Differentiation of organics from schizophrenics at two chronicity levels by use of the Reitan-Halstead organic test battery

What do we know about neuropsychological aspects of schizophrenia?

Application of a neuropsychological perspective to the study of schizophrenia has established a number of important facts about this disorder. Some of the key findings from the existing literature are that, while neurocognitive impairment is present in most, if not all, persons with schizophrenia, there is both substantial interpatient heterogeneity and remarkable within-patient stability of cognitive function over the long-term course of the illness. Such findings have contributed to the firm establishment of neurobiologic models of schizophrenia, and thereby help to reduce the social stigma that was sometimes associated with purely psychogenic models popular during parts of the 20th century. Neuropsychological studies in recent decades have established the primacy of cognitive functions over psychopathologic symptoms as determinants of functional capacity and independence in everyday functioning. Although the cognitive benefits of both conventional and even second generation antipsychotic medications appear marginal at best, recognition of the primacy of cognitive deficits as determinants of functional disability in schizophrenia has catalyzed recent efforts to develop targeted treatments for the cognitive deficits of this disorder. Despite these accomplishments, however, some issues remain to be resolved. Efforts to firmly establish the specific neurocognitive/neuropathologic systems responsible for schizophrenia remain elusive, as do efforts to definitively demonstrate the specific cognitive deficits underlying specific forms of functional impairment. Further progress may be fostered by recent initiatives to integrate neuropsychological studies with experimental neuroscience, perhaps leading to measures of deficits in cognitive processes more clearly associated with specific, identifiable brain systems.

Parkinson's disease, cognition and aging. Clinical, neuropsychological, electrophysiological and cranial computerized tomographic assessment

Forty-three patients with Parkinson's disease (PD) and thirty-seven normal volunteers were subjected to clinical, neuropsychological, neurophysiological (P300 component of the event-related potentials ERP) and radiological (cranial computerized tomographic scanning CCT) evaluation. Intentional memory was more impaired in PD than in normal controls, more so in the demented group of patients, and was related to enlargement of third ventricular size in CCT. While intentional memory was age related in PD patients, perception was age-related in normal controls. Neither global nor specific cognitive functions were related to duration, severity of parkinsonian motor disability, or depression. However, depression in PD was significantly related to parkinsonian motor disability. P300 latency was more prolonged in PD patients than normal controls. P300 parameters of PD patients were not influenced by age, cognitive functions, duration or severity of motor disability, or depression. The reaction time was the only P300 parameter that was age-related in normal controls. Subcortical atrophy as indicated by CCT was more marked in PD and correlated with age in both patients and controls. Subcortical atrophy was significantly related to cognitive functions in PD but not in normal controls. It was concluded that cognitive impairment in PD could be attributed to complex cognitive changes rather than age. It is a disease process, though not directly related to parkinsonian motor disability or depression. PD differed from normal aging as regards the effect of age on the specific cognitive functions, where in PD patients, age was related to intentional memory, yet in normal controls, it was related to perception. Intentional memory deterioration was found to be specific of PD, being related to subcortical atrophy as well as being more pronounced in the demented group of patients.

A new method for detecting brain disorder by measuring perseveration in personality inventory responses

A 130-item personality inventory (the Psychological Screening Inventory, Lanyon, 1970) was used to obtain a novel measure of perseveration coupled with affirmative set. Acquiescent Perseveration (AP), a quantitative behavioral metric, is the sum of the lengths of True (T) response runs 4 and longer, doubling T runs 9 and longer. With male subjects, a one-way ANOVA comparison of heterogeneous organics with five non-organic control groups (normals, neurotics, sociopaths, personality disorders, and schizophrenics) showed mean AP differences greater than .001 versus every control group. The measure, requiring no scoring key, was successfully cross-validated with six similar female groups. AP means for non-organics showed no increase across 5 decades of age. In small supplementary studies AP was related inversely to Shipley Abstraction (Shipley, 1940, 1946) scores and directly to the Halstead-Reitan Impairment Index (Reitan & Davison, 1974). AP, uncorrected for age, IQ or education, matches the best single cognitive neuropsychological tests in distinguishing organics from psychiatric patients. Inventory response sequences contain previously unrecognized latent data sensitive to neuropathology.

