Is lateral bias anomalous in early-onset schizophrenia? Selected comparisons with normal populations

Significant gender-specific difference in brain lateralization of schizophrenia patients assessed by new combined foot dominance scale

Objective

Reduced hemispheric asymmetry has been identified as a potential risk factor for schizophrenia, characterized by diminished brain lateralization and a lack of dominance in the left hemisphere. Moreover, there is growing evidence of disrupted connectivity between various cortical regions. This study aimed to investigate gender differences in left-footedness as a potential biological marker for neuronal dysontogenesis in individuals with schizophrenia and control subjects.

Materials and methods

A New Combined Foot Dominance Scale (14 foot tests), comprising a Modified Chapman & Chapman Subscale (10 foot tests) and a Complex Tasks Subscale (four foot tests) was administered as performance tasks in 180 subjects [98 schizophrenia patients with mean age 34.45 years (SD = 15.67, range 23-79) for men and 42.20 years (SD = 11.38, range 21-63) for women and 82 controls with a mean age 34.70 years (SD = 16,82, range 18-79) for men and 44.50 years (SD = 10.73, range 23-67)]. As our data are not continuous and lacks normal distribution, the non-parametric Mann-Whitney test was used for comparing categorical data.

Results

The mean left-footedness, as assessed by the New Combined Foot Dominance Scale, is significantly higher in individuals with schizophrenia compared to control subjects. Our findings from inter-gender comparisons reveal that female schizophrenia patients exhibit a significantly greater average left-footedness than female control subjects, while in males no such a statistical significant difference is detected.

Conclusion

Left foot dominance is higher in patients with schizophrenia than in control subjects and women contribute significantly more to this difference.

Eye dominance and minor physical anomalies in schizophrenia: relations between two biological markers of abnormal neurodevelopment

Background

To investigate the frequency of left eye dominance and minor physical anomalies (MPAs) in schizophrenia patients and control subjects and determine the interrelations of these two biological markers of neuronal dysontogenesis in schizophrenia.

Subjects and methods

Three tests for eye dominance were administered as performance tasks, not preference questionnaires. Seven MPAs were examined. The sample consisted of 180 (98 schizophrenia patients and 82 control subjects). Several statistical methods for examining the eye tests separately and together were used to assess the difference in left-eyedness between schizophrenia patients and control subjects.

Results

Left eye dominance is significantly higher in schizophrenia subjects. Left-eyed subjects are more stigmatized with MPAs. There is a strong positive correlation between left-eyedness and stigmatization with MPAs in schizophrenia patients.

Conclusion

As hand dominance is under cultural pressure, eye dominance is culturally independent and is useful and reliable indicator of altered hemispheric lateralization. The significant positive correlations between left-eyedness and MPAs and the high concurrence of these biological markers in schizophrenia patients are a potent indicator of underlying aberrant neurodevelopment.

Hair Whorl Direction: The Association with Handedness, Footedness, and Eyedness

Hair whorl direction and handedness were stated to have a common genetic basis in the random recessive model. This study was carried out with a total of 317 healthy young males. The association between hair whorl swirling direction and handedness, footedness and eyedness were assessed. The direction of hair whorl was clockwise at a rate of 76.7%, and counter clock wise at a rate of 23.3%. There was no significant association between hair whorl direction and handedness, footedness, and eyedness (p > .05). The results indicate that hair whorl swirling direction is not an evident marker of functional laterality.

Childhood pegboard task predicts adult-onset psychosis-spectrum disorder among a genetic high-risk sample

Motor abnormalities have been established as a core aspect of psychosis-spectrum disorders, with numerous studies identifying deficits prior to clinical symptom presentation. Additional research is needed to pinpoint standardized motor assessments associated with psychosis-spectrum disorders prior to illness onset to enhance prediction and understanding of etiology. With a long history of findings among people with diagnosable psychosis-spectrum disorders, but little research conducted during the premorbid phase, pegboard tasks are a viable and understudied measure of premorbid for psychosis motor functioning. In the current study, examining data from the Copenhagen Perinatal Cohort, the Simultaneous Pegs Test was performed with children (n=244, aged 10-13) at genetic high risk for psychosis (n=94) and controls (n=150). Findings suggest that children who eventually developed a psychosis-spectrum disorder (n=33) were less likely to successfully complete the task within time limit relative to controls (χ²(2, N=244)=6.94, p=0.03, ϕ=0.17). Additionally, children who eventually developed a psychosis-spectrum disorder took significantly longer to complete the task relative to controls (χ²(2, N=244)=7.06, p=0.03, ϕ=0.17). As pegboard performance is thought to tap both diffuse and specific brain networks, findings suggest that pegboard tests may be useful premorbid measures of motor functioning among those on a trajectory towards a psychosis-spectrum disorder.

