Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-17T04:52:25.029Z Has data issue: false hasContentIssue false
  • English
  • Français

Tower of London versus Real Life Analogue Planning in Schizophrenia with Disorganization and Psychomotor Poverty Symptoms

Published online by Cambridge University Press:  08 April 2011

Kathryn E. Greenwood ,
Til Wykes ,
Thordur Sigmundsson ,
Sabine Landau  and
Robin G. Morris
Kathryn E. Greenwood*
Affiliation:
Department of Psychology, Kings College London, Institute of Psychiatry, London, United Kingdom Department of Psychology, University of Sussex, Falmer, Brighton, United Kingdom Early Intervention in Psychosis Service, Sussex, United Kingdom
Til Wykes
Affiliation:
Department of Psychology, Kings College London, Institute of Psychiatry, London, United Kingdom
Thordur Sigmundsson
Affiliation:
Department of Psychiatry, Landspitalinn, The University Hospital, Reykjavik, Iceland
Sabine Landau
Affiliation:
Department of Biostatistics and Computing, Kings College London, Institute of Psychiatry, London, United Kingdom
Robin G. Morris
Affiliation:
Department of Psychology, Kings College London, Institute of Psychiatry, London, United Kingdom
*
Correspondence and reprint requests to: Kathryn Greenwood, School of Psychology, Pevensey Building, University of Sussex, Falmer, Brighton, United Kingdom. BN1 9QH. E-mail: kathryn.greenwood@kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Neuropsychological models propose qualitatively distinct planning impairments in the psychomotor poverty and disorganization syndromes in schizophrenia. It was proposed that poor plan initiation in psychomotor poverty would lead to longer initial planning times, while poor plan execution in disorganization would lead to greater inefficiency. Participants with psychomotor poverty (n = 30) and disorganization (n = 29) symptoms were contrasted with healthy controls (n = 28) to elucidate distinct planning impairments. Planning was compared in the Tower of London task versus real life analogue performance in the form of a board-game style diary planning task. The specificity of planning impairments was investigated by controlling for current IQ. The disorganization group demonstrated inefficient planning across both tasks, with poor performance on the Tower of London but not on the real life analogue task remaining after intelligence levels were taken into account. Initial planning times did not differ between groups. Previous associations between poor planning and symptoms may have been driven by poor planning with disorganization symptoms and associated lower order impairments in executive function or the semantic system. Targeting these impairments in people with disorganization symptoms may lead to a greater chance of success in promoting generalization to the real world. (JINS, 2011, 17, 474–484)

Keywords

SchizophreniaDisorganizationPsychomotor povertyNegativeSymptomsReal world analogue planning
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 17 , Issue 3 , May 2011 , pp. 474 - 484
Copyright
Copyright © The International Neuropsychological Society 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreasen, N. (1984a). Scale for the assessment of negative symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, N. (1984b). Scale for the assessment of positive symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Andreasen, N., Rezai, K., Alliger, R., Swayze, V.D., Flaum, M., Kirchner, P., O'Leary, D. (1992). Hypofrontality in neuroleptic-naive patients and in patients with chronic schizophrenia. Assessment with xenon 133 single-photon emission computed tomography and the Tower of London. Archives of General Psychiatry, 49(12), 943–958.Google Scholar
