Elsevier

Psychiatry Research

Volume 134, Issue 2, 15 April 2005, Pages 131-141
Psychiatry Research

Deficit in decision making in catatonic schizophrenia: An exploratory study

https://doi.org/10.1016/j.psychres.2004.04.013Get rights and content

Abstract

Catatonic schizophrenia can be distinguished from paranoid schizophrenia by prominent behavioral and motor anomalies. As demonstrated in recent imaging studies, behavioral symptoms may be related to dysfunction in the ventral prefrontal cortex. However, the neuropsychological correlates of ventral prefrontal cortical dysfunction remain unclear. In an exploratory study, we investigated eight patients with catatonic schizophrenia and compared them with 19 patients with paranoid schizophrenia and 26 healthy subjects. The Iowa Gambling Task (IGT) and the Object Alternation Task (OAT) served as measures of ventral prefrontal cortical function. In addition, other prefrontal cortical tests such as a visual working memory task, a Go-NoGo task, and the Wisconsin Card Sorting Test, as well as attentional tasks, were included in the test battery. Catatonic patients showed significant deficits in the IGT characterized by an inability to shift from the initial preference for high-risk cards to a more advantageous strategy with low-risk cards. Moreover, catatonic patients showed significant deficits in the OAT. In conclusion, our preliminary results suggest a specific deficit in catatonic schizophrenia in those neuropsychological measures that are associated with ventral prefrontal cortical function.

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).

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