Excess of non-right-handedness in schizophrenia: meta-analysis of gender effects and potential biases in handedness assessment

BACKGROUND

The notion that schizophrenia is characterised by increased non-right-handedness is a cornerstone of the theory that schizophrenia arises from, and is genetically linked to, abnormal brain lateralisation. Reviews and meta-analyses have reported higher rates of non-right-handers in patients with schizophrenia. However, this was suggested to be the result of a gender artefact or a hidden bias in self-report handedness questionnaires.

AIMS

To investigate using a meta-analytical approach whether the excess of non-right-handedness is seen in both females and males, and also when handedness is assessed behaviourally.

METHOD

Electronic databases were searched for studies that reported (a) the rate of female and male non-right-handers in schizophrenia compared with controls and (b) the rate of non-right-handers in schizophrenia (regardless of gender) based on behavioural handedness assessment.

RESULTS

The odds ratios (ORs) for females (OR = 1.63; based on 621 patients, 3747 controls) and males (OR = 1.50; based on 1213 patients, 3800 controls) differed significantly from 1.0, indicating both female and male patients were more often non-right-handed than controls. Moreover, there was an excess of non-right-handedness in patients with schizophrenia when handedness was assessed behaviourally: OR = 1.84 (1255 patients, 6260 controls). Even when both gender and behavioural handedness assessment were controlled for simultaneously, the excess of non-right-handedness persisted.

CONCLUSIONS

The findings clearly demonstrate that the excess of non-right-handedness in schizophrenia does not result from a gender artefact or from biased handedness questionnaires. It is a true empirical effect and may indeed reflect a genetic link between schizophrenia and brain lateralisation.

Asymmetries of the parietal operculum in chimpanzees (Pan troglodytes) in relation to handedness for tool use

A left larger than right planum temporale (PT) is a neuroanatomical asymmetry common to both humans and chimpanzees. A similar asymmetry was observed in the human parietal operculum (PO), and the convergence of PT and PO asymmetries is strongly associated with right-handedness. Here, we assessed whether this combination also exists in common chimpanzees. Magnetic resonance scans were obtained in 83 captive subjects. PT was quantified following procedures previously employed and PO was defined as the maximal linear distance between the end point of the sylvian fissure and the central sulcus. Handedness was assessed using 2 tasks that were designed to simulate termite fishing of wild chimpanzees and to elicit bimanual coordination without tool use. Chimpanzees showed population-level leftward asymmetries for both PT and PO. As in humans, these leftward asymmetries were not correlated. Handedness for tool use but not for nontool use motor actions mediated the expression of asymmetries in PT and PO, with right-handed apes showing more pronounced leftward asymmetries. Consistent PT and PO asymmetry combinations were observed in chimpanzees. The proportions of individuals showing these combinations were comparable in humans and chimpanzees; however, interaction between handedness and patterns of combined PO and PT asymmetries differed between the 2 species.

Handedness is modulated by sex and self-perception

The distribution of handedness is different for men and women. Less pronounced right- or left-handedness in men is well established and often attributed to direct effects of genetic factors. Many studies observing this sex difference assessed handedness via questionnaire. It may therefore be influenced by a sex-specific bias in self-perception. Permanent inadequate self-perceptions are key characteristics of hypochondriasis. The study therefore tested 1017 participants (614 females) on two standard questionnaires to assess handedness and hypochondriasis: the Edinburgh Inventory and the Whiteley Index. Effects of sex, hypochondriac traits and the direction of handedness (left-handers; right-handers) on the degree of handedness (DH; the strength of lateralisation) were tested with multivariate linear regression. In confirmation of previous results, the DH is lower (less pronounced) in right-handed males than right-handed females, but is similar across sexes in left-handers. Regression analyses showed that for right-handers, male sex and higher hypochondriac traits are independent predictors of lower DH. For left-handers, main effects of sex and hypochondriac traits are not significant whereas a significant interaction of these two factors indicates that in left-handed men higher hypochondriac traits are associated with a differentially stronger shift towards lower DH compared to left-handed women. In conclusion, the DH is modulated by sex-specific effects of self-perception for left-handers but not right-handers. The implications of this finding on current theories of the inheritance of handedness are discussed. The assessment of hypochondriac traits might be useful to control response bias in questionnaire-based studies of human handedness.