Badcock, J.C., Michiel, P.T., Rock, D. (2005). Spatial working memory and planning ability: Contrasts between schizophrenia and bipolar I disorder. Cortex, 41(6), 753–763.Google Scholar
Burgess, P.W. (1997). Theory and methodology in executive function research. In Rabbitt, P. (Ed.), Methodology of frontal and executive function (pp. 81–116). Hove, UK: Psychology Press.Google Scholar
Burgess, P.W., Simons, J.S. (2005). Theories of frontal lobe executive function: Clinical applications. In Halligan, P.W., Wade, D.T. (Eds.), Effectiveness of rehabilitation for cognitive deficits (pp. 211–231). New York: Oxford University Press.CrossRefGoogle Scholar
Canavan, A., Dunn, G., McMillan, T.M. (1986). Principal components of the WAIS-R. The British Journal of Clinical Psychology, 25(2), 81–85.Google Scholar
David, A., Malmberg, A., Brandt, J., Allebeck, P., Lewis, G. (1997). IQ and risk for schizophrenia: A population based cohort study. Psychological Medicine, 27(6), 1311–1323.Google Scholar
Dibben, C.R., Rice, C., Laws, K., McKenna, P.J. (2009). Is executive impairment associated with schizophrenic syndromes? A meta-analysis. Psychological Medicine, 39(3), 381–392.Google Scholar
Donohoe, G., Robertson, I.H. (2003). Can specific deficits in executive functioning explain the negative symptoms of schizophrenia? A review. Neurocase, 9, 97–108.Google Scholar
Elliott, R., McKenna, P., Robbins, T., Sahakian, B. (1998). Specific neuropsychological deficits in schizophrenic patients with preserved intellectual function. Cognitive Neuropsychiatry, 3(1), 45–70.Google Scholar
Evans, J.J. (2009). Rehabilitation of executive functioning: An overview. In Oddy, M.Worthington, A. (Eds.), The rehabilitation of executive disorders: A guide to theory and practice (pp. 59–73). Oxford: Oxford University Press.Google Scholar
Frith, C. (1992). The cognitive neuropsychology of schizophrenia. Hove: Laurence Erlbaum.Google Scholar
Goldberg, T., Gold, J., Greenberg, R., Griffin, S., Schulz, S., Pickar, D., Weinberger, D. (1993). Contrasts between patients with affective disorder and patients with schizophrenia on a neuropsychological test battery. American Journal of Psychiatry, 150(9), 1355–1362.Google Scholar
Goldberg, T.E., Aloia, M.S., Gourovitch, M.L., Missar, D., Pickar, D., Weinberger, D.R. (1998). Cognitive substrates of thought disorder, I: The semantic system. American Journal of Psychiatry, 155(12), 1671–1676.CrossRefGoogle ScholarPubMed
Goldberg, T.E., Dodge, M., Aloia, M., Egan, M.F., Weinberger, D.R. (2000). Effects of neuroleptic medication on speech disorganization: Biasing associative networks towards meaning. Psychological Medicine, 30, 1123–1130.Google Scholar
Grafman, J., Spector, L., Rattermann, M.J. (2005). Planning and the brain. In Morris, R.G.Ward, G. (Eds.), The cognitive psychology of planning (pp. 181–198). New York: Psychology Press.Google Scholar
Green, M.F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153(3), 321–330.Google ScholarPubMed
Greeno, J.G. (1978). Natures of problem-solving abilities. In Estes, W.K. (Ed.), Handbook of learning & cognitive processes: V. Human information (pp. 239–270). Oxford, England: Lawrence Erlbaum.Google Scholar
Greenwood, K.E., Morris, R.G., Sigmundsson, T., Landau, S., Wykes, T. (2008). Executive functioning in Schizophrenia and the relationship with symptom profile and chronicity. Journal of the International Neuropsychological Society, 14, 782–792.CrossRefGoogle ScholarPubMed
Harvey, P.D., Earle-Boyer, E.A., Levinson, J.C. (1988). Cognitive deficits and thought disorder: A retest study. Schizophrenia Bulletin, 14(1), 57–66.Google Scholar
Hill, S.K., Ragland, J.D., Gur, R.C., Gur, R.E. (2002). Neuropsychological profiles delineate distinct profiles of schizophrenia, an interaction between memory and executive function, and uneven distribution of clinical subtypes. Journal of Clinical and Experimental Neuropsychology, 24, 765–780.Google Scholar
