Psychological Medicine

Executive function in first-episode schizophrenia

S. B. HUTTON a1, B. K. PURI a1, L.-J. DUNCAN a1, T. W. ROBBINS a1, T. R. E. BARNES a1 and E. M. JOYCE a1c1
a1 From the Division of Neuroscience and Psychological Medicine, Imperial College School of Medicine, Charing Cross Hospital, Mental Health Unit, Queen Mary's University Hospital and Robert Steiner MRI Unit, Hammersmith Hospital, London; and the Department of Experimental Psychology, University of Cambridge


Background. We tested the hypothesis that schizophrenia is primarily a frontostriatal disorder by examining executive function in first-episode patients. Previous studies have shown either equal decrements in many cognitive domains or specific deficits in memory. Such studies have grouped test results or have used few executive measures, thus, possibly losing information. We, therefore, measured a range of executive ability with tests known to be sensitive to frontal lobe function.

Methods. Thirty first-episode schizophrenic patients and 30 normal volunteers, matched for age and NART IQ, were tested on computerized test of planning, spatial working memory and attentional set shifting from the Cambridge Automated Neuropsychological Test Battery. Computerized and traditional tests of memory were also administered for comparison.

Results. Patients were worse on all tests but the profile was non-uniform. A componential analysis indicated that the patients were characterized by a poor ability to think ahead and organize responses but an intact ability to switch attention and inhibit prepotent responses. Patients also demonstrated poor memory, especially for free recall of a story and associate learning of unrelated word pairs.

Conclusions. In contradistinction to previous studies, schizophrenic patients do have profound executive impairments at the beginning of the illness. However, these concern planning and strategy use rather than attentional set shifting, which is generally unimpaired. Previous findings in more chronic patients, of severe attentional set shifting impairment, suggest that executive cognitive deficits are progressive during the course of schizophrenia. The finding of severe mnemonic impairment at first episode suggests that cognitive deficits are not restricted to one cognitive domain.

c1 Address for correspondence: Dr E. M. Joyce, Mental Health Unit, Queen Mary's University Hospital, Roehampton Lane, London SW15 5PN.