Saccadic eye movements in schizophrenic patients

Pre-saccadic shifts of attention in individuals diagnosed with schizophrenia

INTRODUCTION

Pathophysiological theories of schizophrenia (SZ) symptoms posit an abnormality in using predictions to guide behavior. One such prediction is based on imminent movements, via corollary discharge signals (CD) that relay information about planned movement kinematics to sensory brain regions. Empirical evidence suggests a reduced influence of sensorimotor predictions in individuals with SZ within multiple sensory systems, including in the visual system. One function of CD in the visual system is to selectively enhance visual sensitivity at the location of planned eye movements (pre-saccadic attention), thus enabling a prediction of the to-be-foveated stimulus. We expected pre-saccadic attention shifts to be less pronounced in individuals with SZ than in healthy controls (HC), resulting in unexpected sensory consequences of eye movements, which may relate to symptoms than can be explained in the context of altered allocation of attention.

METHODS

We examined this question by testing 30 SZ and 30 HC on a pre-saccadic attention task. On each trial participants made a saccade to a cued location in an array of four stimuli. A discrimination target that was either congruent or incongruent with the cued location was briefly presented after the cue, during saccade preparation. Pre-saccadic attention was quantified by comparing accuracy on congruent trials to incongruent trials within the interval preceding the saccade.

RESULTS

Although SZs were less accurate overall, the magnitude of the pre-saccadic attention effect generally did not differ across groups nor show a convincing relationship with symptom severity. We did, however, observe that SZ had reduced pre-saccadic attention effects when the discrimination target (probe) was presented at early stages of saccade planning, when pre-saccadic attention effects first emerged in HC.

CONCLUSION

These findings suggest generally intact pre-saccadic shifts of attention in SZ, albeit slightly delayed. Results contribute to our understanding of altered sensory predictions in people with schizophrenia.

Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology

Body dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived appearance flaw or flaws that are not observable to others. BDD is associated with distress and impairment of functioning. Psychiatric comorbidities, including depression, social anxiety, and obsessive-compulsive disorder are common and impact treatment. Treatment should encompass psychoeducation, particularly addressing the dangers associated with cosmetic procedures, and may require high doses of selective serotonin reuptake inhibitors* (SSRI*) and protracted periods to establish full benefit. If there is an inadequate response to SSRIs, various adjunctive medications can be employed including atypical antipsychotics*, anxiolytics*, and the anticonvulsant levetiracetam*. However, large-scale randomized controlled trials are lacking and BDD is not an approved indication for these medications. Oxytocin* may have a potential role in treating BDD, but this requires further exploration. Cognitive-behavioural therapy has good evidence for efficacy for BDD, and on-line and telephone-assisted forms of therapy are showing promise. CBT for BDD should be customized to address such issues as mirror use, perturbations of gaze, and misinterpretation of others' emotions, as well as overvalued ideas about how others view the individual.

Eye Movements and Cognitive Functioning in Patients With Schizophrenia Spectrum Disorders: Network Analysis

Background: Eye movement parameters are often used during cognitive functioning assessments of patients with psychotic spectrum disorders. It is interesting to compare these oculomotor parameters with cognitive functions, as assessed using psychometric cognitive tests. A network analysis is preferable for understanding complex systems; therefore, the aim of this study was to determine the multidimensional relationships that exist between oculomotor reactions and neurocognition in patients with schizophrenia spectrum disorders. Materials and Methods: A total of 134 subjects (93 inpatients with schizophrenia spectrum disorders (ICD-10) and 41 healthy volunteers) participated in this study. Psychiatric symptom severity was assessed using the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, and the Young Mania Rating Scale. Extrapyramidal symptoms were assessed using the Simpson-Angus Scale, and akathisia was assessed using the Barnes Akathisia Rating Scale. Eye movements were recorded using an eye-tracker SMI RED 500, and cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia. The statistical analyses were conducted using Minitab 17 Statistical Software, version 17.2.1. Data visualization and additional analyses were performed in the R 4.0.3 environment, using RStudio V 1.3.1093 software. Results: A network model of neurocognitive and oculomotor functions was constructed for the patients. In the full network (which includes all correlations) the median antisaccade latency value is the central element of the oculomotor domain, and the Symbol Coding test, the Digit Sequencing test, and the Verbal Fluency test are central elements in the neurocognitive domain. Additionally, there were connections between other cognitive and oculomotor functions, except for the antisaccade error latency in the oculomotor domain and the Token Motor Task in the neurocognitive domain. Conclusion: Network analysis provides measurable criteria for the assessment of neurophysiological and neurocognitive abnormalities in patients with schizophrenic spectrum disorders and allows to select key targets for their management and cognitive remediation.