Cognitive functioning and symptomatology in chronic schizophrenia

Chronic schizophrenic patients in a long stay hospital were found to have low levels of intelligence (mean IQ of 80), which was attributed to the effects of substantial intellectual deterioration on below average pre-morbid levels of functioning. Patients with the lowest IQ scores had the least severe positive symptoms but symptomatology was not related to age or extent of intellectual decline. Speed of functioning was relatively more impaired than level of intellectual functioning, with cognitive speed being more affected than motor speed. The severity of negative but not positive symptoms was significantly related to the severity of bradyphrenia (cognitive slowing), a result which would be consistent with the notion of a subcortical pathology in patients with Type II schizophrenia.

Current conceptualizations of psychiatric illnesses as neurological disorders

This paper reviews a recent body of evidence from computed tomography, imaging methods, and neuropsychological testing, emphasizing schizophrenia. The review indicates important characteristics of this disorder that can be conceptualized as similar to neurological disorders, and that have a probable neuropathologic basis. Although the argument is compelling in many respects, cautionary observations are also discussed, and a need for positioning subgroups based on neurological etiology is advanced. This serves as an introduction to a discussion of neurological diseases as potential models for psychiatric disorders.

Neuropsychological performance in psychiatric patients with or without documented brain dysfunction

The current study examined neuropsychological performance of schizophrenic and depressed patients with and without structural or EEG signs of brain dysfunctioning. The neuropsychological test battery was designed to sample intellectual functioning, psychomotor skills, nonverbal memory, and novel problem solving ability. Patients were classified into four groups: schizophrenics without signs of brain dysfunctioning, schizophrenics with signs of brain dysfunctioning, depressed without signs of brain dysfunctioning, and depressed with signs of brain dysfunctioning. The Trail Making Test--Parts A & B, the difference between these two components of the Trail Making Test, the World Fluency Test and a Laterality Index based on the age scale scores of the WAIS significantly discriminated between patients with and without brain dysfunction. Using these variables and a Linear Discriminant Function Analysis, we found that 84.5% of our subjects could be correctly classified. Substantially fewer patients could be correctly classified with respect to their psychiatric diagnosis (i.e., 66.7% correct classification). In fact, only the PIQ from the WAIS-R showed significant differences between the depressed and schizophrenic subjects. Poor neuropsychological performance was interpreted as showing more than the behavioral disorganization associated with psychiatric states and was felt to be related to the presence of objective signs of brain dysfunctioning.

Memory assessment in neuropsychology: theoretical considerations and practical utility

Memory assessment is one of the principal objectives of neuropsychological evaluation. Yet, careful examination reveals very clear shortcomings in the memory tests employed by neuropsychologists. Specifically, most procedures are selected on the basis of their ability to detect structural brain pathology rather than their ability to assess memory performance per se or the constituent operations that underlie it. This paper addresses the shortcomings in the structure of several representative memory tests in neuropsychology, how some of these limitations have been overcome with newer scales, and presents practical and theoretical considerations for the development of new clinical memory measures.

Hypofrontality in schizophrenia: a review of the evidence

This paper reviews the possible role of frontal lobe dysfunction in the pathophysiology of schizophrenia. Pathological, computerized axial tomography (CAT) scan and magnetic resonance imaging (MRI) studies have indicated that a substantial number of schizophrenic patients show structural abnormalities in the frontal lobe areas and other parts of the brain. In some cases, these changes can be correlated with negative symptoms. Attempts to study frontal lobe function with neuropsychological tests, topographic EEG, cerebral blood flow (CBF) and positron emission tomography (PET) scans have also indicated that a substantial number of schizophrenics show abnormalities compared to normal controls. However, these abnormalities can be seen to some degree in other conditions. As well, patients early in the course of their illness tend not to show frontal lobe functional abnormalities. The implications of these findings for current theories of schizophrenia are discussed.