Hoffman, R., Stopek, S., Andreasen, N. (1986). A comparative study of manic vs schizophrenic speech disorganization. Archives of General Psychiatry, 43, 831–838.Google Scholar
Jones, P.B., Bebbington, P., Foerster, A., Lewis, S.W., Murray, R.M., Russell, A., Wilkins, S. (1993). Premorbid social underachievement in schizophrenia: Results from the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry, 162, 65–71.Google Scholar
Jogems-Kosterman, B.J., Hulstijn, W., Wezenberg, E., van Hoof, J.J. (2006). Movement planning deficits in schizophrenia: Failure to inhibit automatic response tendencies. Cognitive Neuropsychiatry, 11(1), 47–64.CrossRefGoogle ScholarPubMed
Jogems-Kosterman, B.J., Zitman, F.G., Van Hoof, J.J., Hulstijn, W. (2001). Psychomotor slowing and planning deficits in schizophrenia. Schizophrenia Research, 48(2–3), 317–333.CrossRefGoogle ScholarPubMed
Joyce, E., Hutton, S., Mutsatsa, S., Gibbins, H., Webb, E., Paul, S., Barnes, T. (2002). Executive dysfunction in first-episode schizophrenia and relationship to duration of untreated psychosis: The West London Study. British Journal of Psychiatry – Supplementum, 43, s38–s44.Google Scholar
Joyce, E.M., Roiser, J.P. (2007). Cognitive heterogeneity in schizophrenia. Current Opinion in Psychiatry, 20, 268–272.CrossRefGoogle ScholarPubMed
Keefe, R. (1995). The contribution of neuropsychology to psychiatry. American Journal of Psychiatry, 152, 6–15.Google ScholarPubMed
Kravariti, E., Morris, R.G., Rabe-Hesketh, S., Murray, R.M., Frangou, S. (2003). The Maudsley early onset schizophrenia study: Cognitive function in adolescents with recent onset schizophrenia. Schizophrenia Research, 61, 137–148.Google Scholar
Kravariti, E., Morris, R.G., Rabe-Hesketh, S., Murray, R., Frangou, S. (2007). Comparative profile analysis of cognitive function in recent-onset and chronic patients with adolescent onset schizophrenia. Schizophrenia Research, 94, 240–244.Google Scholar
Kravariti, E., Morgan, K., Fearon, P., Zanelli, J., Lappin, J., Dazzan, P., Reichenberg, A. (2009). Neuropsychological functioning in first episode schizophrenia. British Journal of Psychiatry, 195, 336–345.Google Scholar
Kremen, W.S., Seidman, L.J., Faraone, S.V., Pepple, J.R., Lyons, M.J., Tsuang, M.T. (1996). The 3 R's and neuropsychological function in schizophrenia: An empirical test of the matching fallacy. Neuropsychology, 10(1), 22–31.CrossRefGoogle Scholar
Kremen, W.S., Seidman, L.J., Faraone, S.V., Toomey, R., Tsuang, M.T. (2004). Heterogeneity of schizophrenia: A study of individual neuropsychological profiles. Schizophrenia Research, 71, 307–321.Google Scholar
Lanser, M.G., Berger, H.J., Ellenbroek, B.A., Cools, A.R., Zitman, F.G. (2002). Perseveration in schizophrenia: Failure to generate a plan and relationship with the psychomotor poverty subsyndrome. Psychiatry Research, 112(1), 13–26.CrossRefGoogle ScholarPubMed
Laws, K.R. (1999). A meta-analytic review of Wisconsin Card Sort studies in schizophrenia: General intellectual deficit in disguise? Cognitive Neuropsychiatry, 4(1), 1–30.Google Scholar
Leeson, V.C., Robbins, T.W., Franklin, C., Harrison, M., Harrison, I., Ron, M.A., Joyce, E.M. (2009). Dissociation of long-term verbal memory and fronto-executive impairment in first-episode psychosis. Psychological Medicine, 39, 1799–1808.CrossRefGoogle ScholarPubMed
Leeson, V.C., Barnes, T.R., Hutton, S.B., Ron, M.A., Joyce, E.M. (2009). IQ as a predictor of functional outcome in schizophrenia: A longitudinal, four-year study of first-episode psychosis. Schizophrenia Research, 107(1), 55–60.Google Scholar