A psychometric approach to the relationship between hand-foot preference and auditory hallucinations in the general population: atypical cerebral lateralization may cause an abnormal sense of agency

The present study examined the relationship between the atypical cerebral lateralization pattern represented in hand and foot preferences and schizotypal personality traits, especially proneness to auditory hallucinations as related to a sense of agency. A sense of agency, measured with questionnaires in the present study, is the sense that "I am the one who causes the actions." Although atypical lateralization and an abnormal sense of agency may be related to schizophrenia or schizotypal personality, the connection between them has remained unclear. The present study used cluster analysis to categorize the handedness-footedness combinations. The results indicated that people with right-handedness and left-footedness may have more schizotypal traits and that their abnormal sense of agency may cause schizotypal personality traits. Although the reasons for crossed lateral preference remain unclear, we discuss this in terms of early switching in handedness, which may underlie atypical lateralization and lead to the experience of auditory hallucinations deriving from an abnormal sense of agency.

Reduced language lateralization in first-episode medication-naive schizophrenia

Diminished functional lateralization in language-related areas is found in chronic schizophrenia. It is not clear at what stage of illness these abnormalities in lateralization arise, or whether they are affected by medication. In addition, it is hypothesized that reduced language lateralization is related to positive symptoms of schizophrenia, but studies addressing this issue have yielded contradictory results. In this study we used functional MRI to measure language lateralization in 35 first-episode medication-naive schizophrenia patients and 43 matched healthy controls. Subjects performed three language tasks: a paced verb generation task, an antonym generation task, and a semantic decision task. Lateralization Index (LI) was calculated, using a relative threshold technique, in seven Regions of Interest (ROIs), including the main language-related areas and their contralateral homologues. In addition, we investigated whether language lateralization was correlated with psychotic symptoms. Across all ROIs, LI was significantly reduced in patients (p<0.001) compared to controls. Post-hoc tests revealed that this reduction was most prominent in the inferior frontal gyrus (part of Broca's area) (p=0.003) and the superior temporal gyrus (part of Wernicke's area) (p<0.001). LI was not correlated with the positive subscale of the PANSS, nor with hallucinations or disorganization. This is the first study to report reduced LI at the onset of schizophrenia, before medical treatment is initiated.

Increased ratio of 2nd to 4th digit (2D:4D) in schizophrenia

Sex differences in the onset, epidemiology, clinical presentation and neuropathology of schizophrenia suggest that sexual dimorphism in brain development may be relevant to pathogenesis. Sex hormones, in particular testosterone, are considered to be crucial in brain development, but few investigations have examined the potential role of prenatal testosterone in schizophrenia. In this study, we examined a retrospective marker of prenatal testosterone release - 2D:4D finger length ratio (2D:4D), the relative length of 2nd to 4th digit, in 64 Asian patients with schizophrenia and 64 sex-matched controls. No significant difference in mean finger lengths was present, however 2D:4D ratio was significantly different between patients and controls. The effect was primarily seen in males consistent with a 'less masculinised' pattern and hypotheses suggesting that schizophrenia may be associated with an abnormality in prenatal circulating testosterone.

RELATIONSHIPS BETWEEN HAND AND FOOT PREFERENCES

The aim of this study was to evaluate the relations between hand and foot preferences in male and female individuals (343 male, 290 female) aged between 18-42 years (22.11 +/- 2.07). Of the right-handed men, 75.5% preferred the right foot, 7.1% the left foot, and 17.4% both feet. Of ambidextrous men, 44.0% preferred the right foot, 28.0% the left foot, and 28.0% both feet. Of left-handed men, 32.3% preferred the right foot, 56.9% the left foot, and 10.8% both feet. The differences between these percentages were found to be statistically significant. Of the right-handed women, 89.9% preferred the right foot, left foot 1.2%, both feet 8.9%, whereas 50.0% preferred the right foot, 12.5% the left foot, and 37.5% both feet in the ambidextrous women. In the left-handed women, 8.8% preferred the right foot, 79.4% the left foot, and 11.8% both feet. The differences between these percentages were found to be statistically significant. The results suggested that the cultural differences among the difference study groups may be the reason for the inconsistencies with regard to hand and foot preferences. Moreover, the results may bring insight into the foot preference in relation to hand preference in the Turkish population.