Clinical utility of Wechsler's Deterioration Index in screening for behavioral impairment

Utilizing the Halstead Impairment Index derived from the Halstead-Reitan neuropsychological battery as the defining criterion for the presence or absence of brain-behavior deficiency, the current investigation examined the hypothesis that the Wechsler Deterioration Index is a predictively efficient measure for screening behaviorally impaired subjects from nonimpaired subjects. Subjects were 35 adult examinees consecutively referred for neuropsychological assessment and were divided into two groups on the basis of Halstead indices. The impaired group included 12 men and 7 women whose ages ranged from 17 to 59 yr.; the nonimpaired group were 10 men and 6 women whose ages ranged from 16 to 43 yr. The Wechsler indices for the impaired and nonimpaired groups represent two significantly different populations with the discrepancy between the two groups' scores falling within the predicted direction. A positive correlation between the Halstead Index and the Wechsler Index was indicated for all subjects, but no significant relationship between the Halstead Index and other psychometric ratios. Implications of the results are restricted because there was no normal control group and independent neurological screening was limited.

Separation of brain-damaged from psychiatric patients with the combined use of an ability and a personality test: a validation study with a Puerto Rican population

The purpose of this study was to validate the results obtained by Watson, Gasser, Schaefer, Buranen, and Wold (1981) by utilizing the Smith Symbol-Digit Modalities Test (Form W) and the MMPI (Psychiatric-Organic) scale in combination. Forty recently admitted/readmitted male patients were given both the SDMT and the MMPI (P-O) at a point in their hospitalization in a private inpatient psychiatric hospital in Puerto Rico. The combined use of the Smith and the P-O scale, with the criteria originally developed by Watson et al. (1981), provided a modest level of discrimination by correctly identifying 80% of the brain-damaged sample (organic group) and 55% of the functional sample (psychiatric group) subjects. This combination of tests yielded an overall mean hit rate of 67.5%. These results moderately support the findings obtained by Watson et al. (1981).

The Cognitive Deficit subscale of the SCL-90-R and prediction of outcome in first episode schizophrenics

This study examined the relationship between the Cognitive Deficit scale and psychiatric outcome in a sample of 31 first episode schizophrenics. These patients initially were evaluated during their inpatient hospitalization and thereafter assessed for psychiatric symptomatology at 3-, 6-, and 12-month intervals. At the end of 12 months, 51.6% of the sample were in remission, and 48.4% either remained in their psychotic episode during the follow-up period or relapsed. However, the two Cognitive Deficit scores obtained at baseline showed no relationship with subsequent outcome of psychiatric illness. It is suggested that this scale may not be sensitive enough to be used as a diagnostic tool with this group of patients.

Some cognitive correlates of schizophrenic illnesses

A battery of tests was developed to assess verbal, non-verbal and mixed cognitive functions. Interest was based on pattern of response rather than absolute scores. The subjects were 167 men held in prison on criminal charges or in a maximum security hospital after conviction. The present paper deals exclusively with two subgroups: the 61 schizophrenic men and the 41 men with no psychiatric disorder. The schizophrenic group as a whole presented a very different cognitive pattern from the 'normal' men. First, with the exception of the vocabulary subtest of the WAIS, the schizophrenics were inferior on all tests, whether verbal, non-verbal or mixed function. Secondly, they showed considerably more variation within subtests. The schizophrenic sample was therefore subdivided into four clinical groups. Each showed a distinctive cognitive profile. It is argued that these cognitive differences reflect real differences in the disorder and type of illness being experienced by members of these subgroups.

The schizophrenia-organicity (SC-O) and psychiatric-organic (P-O) MMPI scales: a review

Reviewed the research on the MMPI Schizophrenia-Organicity (Sc-O) and Psychiatric-Organic (P-O) Scales, measures developed to separate brain-damaged patients from schizophrenics and from functional psychiatric patients as a whole. Over 10 cross-validations, the average Sc-O scale hit rate has been 69%, which suggests that it is a better differentiator of brain-damaged from schizophrenic males than most popular ability-based organicity tests. Hit rates for five studies that contrasted organic and psychiatric patients on the P-O scale also averaged 69%. The scales appear to be useful in both medical and psychiatric hospitals, but their validities in female samples are not well established. A system for making diagnostic decisions from ability and personality measures in combination is described, and evidence is cited that it improves on the hit rates achieved by either type of test alone.

