings and directions for future research.

Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test

The specific role of particular cerebral regions with regard to executive functions remains elusive. We conducted a functional magnetic resonance imaging (fMRI) study to segregate different network components underlying the Wisconsin Card Sorting Test (WCST), a test widely applied clinically to assess executive abilities. Three different test variants of the WCST, differing in task complexity (A > B > C), were contrasted with a high-level baseline condition (HLB). Cognitive subcomponents were extracted in a serial subtraction approach (A-C, A-B, B-C). Imaging data were further subjected to a correlational analysis with individual behavioral parameters. Contrasting A with the HLB revealed the entire neural network underlying WCST performance, including frontoparietal regions and the striatum. Further analysis showed that, within this network, right ventrolateral prefrontal cortex related to simple working memory operations, while right dorsolateral prefrontal cortex related to more complex/manipulative working memory operations. The rostral anterior cingulate cortex (ACC) and the temporoparietal junction bilaterally represented an attentional network for error detection. In contrast, activation of the caudal ACC and the right dorsolateral prefrontal cortex was associated with increased attentional control in the context of increasing demands of working memory and cognitive control. Non-frontal activations were found to be related to (uninstructed relative to instructed) set-shifting (cerebellum) and working memory representations (superior parietal cortex, retrosplenium). The data provide neural correlates for the different cognitive components involved in the WCST. They support a central role of the right dorsolateral prefrontal cortex in executive working memory operations and cognitive control functions but also suggest a functional dissociation of the rostral and caudal ACC in the implementation of attentional control.

Cognition in schizophrenia: impairments, determinants, and functional importance

Recent findings support and add to earlier findings of cognitive dysfunction in schizophrenia. Deficits across neurocognitive domains such as attention, working memory, language skills, and executive functioning tend to be moderate, with the most pronounced deficits found in verbal learning and memory. All these neurocognitive domains are related to adaptive and social skills, with executive functions and verbal learning and memory showing more variance across more domains than other neuro-cognitive variables. Negative symptoms and neurocognitive domains, although correlated, are distinct and have differential pathways of change with treatment. General psychopathology symptoms, such as depression and anxiety, may become important treatment targets as strategies are developed for translating cognitive enhancement to real-world functional performance.

Systemic and prefrontal cortical NMDA receptor blockade differentially affect discrimination learning and set-shift ability in rats

The authors examined discrimination rule learning and extradimensional set-shifting ability in rats given systemic or intracranial injections of the N-methyl-D-aspartate (NMDA) receptor antagonist MK801. Pretraining systemic injections of MK801 impaired both the acquisition of the initial discrimination rule (Set 1) and the shift to the 2nd rule (Set 2). Pretraining intramedial prefrontal cortical (mPFC) administration of MK801 did not impair Set 1 acquisition. Intra-mPFC injection of MK801 was previously found to impair Set 2 acquisition. Impaired Set 2 performance was due to increased cognitive perseveration. The data suggest that discrimination learning in naive subjects requires NMDA receptors outside the mPFC, whereas NMDA receptors within the mPFC are selectively involved in the modification of previous knowledge and/or the inhibition of previously learned responses.

Impairment in perceptual attentional set-shifting following PCP administration: a rodent model of set-shifting deficits in schizophrenia

RATIONALE

Impaired ability to shift perceptual attentional set forms a core feature of schizophrenic illness and is associated with prefrontal cortical dysfunction. A pharmacological model producing equivalent deficits in rodents may enable the development of novel therapeutic strategies for effective treatment of cognitive impairments in schizophrenia.

OBJECTIVE

This study was designed to investigate the effects of phencyclidine (PCP) administration on performance in a rodent attentional set-shifting task and the neural correlates of PCP-induced deficits in task performance.

METHODS

Twenty-four hours following acute administration of 2.58 mg/kg PCP or vehicle, rats were tested on a perceptual attentional set shifting task (Birrell and Brown in J Neurosci 20:4320-4324, 2000). Following completion of the task, in situ hybridisation was employed to detect concurrent regional alterations in zif-268 and parvalbumin mRNA expression.

RESULTS

PCP administration selectively decreased the ability of rats to shift attentional set between perceptual dimensions (extra-dimensional shift, EDS). This impairment was accompanied by, and correlated with, decreases in expression of zif-286 in the infralimbic cortex and of parvalbumin in the dorsal reticular nucleus of the thalamus.

CONCLUSION

Acute administration of PCP produces deficits in perceptual set shifting comparable to an aspect of executive dysfunction in schizophrenia. Moreover, this impairment is associated with altered medial prefrontal cortical and reticular thalamic activity. Therefore, this rodent paradigm may model the set-shifting deficits that form a core feature of schizophrenic pathology.