Mixed handedness and achievement test scores of middle school boys

The purpose of the study was to replicate findings of an earlier study of fourth grade boys manifesting mixed handedness with a sample. Among 32 mixed-handed boys in Grades 6 to 8, the right-handed writer, left-handed thrower group obtained low spelling scores (Normal Curve Equivalent Scores) on the California Achievement Test significantly more frequently than the left-handed writer, right-handed thrower group. These findings are consistent with data for Grade 4 boys in the earlier study. Findings strengthen the hypotheses that mixed handedness is not a unitary neuropsychological entity and that boys who write with the right hand and throw with the left hand might be at risk for certain academic deficits.

Schizotypy is increased in mixed-handers, especially right-handed writers who use the left hand for primary actions

Associations between schizotypy and handedness were examined in 733 undergraduates for the Sta and Unex scales of the O-LIFE inventory and several measures derived from the Annett hand preference questionnaire. Higher schizotypy scores were found for mixed-handers defined in various ways, including inconsistent preference for any item of the questionnaire and also the presence of either hand responses. There was a marked elevation of schizotypy scores (p<.001) for right-handed writers who prefer the left hand for other 'primary' actions (throwing, racket, match, hammer, toothbrush and scissors). This observation was replicated in 182 students assessed on the Rust Scale of Schizotypal Cognitions. Several findings agree that inconsistent hand preference is associated with a raised probability of schizotypal thinking.

Laterality phenotypes in patients with schizophrenia, their siblings and controls: associations with clinical and cognitive variables

BACKGROUND

Various behavioural indices of brain lateralisation significantly intercorrelate, but current research in this area still focuses on single behavioural asymmetries, such as handedness.

AIMS

To describe a novel approach, which simultaneously integrates various laterality indices and delineates complex phenotypes.

METHOD

Grade of membership analysis was used to describe latent, complex lateralisation phenotypes in patients with schizophrenia (n=157), their siblings (n=74) and controls (n=77). The indices used were asymmetries of eye, foot and hand; hand motor proficiency; and handedness of patient's first-degree relatives.

RESULTS

Three distinct pure types of lateralisation ('right', 'left' and 'mixed') were evident in patients compared with two ('right' and 'left') in siblings and controls. The 'mixed' type in patients featured absence of eye and foot lateralisation and presence of familial sinistrality, despite a right-hand dominance for writing. Patients with schizophrenia expressing the 'left' phenotype had a more severe course of illness, significantly increased scores on two schizotypy factors and poorer neurocognitive performance. The pure types in the siblings were similar to those in healthy controls.

CONCLUSIONS

The findings suggest that a leftward reversal, rather than a reduction in lateralisation, is associated with clinical severity and neurocognitive deficits in patients with schizophrenia.

Handedness in schizophrenia: a quantitative review of evidence

OBJECTIVE

The prevalence of various anomalous handedness subtypes in schizophrenia patients remains ambiguous. Although current literature favours the notion that the shift in lateral preferences seen is because of an increase of mixed-handedness, several studies suggest that exclusive left handedness is more prevalent than in the general population.

METHOD

Over 40 studies with reported prevalence data on various handedness subtypes in a schizophrenia population were evaluated by meta-analysis. Combined odds ratios for the three common handedness subtypes (left, mixed, and right) were separately calculated.

RESULTS

Each of the three atypical hand dominance patterns were significantly greater in schizophrenia patients than in control subjects, showing that the leftward shift in handedness distribution is not entirely because of an increase in mixed-handedness alone.

CONCLUSION

An increase of exclusive left-handedness is at variance with the prevailing assertion that the handedness shift in schizophrenia patients is because of a diffuse and bilateral hemispheric insult.