A comparison of the effectiveness of MMPI indices in the discrimination of brain-damaged and schizophrenic patients

Assessed the effectiveness of 22 published MMPI procedures to differentiate organic brain syndrome (OBS) from schizophrenic (Sc) patients. Generally, each procedure previously has been suggested to have some effectiveness in making this differentiation. When assessed across studies, however, the S groups have differed on so many relevant variables (age, sex, clinical setting, etc.) that direct comparisons of their relative effectiveness cannot be made. In the current study the accuracy rates are presented for each of the 22 discrimination procedures with a sample matched on age, education, and IQ and also with an unmatched sample, all selected from the patient population at a neuropsychiatric setting. With the matched sample the Hs-Pt Index (Watson, Plemel , & Jacobs, 1978) and the Sc-O Scale, Unweighted Long form (Watson, 1971) reached statistical significance (p less than .10). With the unmatched sample both of the above procedures plus the OBS Signs procedure ( Markowitz , 1973) and P-O Scale (Watson & Plemel , 1978) reached statistical significance (p less than .10). Overall accuracy rates of those procedures found to be statistically significant ranged from 61.5 to 70.0%. These accuracy rates compare favorably to those obtained with more complex and time-consuming neuropsychiatric batteries.

Schizophrenia, conduct disorder and depressive disorder: neuropsychological, speech sample and EEG results

The relationship between degree of schizophrenia and neuropsychological impairment was investigated in 24 adolescent and adult hospitalized and non-hospitalized psychiatric patients with diagnoses of depressive disorder, conduct disorder, and schizophrenia. Schizophrenic adults and conduct disordered adolescents showed greater cognitive impairment than depressed patients on a neuropsychological test of rhythm perception and attention and showed greater frequency of EEG abnormality. Schizophrenics were differentiated from other groups by their impaired abstraction ability on the Halstead-Reitan Category Test. Use of these tests for prediction of adolescents at high risk for schizophrenia was discussed.

Cognitive dysfunction in schizophrenia, affective disorder and organic brain disease

We used the Wechsler Adult Intelligence Scale (WAIS) to study a sample of patients with affective disorder (N = 52), schizophrenia (N = 17) and organic brain disease (N = 8). Schizophrenic patients had lower verbal, performance and full-scale IQs than patients with affective disorder, but were no different from those with organic brain disease. An individual WAIS subscale analysis showed that, compared with affectives, schizophrenics had relatively poorer performance on language than non-language tasks. These differences were independent of age, sex, handedness, educational level or drug administration and are consistent with a variety of studies demonstrating significant cerebral dysfunction in carefully diagnosed schizophrenic patients.

Separation of brain-damaged from psychiatric patients with ability and personality measures

Previous research indicates that many brain-damage screening tests lack the ability to separate organic from functional patients at a satisfactory level. However, the Smith Symbol-Digit Modalities Test, the Benton Visual Retention Test, the Background Interference Procedure variation of the Minnesota Percepto-Diagnostic Test, and the MMPI Psychiatric-Organic Scale have shown some promise in earlier studies. Their abilities to separate brain-damaged patients from five functional samples in a psychiatric setting were compared here. The Smith proved capable of discriminating organics from all functional samples both before and after demographic matching. The Benton and the Minnesota Percepto-Diagnostic Test separated our organics from our functional groups before matching, but results with them after matching were unencouraging. The P-O scale separated the organics from four of the five functional samples before matching and two afterward. The combined use of the P-O and Smith provided a higher level of discrimination than that attained with either alone, correctly identifying 90% of the organics and 79% of the functional Ss.

Problem-solving task performance in brain-damaged subjects

Investigated the relationship between the Halstead Category Test and the Wisconsin Card Sorting Test. A correlational analysis revealed a statistically significant but modest relationship between the two variables in separate samples of brain-damaged and non-brain-damaged individuals (N = 156). Thus, in spite of the apparent similarity of the two measures, their relationship is not sufficiently close to suggest that in fact they are measuring the same abilities. However, the combination of hit rates of the two measures and the high base rate of brain dysfunction in the present sample yielded good diagnostic accuracy for decisions with regard to the presence of brain damage.

