Deficit in decision making in catatonic schizophrenia: An exploratory study
Introduction
Catatonia is a psychomotor syndrome that can be characterized by concurrent emotional (anxieties, depression, and mania), behavioral (mutism, stupor, stereotypies, and perseveration) and motor (akinesia, posturing, and catalepsy) alterations (Kahlbaum, 1878, Fink et al., 1993, Gelenberg, 1976, Northoff, 1997, Northoff, 2002, Taylor, 1990). Catatonia occurs in a variety of different diseases, but predominantly in schizophrenic or affective psychosis (Northoff, 1997, Northoff, 2002, Taylor, 1990). In addition to motor anomalies, behavioral symptoms like automatic obedience, negativism, and echolalia/praxia are the most bizarre characteristics. These behavioral anomalies may be related to ventral prefrontal cortical dysfunction. This possible relationship is supported by evidence from both lesion and imaging studies. Studies in patients with lesions in the ventral prefrontal cortex show more or less similar behavioral anomalies (Bechara et al., 1999, Dias et al., 1996, Dias et al., 1997, Rolls, 1998). Imaging studies in catatonia reveal dysfunction in the ventromedial prefrontal cortex (Northoff, 2002, Northoff et al., 2004). However, the neuropsychological correlates of ventral prefrontal cortical dysfunction in catatonia remain unclear. One neuropsychological task, the Iowa Gambling Task, has been shown to be related to ventral prefrontal cortical function (see Bechara et al., 1994, Bechara et al., 1999). We therefore administered the Iowa Gambling Task in an exploratory neuropsychological study of patients with catatonic schizophrenia.
Behavioral anomalies are the features that best distinguish catatonic schizophrenia from paranoid schizophrenia. Since both groups of patients suffer from the same underlying disease, i.e., schizophrenia, the behavioral anomalies found in catatonic patients may be specifically related to the catatonic subtype of schizophrenia. Accordingly, the behavioral anomalies may be characterized as subtype- rather than disease-related. Or one may conceive of the behavioral anomalies as being not only subtype-related but syndrome-related because catatonia is often associated with affective psychosis and other diseases (Taylor, 1990, Northoff, 1997, Northoff, 2002).
In the present study, we tested only the first hypothesis, the occurrence of ventral prefrontal cortical neuropsychological anomalies specifically in catatonic schizophrenia as distinguished from paranoid schizophrenia: Is ventral prefrontal cortical neuropsychological dysfunction subtype-related in schizophrenia? Earlier investigations (Abbruzzese et al., 1997, Wilder et al., 1998, Cavallaro et al., 2003) demonstrated no deficit in the gambling task or other ventral prefrontal measures in patients with paranoid schizophrenia. In contrast, these patients showed severe deficits in tests examining the function of the dorsolateral prefrontal cortex (DLPFC) such as the Wisconsin Card Sorting Test and other tests of executive function. In addition to the gambling task, we therefore included the Wisconsin Card Sorting Test and executive tasks in our test battery.
Because our study includes only the catatonic and paranoid subtypes of schizophrenia, its exploratory findings cannot be generalized to other subtypes of schizophrenia (e.g., residual and disorganized subtypes). Moreover, due to the rare occurrence of catatonia in general and catatonic schizophrenia in particular, the number of investigated patients is necessarily low (n = 8).
Section snippets
Subjects
Three groups of subjects were investigated: catatonic schizophrenic patients, paranoid schizophrenic patients and healthy subjects (see Table 1).
Clinical and demographic data
Demographic data and non-catatonic psychopathological scores showed no significant differences between catatonic and paranoid schizophrenic patients.
General intellectual function
No significant differences in (mean ± SD) verbal (MWT-B: catatonic: 31.4 ± 2.4; paranoid: 30.6 ± 2.7; healthy: 32.1 ± 1.9) and non-verbal (SPM: catatonic: 27.5 ± 1.9; paranoid: 26.7 ± 2.1; healthy: 27.8 ± 2.0) intelligence scores were found.
Gambling task
Healthy and paranoid schizophrenic subjects showed significant differences between early and late cards in the within-group
Discussion
The main findings in the present neuropsychological study are the following: (i) specific abnormalities in the Iowa gambling task in catatonic schizophrenia; (ii) specific abnormalities in the Object Alternation Task (OAT) in catatonic schizophrenia.
Acknowledgments
Special thanks are due to H. Walter, who provided an electronic version of the Gambling Test; K. Obermeier, who provided an electronic version of the Object Alternation Test; and D. Krell, who implemented these tests. The study was financially supported by a Heisenberg grant to G.N. (DFG 304/4-1).
References (44)
- et al.
The selective breakdown of frontal functions in patients with obsessive–compulsive disorder and in patients with schizophrenia: a double dissociation experimental finding
Neuropsychologia
(1997) - et al.
Insensitivity to future consequences following damage to human prefrontal cortex
Cognition
(1994) - et al.
Typical and atypical antipsychotic medications differentially affect two nondeclarative memory tasks in schizophrenic patients: a double dissociation
Schizophrenia Research
(2003) - et al.
Basal-cortico-frontal circuits in schizophrenia and obsessive–compulsive disorder: a controlled, double dissociation study
Biological Psychiatry
(2003) Object alternation and orbitofrontal system in Alzheimer's and Parkinson's disease
Brain and Cognition
(1990)The catatonic syndrome
Lancet
(1976)- et al.
Analysis of lorazepm and its glucuronide metabolite by electron-capture gas liquid chromatography
Journal of Chromatography
(1978) - et al.
Schizophrenic subjects show aberrant fMRI activation of dorsolateral prefrontal cortex and basal ganglia during working performance
Biological Psychiatry
(2000) - et al.
Functional neuroanatomy of auditory working memory in schizophrenia: relation to positive and negative symptoms
Neuroimage
(2001) - et al.
Impairment in visual–spatial function in catatonia: a neuropsychological investigation
Schizophrenia Research
(1999)