Relative left-frontal activity is associated with increased depression in high reassurance-seekers

Excessive reassurance-seeking, which has been associated with depression in many studies, can be defined as the relatively stable tendency to seek assurance perseveratively from others. We hypothesized that although depression has been associated with left-frontal EEG hypoactivity, reassurance-seekers may possess a unique diathesis that is more likely to be associated with increased left-frontal activity. Data were collected from 12 volunteers who were receiving therapeutic services from a University Clinic. EEG asymmetry scores were averaged over two measurement occasions at least 3 weeks apart. As predicted, stable relative right-frontal activity was associated with increased depression in those who were low on reassurance-seeking, while stable relative left-frontal activity was associated with increased depression among high reassurance-seekers. Perhaps those who seek reassurance excessively do so because of their inability to alter their behavior even when environmental cues are no longer reinforcing, which can maintain or exacerbate their depressive symptoms.

The impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance

Several lesion and imaging studies have suggested that the Wisconsin Card Sorting Test (WCST) is a measure of executive dysfunction. However, some studies have reported that this measure has poor anatomical specificity because patients with either frontal or non-frontal focal lesions exhibit similar performance. This study examined 25 frontal, 20 non-frontal low-grade brain tumor patients, and 63 normal controls (NC) on the WCST. The frontal patients were also assigned to either a left frontal (n=10) group or a right frontal group (n=15) and compared with the non-frontal group and NC. It was hypothesized that the frontal brain tumor patients would display greater deficits on categories achieved and a higher number of perseverative errors than non-frontal brain tumor patients on the WCST. Finally, it was predicted that right frontal brain tumors would result in greater executive functioning deficits than left frontal or non-frontal brain tumors. Results indicated that the left frontal group achieved the fewest categories and committed the most perseverative errors compared to the other patient and normal control groups. In addition, the left frontal group committed significantly more perseverative errors than the right frontal group. These results suggest that the WCST is sensitive to the effects of low-grade brain tumors on executive functioning.

Glutamate receptors in the rat medial prefrontal cortex regulate set-shifting ability

The authors examined set-shifting abilities in rats injected with antagonists of N-methyl-D-aspartate (NMDA) receptors (MK801) or alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptors (LY293558) into the medial prefrontal cortex (mPFC). Set-shifting was assessed with a maze-based task requiring a switch between brightness and texture discrimination strategies. Intra-mPFC injection of MK801 prior to training on the 2nd discrimination impaired discrimination strategy acquisition. The MK801-induced deficit was due to increased perseverative responding. AMPA receptor blockade also impaired acquisition of the 2nd discrimination; these impairments were due to more general cognitive deficits. Results suggest that, within the mPFC, both AMPA and NMDA receptors are necessary for set-shifting, and that NMDA receptor hypofunction impairs the capacity to modify existing knowledge or to inhibit responses that are no longer appropriate.

Typical and atypical antipsychotic medications differentially affect two nondeclarative memory tasks in schizophrenic patients: a double dissociation

Nondeclarative memory (NDM) has subtypes associated with different brain regions; learning of a probabilistic classification task is impaired by striatal damage and learning of a gambling task is impaired by ventromedial prefrontocortical damage. Typical and atypical antipsychotic medications differentially affect immediate early gene expression in the striatum and frontal cortex in normal rats. This suggested the hypothesis that schizophrenic patients treated with typical antipsychotics will have impaired probabilistic classification learning (PCL) and that similar patients treated with atypical antipsychotics will have impaired learning of the gambling task. Groups of schizophrenia patients treated with typical or atypical antipsychotics did not differ from each other on the Brief Psychiatric Rating Scale (BPRS), Mini Mental State Exam (MMSE) or a number of indexes of the Wisconsin Card Sorting Task (WCST) but performed worse than normal controls on these instruments. In the first study, patients treated with typicals (n=20) but not atypicals (n=20) or normal controls (n=32) were impaired in probabilistic classification. In the second study, those treated with atypicals (n=18) but not typicals (n=18) or normal controls (n=18) were impaired in the gambling task. Results suggest that typical and atypical antipsychotics differentially affect nondeclarative memory mediated by different brain regions.

A meta-analytic review of the sensitivity of the Wisconsin Card Sorting Test to frontal and lateralized frontal brain damage

The author conducted 2 meta-analyses on the Wisconsin Card Sorting Test (WCST). The 1st compared participants with frontal lobe damage to those with posterior brain damage, whereas the 2nd compared participants with left and right frontal damage. Effect sizes based on the difference between groups were calculated for WCST variables and a composite measure. Effect sizes for these variables, except nonperseverative errors, indicated significantly poorer performance for participants with frontal damage. There were no significant differences for the left versus right comparisons. Moderator analyses using the composite measure for the frontal versus nonfrontal analyses indicated that the largest effect size was for dorsolateral damage. Though this study indicates that the WCST is sensitive to frontal lobe damage, caveats are discussed.