Halstead-Reitan Test Battery: A Problem of Differential Diagnosis

The Halstead-Reitan Test Battery is one of the most widely recognized neuropsychological test batteries. Many claims have been made as to its validity. Despite these claims, doubts persist. A critical review of the literature shows that the battery can separate brain-damaged patients from normal patients, general medical patients, and patients with certain psychiatric disorders. However, the battery cannot separate brain-damaged patients as a group from schizophrenics as a group, though in individual cases there may exist pathognomonic signs indicating brain damage. The impairment index, as a summary score of the basic tests, as well as other “methods of inference,” fail at this point. Four alternatives are discussed. First, brain-damaged patients differ from schizophrenic patients not in test performance but in test-taking behavior. Second, the battery is a valid measure of brain damage but has limited applicability. Third, the battery is a measure not of brain damage but of degree of degradation of psychological processes. And fourth, schizophrenics perform poorly on the battery because they have undetected brain damage. Only the third and fourth alternatives appear viable. Both question the validity of the traditional criteria of brain damage. It is argued that future validation studies of the battery should be of construct validation type and not of the criterion-oriented type, as these are defined by Cronbach and Meehl (1955). Possible procedures for construct validation are briefly discussed.

Neuropsychological test performances of paranoid schizophrenic and brain-damaged patients

Predicted that simple tests that require attention and motor speed would be able to differentiate paranoid schizophrenics from brain-damaged patients better than more complex, problem-solving neuropsychological tests. The strategy was to improve discrimination between schizophrenic and brain-damaged patients by selecting a schizophrenic subgroup with a recognized cognitive strong point. Fourteen organic, 14 paranoid schizophrenic, and 14 nonpsychotic psychiatric patients matched for sex, education, and IQ were tested. As predicted, the attention and speed measures differentiated the brain-damaged and paranoid groups, while the four more complex measures from the Halstead-Reitan Battery did not separate the groups. There were no significant differences between the two psychiatric groups.

Neuropsychological impairment with schizophrenia vs. acute and chronic cerebral lesions

Performed detailed neuropsychological evaluations with 25 recently hospitalized schizophrenics in whom systematic neurologic workups had failed to reveal CNS disease. Efforts were made to minimize possible effects of drug-induced extrapyramidal symptoms on test performance. Although the schizophrenics showed some neuropsychological impairment relative to 25 normals, their deficits were not as severe as those of patients known to have either acute or chronic brain disorders (N = 25). The diagnostic accuracy achieved by the tests supports their use in short-term treatment facilities when the differential diagnosis includes schizophrenia and brain disorder, especially acute brain disorder. Schizophrenics' neuropsychological impairment was more correlated with degree of EEG abnormality than with degree of psychosis, which suggests a possible organic basis for the deficits that they showed on testing.

Diagnostic efficiency of the Trail Making Test as a function of cut-off score, diagnosis, and age

This study is a reinvestigation of the effectiveness of the Trail Making Test in discriminating between brain-damaged (n = 51) and pseudoneurologic (n = 72) subjects. All subjects were hospitalized male veterans at the Allen Park Veterans Administration Hospital. An analysis of covariance showed that the pseudoneurologic subjects performed at a significantly higher level than the brain-damaged subjects. Further analysis with two different cut-off scores exhibited unequal discriminatory power throughout the whole range of Trail Making Test scores. These results suggested diagnosing only when the scores were 9 or lower and 13 or higher. This use of extreme scores resulted in an over-all hit rate of 87% in the study. Comparisons with five major subgroupings of the pseudoneurologic subjects yielded only one significant difference: more accurate discrimination with the 12 cut-off score between 10 general-medical and peripheral nerve-damaged subjects (100% correct) and 18 psychotic subjects (39% accuracy).