Leeson, V.C., Barnes, T.R.E., Harrison, M., Matheson, E., Harrison, I., Mutsatsa, S.H., Joyce, E.M. (2010). The relationship between IQ, memory, executive function, and processing speed in recent-onset psychosis: 1-year stability and clinical outcome. Schizophrenia Bulletin, 36(2), 400–409.Google Scholar
Levaux, M.-N., Ptovin, S., Sepehry, A., Sablier, J., Mendrek, A., Stip, E. (2007). Computerised assessment of cognition in schizophrenia: Promises and pitfalls of CANTAB. European Psychiatry, 22, 104–115.Google Scholar
Liddle, P. (1987a). The symptoms of chronic schizophrenia: A re-examination of the positive negative-dichotomy. British Journal of Psychiatry, 151, 145–151.Google Scholar
Liddle, P. (1987b). Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine, 17, 49–57.Google Scholar
Liddle, P., Morris, D. (1991). Schizophrenic syndromes and frontal lobe performance. British Journal of Psychiatry, 158, 340–345.Google Scholar
Marczewski, P., Van der Linden, M., Laroi, F. (2001). Further investigation of the supervisory attentional system in schizophrenia: Planning, inhibition, and rule abstraction. Cognitive Neuropsychiatry, 6(3), 175–179.Google Scholar
McGrath, J. (1991). Ordering thoughts on thought disorder. British Journal of Psychiatry, 158, 307–316.Google Scholar
McIntosh, A.M., Harrison, L.K., Forrester, K., Lawrie, S.M., Johnstone, E.C. (2005). Neuropsychological impairments in people with schizophrenia or bipolar disorder and their unaffected relatives. British Journal of Psychiatry, 186, 378–385.Google Scholar
Meehl, P.E. (1970). Nuisance variables and the ex post facto design. In Radner, M.Winokur, S. (Eds.), Minnesota studies in the philosophy of science (pp. 373–402). Minneapolis, MN: University of Minnesota Press.Google Scholar
Miotto, E.C., Evans, J.J., de Lucia, M.C., Scaff, M. (2009). Rehabilitation of executive dysfunction: A controlled trial of an attention and problem solving treatment group. Neuropsychological Rehabilitation, 19(4), 517–540.Google Scholar
Miotto, E., Morris, R. (1998). Virtual planning in patients with frontal lobe lesions. Cortex, 34(5), 639–657.Google Scholar
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., Wager, T.D. (2000). The unity and diversity of executive tasks and their relationships to complex ‘frontal lobe’ tasks: A latent variable analysis. Cognitive Psychology, 41, 49–100.Google Scholar
Morris, R.G., Ward, G. (2005). The cognitive psychology of planning. New York: Psychology Press.Google Scholar
Morris, R.G., Kotitsa, M., Bramham, J. (2005). Planning in patients with focal brain damage: From simple to complex task performance. In Morris, R.G.Ward, G. (Eds.), The cognitive psychology of planning (pp. 153–179). New York: Psychology Press.Google Scholar
Morris, R., Rushe, T., Woodruffe, P., Murray, R. (1995). Problem solving in schizophrenia: A specific deficit in planning ability. Schizophrenia Research, 14, 235–246.Google Scholar
Nelson, H., Willison, J. (1991). National Adult Reading Test (NART): Test manual (2nd ed.). Windsor Berks: NFER.Google Scholar
Office of Population Consensus’ and Surveys (1991). Standard occupational classifications (Vol. 1–3): London: HMSO.Google Scholar
O'Carroll, R., Walker, M., Duncan, J., Murray, C., Blackwood, D., Ebmeir, K.P., Goodwin, G. (1992). Selecting controls for schizophrenia research studies: The use of the National Adult Reading Test (NART) as a measure of pre-morbid ability. Schizophrenia Research, 8(2), 137–141.Google Scholar
O'Connor, M., Harris, J.M., McIntosh, A.M., Owens, D.G., Lawrie, S.M., Johnstone, E.C. (2009). Specific cognitive deficits in a group at genetic high risk of schizophrenia. Psychological Medicine, 39(10), 1649–1655.CrossRefGoogle Scholar
O'Neil-Pirozzi, T.M., Goldstein, R. (2005). Test-re-test reliability of the virtual planning test. Brain Injury, 19(14), 1191–1196.Google Scholar