Perseveration in schizophrenia: failure to generate a plan and relationship with the psychomotor poverty subsyndrome

Although perseveration in the Wisconsin Card Sorting Test (WCST) has been studied extensively in schizophrenia, the underlying cognitive dysfunctions are not yet clear. In schizophrenia, perseveration has been found to relate to frontal and striatal abnormalities. Therefore, both a failure to generate a plan as seen in patients with frontal abnormalities, or a failure to execute a plan as observed in Parkinson patients, who suffer primarily from striatal abnormalities, could explain perseveration in schizophrenia. The aim of the present study was to distinguish between these two cognitive dysfunctions, which are described by Frith in his routes-to-action model. The main difference between these dysfunctions is the ability to use external guidance. In the present study, 39 schizophrenic patients and 36 healthy controls were assessed with the California Verbal Learning Test (CVLT) and the WCST, in which use of external guidance can be measured, and with the Positive and Negative Syndrome Scale (PANSS) to determine the relationship with symptomatology. The results showed that half of the schizophrenic patients showed perseveration, which could be explained by a failure to generate a plan and was related to the psychomotor poverty subsyndrome. No evidence was found for a failure to execute a plan. Type of antipsychotic medication used (atypical vs. typical) proved not relevant. The results are discussed in the light of evidence for involvement of the dorsolateral prefrontal cortex in perseveration in schizophrenia.

Associations between EEG asymmetries and electrodermal lability in low vs. high depressive and anxious normal individuals

In order to investigate one aspect of cortical-autonomic control, cortical activation asymmetries, measured by EEG, were related to activity of the sympathetic nervous system, measured by EDA (electrodermal lability, number of spontaneous fluctuations), in two large samples. Since it may help to explain the participation of psychological factors in the development of various somatic complaints and disorders, we examined whether inter-individual differences in autonomic nervous system regulation may exist that are related to stress/anxiety and depression within the normal range. Results demonstrate substantial modifications of functional hemisphere asymmetries in the modulation of EDA by these emotional factors and suggest that activation asymmetries in orbital and dorsolateral frontal regions reflect two different cortical sub-systems regulating electrodermal activity. The findings may, to some extent, provide an explanation for contradictory results in previous studies and may encourage research in psychosomatics and other clinical fields (e.g. schizophrenia).

Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes

Forty-six patients with single focal lesions (35 frontal, 11 nonfrontal) were administered the Wisconsin Card Sorting Test (WCST) under three conditions of test administration. The three conditions varied in the amount of external support provided via specificity of instructions. The WCST, while a multifactorial test, is specifically sensitive to the effects of frontal lobe damage if deficits in language comprehension and visual-spatial search are controlled. There is also specificity of functioning within the frontal lobes: patients with inferior medial frontal lesions, unilateral or bilateral, were not impaired on the standard measures although they had increased loss of set when informed of the sorting categories. Verbal instructions may provide a probe to improve diagnosis and prognosis, assessment of the potential efficacy of treatment, and the time frame of plasticity of specific cognitive operations.

A meta-analytic review of Wisconsin Card Sort studies in schizophrenia: general intellectual deficit in disguise?

A majority of studies show that schizophrenics perform poorly on so-called tests of executive or frontal lobe function--the paradigmatic case being the Wisconsin Card Sort Test (WCST). Nevertheless, the specific character of this deficit in schizophrenia remains underspecified. In particular, it seems premature to assume that schizophrenia is characterised by an executive dysfunction and/or a disorder of frontal lobe function before determining whether any deficit is: selective; disproportionate to the general level of intellectual functioning; or qualitatively comparable with that of frontal lobe patients. A meta-analysis was conducted on 29 studies comparing the performance of schizophrenics and normal controls on the WCST. This showed that the mean weighted effect size was large for categories achieved (d = 0.91), medium for absolute level of perseveration (d = 0.53), but only small for the proportion of perseverative errors (d = 0.18). By contrast, the effect size for Wechsler Adult Intelligence Scale Intelligence Quotient (WAIS IQ) in a subset of these studies (d = 1.23) was significantly larger than for any WCST measures. This pattern of findings challenges notions that schizophrenia is characterised by an executive dysfunction that is: selective; disproportionate to IQ level; and analogous to that found in frontal lobe patients. Rather, the poor WCST performance of schizophrenics appears to reflect a generalised intellectual deficit.