The separation of organics from depressives with ability- and personality-based tests

Previous research has indicated that ability-oriented organicity tests are of limited value in the separation of brain-damaged from schizophrenic patients in psychiatric hospitals. In the present study the capabilities of nine ability test measures and the MMPI Depression scale to differentiate organics from depressives were evaluated. Only six of the nine ts used to evaluate the differences between the two groups were significant at the 0.5 level and, after the samples were levelled for age, education and IQ, the number fell to zero. In contrast, the Depression scale differences were highly significant both before and after levelling. Multiple correlations run to evaluate the use of personality and ability measures in combination showed that they had considerable promise and suggest that the separation of organic from functional psychiatric hospital groups is best achieved by such combinations.

An MMPI sign to separate organic from functional psychiatric patients

Evaluated the utilities of all 90 possible unweighted additive/subtractive two-scale MMPI combinations as indices to separate brain-damaged from functional patient groups in a Veterans Administration psychiatric hospital. One index, Hs-PT, showed more promise than any of the other 89. Hs-PT mean scores were significantly higher among organics than among alcoholics, neurotics, affective psychoses, character disorders, process schizophrenics or reactive schizophrenics. Interpretative information on the Hs-PT index was presented.

Psychometrics of a neuropsychological test battery

Compared factor analysis (linear) and hierarchical cluster analysis (nonlinear) of a neuropsychological battery of tests, including the Wechsler Adult Intelligence Scale, the Wechsler Memory Scale, the Graham-Kendall Memory for Designs Test, and the Bender Visual Motor Gestalt Designs Test. The results were discussed within the framework of descriptive and predictive analysis of the major cognitive functions of verbal intelligence, perceptual performance, and memory.

Schizophrenic performance on the Halstead-Reitan battery

Compared Halstead-Reitan Battery scores of hospitalized male schizophrenics with scores of normals and brain-damaged Ss to determine performance patterns that differentiate the groups. Schizophrenics performed less well than normals on the Categories, TPT-Memory, and TPT-Location subtests and better than brain-damaged Ss on all subtests except Categories. In general, the effects of medication produced nonsignificant results.

Further evidence that concerns the validity of an MMPI key for separation of brain-damaged and schizophrenic patients

This study attempted to cross-validate an MMPI Key for the separation of brain-damaged and schizophrenic inpatients. MMPI profiles generated by 20 males with a variety of documented brain dysfunctions were compared to those of 20 heterogenous male schizophrenics. The groups were matched on the variables of age and education. The procedure provided 82.5% correct classification, which included 85% correct schizophrenic identification and 80% correct brain-damage identification. The Key was recommended for use as a rough screening device or as a supplement to appropriate neuropsychological procedures.

Neuropsychological effects of electroconvulsive therapy

Although ECT as the treatment of choice for psychotic depression has been in use for many years, little is known about the neocortical residual of such treatments inferred from behavioral measures. The major portion of the literature has been concerned with inferred or observed changes in affective state. The present study compared pre- and posttreatment performances on the Halstead-Reitan neuropsychological battery of 20 patients who were receiving ECT from two different machines. Most Ss gave indicators of cerebral impairment prior to treatment when performance of one side of the body was contrasted with performance of the other side. After treatment, there was an increased number of Ss who evidenced signs consistent with damage to the right cerebral hemisphere. Some concern was raised that a large number of patients who eventually are subject ot ECT because of depression behave in this way because of an undiagnosed neocortical dysfunction. There is some suggestion that the effect of the procedure is to either create or intensify a right hemisphere focus as inferred from behavioral measures.

MMPI profiles of brain-damaged and schizophrenic subjects

MMPI mean profiles for matched groups of 50 brain-damaged and 50 schizophrenic Ss from a short-term hospital were compared. The profiles are quite different. F tests demonstrated that the Sc scale best differentiated the two groups at far beyond the .01 level, and scales F, PA and PT also differentiated the two groups beyond the .01 level. A cut-off point of 80 on the SC scale correctly classified 78% of the two groups. Neither the 2-9 nor the 1-3-9 profile occurred a sufficient number of times in either group to be of any help in diagnosis.