Pantelis, C., Barnes, T.R., Nelson, H.E., Tanner, S., Weatherley, L., Owen, A.M., Robbins, T.W. (1997). Frontal-striatal cognitive deficits in patients with chronic schizophrenia. Brain, 120(10), 1823–1843.Google Scholar
Philips, L.H., MacLeod, M., Kliegel, M. (2005). Adult ageing and cognitive planning. In Morris, R.G.Ward, G. (Eds.), The cognitive psychology of planning (pp. 111–134). New York: Psychology Press.Google Scholar
Poole, J.H., Ober, B.A., Shenaut, G.K., Vinogradov, S. (1999). Independent frontal-system deficits in schizophrenia: Cognitive, clinical, and adaptive implications. Psychiatry Research, 85, 161–176.CrossRefGoogle ScholarPubMed
Prouteau, A., Verdoux, H., Briand, C., Lesage, A., Lalonde, P., Nicole, L., Stip, E. (2005). Cognitive predictors of psychosocial functioning outcome in schizophrenia: A follow up study of subjects participating in a rehabilitation programme. Schizophrenia Research, 77(23), 343–353.Google Scholar
Rushe, T., Morris, R., Miotto, E., Feigenbaum, J., Woodruff, P., Murray, R. (1999). Problem-solving and spatial working memory in patients with schizophrenia and with focal frontal and temporal lobe lesions. Schizophrenia Research, 37(1), 21–33.Google Scholar
Schall, R. (1991). Estimation in generalised linear models with random effects. Biometrika, 78, 719–727.Google Scholar
Shallice, T. (1982). Specific impairments in planning. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 298, 199–209.Google ScholarPubMed
Shallice, T., Burgess, P. (1996). The domain of supervisory processes and temporal organization of behaviour. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 351, 1405–1411.Google Scholar
Shallice, T. (2002). Fractionation of the supervisory system. In Stuss, D.T., Knight, R.T. (Eds.), Principles of frontal lobe function (pp. 261–277). New York: Oxford University Press.Google Scholar
Strauss, M. (1993). Relations of symptoms to cognitive deficits in schizophrenia. Schizophrenia Bulletin, 19(2), 215–231.CrossRefGoogle ScholarPubMed
Toulopoulou, T., Morris, R.G., Rabe-Hesketh, S., Murray, R.M. (2003). Selectivity of verbal memory deficit in schizophrenic patients and their relatives. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics, 116(1), 1–7.CrossRefGoogle Scholar
Tyson, P.J., Laws, K.R., Roberts, K.H., Mortimer, A.M. (2004). Stability of set-shifting and planning abilities in patients with schizophrenia. Psychiatry Research, 129(3), 229–239.Google Scholar
van Beilen, M., van Zomeren, E.H., van den Bosch, R., Withaar, F.K., Bouma, A. (2005). Measuring the executive functions in schizophrenia: The voluntary allocation of effort. Journal of Psychiatric Research, 39(6), 585–593.Google Scholar
Wang, Q., Vassos, E., Deng, W., Ma, X., Hu, X., Murray, R.M., Li, T. (2010). Factor structures of the neurocognitive assessments and familial analysis in first-episode schizophrenia patients, their relatives and controls. Australian and New Zealand Journal of Psychiatry, 44, 109–119.Google Scholar
Walker, E., Lewine, R. (1988). Negative symptom distinction in schizophrenia: Validity and etiological relevance. Schizophrenia Research, 1, 315–328.CrossRefGoogle ScholarPubMed
Wykes, T., Reeder, C., Landau, S., Everitt, B., Knapp, M., Patel, A., Romeo, R. (2007). Cognitive remediation therapy in schizophrenia: Randomised controlled trial. British Journal of Psychiatry, 190, 421–427.Google Scholar
Young, S., Morris, R., Toone, B., Tyson, C. (2007). Planning ability in adults with attention-deficit/hyperactivity disorder. Neuropsychology, 21(5), 581–589.Google Scholar
Zalla, T., Posada, A., Franck, N., Georgieff, N., Sirigu, A. (2001). A component analysis of action planning processes in schizophrenia: A comparison with patients with frontal lobe damage. Cognitive Neuropsychiatry, 6(4), 271–296.Google Scholar