Assessment of conceptual deficits in brain-damaged and schizophrenic patients

Five concept-formation scores for 20 brain-damaged and 20 schizophrenic inpatients were factor analyzed, along with WAIS Vocabulary and Block Design. One factor emerged from this analysis, suggesting that these concept-formation tests do not measure an ability which is greatly different from general intelligence when administered to patients of the type studied. None of the single concept-formation scores discriminated between the brain-damaged and schizophrenic groups independently of general intellectual level, although an exploratory analysis of the subtests of the Halstead Category Test indicated that differential performance on Subtest IV versus Subtest V produced valid criterion variance beyond that attributable to Vocabulary and Block Design alone. The findings were discussed in terms both of the factors underlying the performance of the present subjects versus those from different patient populations, and the need for refining ability-oriented diagnostic strategies when studying impaired patients who do not manifest highly specific psychological deficits on standard clinical tests yielding single scores.

Validation of a brain-damage vs. schizophrenia MMPI key

Since neuropsychologic tests largely have failed to separate schizophrenic from brain-damaged patients, an MMPI key was constructed to make such a separation. When cross-validated, this key provided a 76% correct separation and achi2 significant beyond the .001 level for 50 schizophrenic and 50 brain-damaged profiles. Neuropsychologic tests should be used to separate normals from brain-damaged patients and the MMPI to separate schizophrenic from brain-damaged patients.

Psychosomatic studies of psychiatric disorders: schizophrenia

This paper uses some of the data on central nervous dysfunction in schizophrenic patients as a paradigm for the integration of biologic data with psychopathologic conditions. As such, a good portion of the paper emphasizes the methodologic and interpretive problems one must consider in "psychosomatic" studies of mental illness. A possible theory to integrate these findings is presented.

Psychosis, neurosis and epilepsy. Developmental and gender-related effects and their aetiological contribution

It is generally accepted that in mammalian evolution from rodents to primates, including man, aggressiveness, and more particularly intra-species aggression related to the assertion of dominance in the social hierarchy of the group, is a characteristic of the male (Gray, 1971). There is also an increasing body of evidence which shows that mammalian behaviour patterns are basically female and that male patterns are determined by the action of the sex hormone testosterone on neural structures during critical phases of intra-uterine development (Seymour Levine, 1966). Ounsted and Taylor (1972) have proposed that the X chromosome is sexually neutral, essentially equivalent to an autosome, and that its role in sexual differentiation lies in that it maintains ovarian function in the female. The Y chromosome is sex-determining by causing potential autosomal and X-coded information to become manifest in the phenotype. This is achieved in part by determining the development of foetal testosterone during a critical phase of foetal life. In the absence of testosterone the fundamental female morphology would be established in either sex.

Separation of brain-damaged from schizophrenic patients by Reitan-Halstead pattern analysis: an unsuccessful replication

An attempt was made to cross-validate diagnostic patterns DeWolfe, et al. have suggested may be useful in the separation of brain-damaged from schizophrenic Ss by use of the Halstead tests. The attempt failed. The ramifications of the inconsistent and generally negative results of this project and the DeWolfe, et al. study are discussed.

The Halstead category test of brain dysfunction: feasibility of a short form

Although the Halstead Category Test is one of the best indicators of brain dysfunction among the subtests of the Halstead-Reitan Neuropsychological Test Battery, it has been used infrequently by psychologists in clinical settings. The feasibility of a short form was considered. For the test protocols of 41 Ss the product-moment correlation for errors on odd items and total errors was .90, on even items and total errors, .99. The split-half correlation was .97. Research on the discriminative power of a short form was discussed; a short form is apparently feasible for use by the psychologist.

Improving prediction of brain damage with the tactile performance test for a psychiatric population

The Reitan-Halstead Organic Test Battery has been found of little practical value in general psychiatric populations in that it does not separate hospitalized organics from schizophrenics. An attempt was made to improve such discrimination through the application of response-contingent censure for poor performance during administration of one test from this battery. Ss were 48 hospitalized patients diagnosed schizophrenic reaction or brain syndrome. The Tactile Performance Test was administered to half of each group under standard administration conditions and to the other half under conditions of response-contingent censure. Under the latter condition there was a significant difference in performance by the groups, fewer schizophrenics scoring within the brain-damaged range.