Structural imaging of the retina in psychosis spectrum disorders: current status and perspectives

PURPOSE OF REVIEW

Structural changes of the retina in schizophrenia and other psychotic disorders seem plausible as these conditions are accompanied by widespread morphological abnormalities of the brain. Advances in structural retinal imaging have led to the possibility of precise quantification of individual retinal layers, using optical coherence tomography (OCT) scanners.

RECENT FINDINGS

The aggregation of information related to OCT findings in schizophrenia has resulted in three metaanalyses, which are currently described. Areas where retinal changes were reported include retinal nerve fiber layer (RNFL), ganglion cell layer complex (GCC), macular volume, and macular thickness, but findings on affected retinal segments vary to some extent across studies. Discrepancies in individual studies could be because of small samples, heterogeneity within schizophrenia (phase of the illness, illness duration, predominant symptomatology), inconsistent reporting of antipsychotic therapy, insufficient control of confounding variables (somatic comorbidities, smoking, and so on), and use of the different types of OCT scanners.

SUMMARY

Exploration of potential disturbances in retinal architecture could provide new insights into neuronal changes associated with psychosis spectrum disorders, with potential to elucidate the nature and timing of developmental, progressive, inflammatory, and degenerative aspects of neuropathology and pathophysiology, and to assist with characterizing heterogeneity and facilitating personalized treatment approaches.

Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics

Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.

Computerized assessment of cognition in schizophrenia: Promises and pitfalls of CANTAB

Objective

Over the last decade, the Cambridge Neuropsychological Test Automated Battery (CANTAB), which comprises visuo-spatial tasks, has been utilized in cognitive studies of schizophrenia. A clear approach concerning the usage of CANTAB for the appraisal of neurocognitive dysfunction in schizophrenia is currently lacking.

Method

In this paper, we have first reviewed the overall applications of CANTAB and then evaluated methodological strengths and weaknesses of CANTAB as a neurocognitive battery for schizophrenia. We carried out a systematic search and assessment of studies where CANTAB was utilized to measure cognitive function in schizophrenia. We have also attempted to quantify the available data and perform a meta-analysis, but this approach turned out to be still premature.

Results

CANTAB has enabled researchers to highlight significant deficits affecting broad cognitive domains in schizophrenia, such as working memory, decision-making, attention, executive functions and visual memory. So far, the most consistent deficit observed with CANTAB testing has been attentional set-shifting, suggestive of fronto-striatal dysfunctions. In addition, preliminary evidence points towards the potential use of CANTAB to identify cognitive predictors of psychosocial functioning, to describe the relationships between symptoms and cognition, and to measure the impact of pharmacological agents on cognitive functioning.

Conclusion

CANTAB has been used successfully to highlight the range of visuo-spatial cognitive deficits in schizophrenia, producing similar results to those obtained with some traditional neuropsychological tests. Further studies validating the use of CANTAB following the standard set by Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) are warranted.

The effect of high vs. low dose lurasidone on eye movement biomarkers of prefrontal abilities in treatment-resistant schizophrenia

OBJECTIVE

Eye movement (EM) measures can serve as biomarkers to evaluate pharmacological effects on brain systems involved in cognition. In recent onset schizophrenia, antipsychotic treatment can improve attentional control on the antisaccade task and exacerbate working memory impairment on the memory guided saccade task; effects in treatment-resistant schizophrenia (TRS) are less clear. This study evaluated the effects of high versus low dose lurasidone on EM performance in TRS.

METHODS

TRS patients completed EM testing: 1) at baseline, on existing medication regimen (n = 42), 2) after 6 weeks of low dose (80 mg) lurasidone (n = 38), 3) after 12 weeks following randomization to low (80 mg) or high dose (240 mg) lurasidone (n = 27), and 4) after 24 weeks of treatment (n = 23). EM testing included prosaccade, antisaccade, and memory guided saccade tasks.

RESULTS

Six weeks of lurasidone resulted in increased prosaccade saccade latency and reduced antisaccade errors, with no change in memory guided saccade accuracy. After randomization, prosaccade and antisaccade latencies increased in only the high dose group, with no change in antisaccade errors in both groups. Memory guided saccade error increased in the high dose group and remained stable in the low dose group.

CONCLUSION

Among TRS, stabilization on low dose lurasidone was associated with improved executive control of attention reflected by reduced antisaccade errors. High dose lurasidone resulted in prolonged speed of reflexive and executive shifts of attention and reduced spatial working memory relative to low dose. These findings indicate that EM measures are helpful biomarkers of dose-dependent antipsychotic treatment effects on executive cognitive abilities in TRS.

A review of impaired visual processing and the daily visual world in patients with schizophrenia

Several studies have investigated perceptual processes in patients with schizophrenia. Research confirms that visual impairments are one of the most important features of schizophrenia. Many studies, using behavioral and psychological experiments, confirm that visual impairments can be used to determine illness severity, state, and best treatments. Herein, we review recent research pertaining to visual function in patients with schizophrenia and highlight the relationship between laboratory findings and subjective, real-life reports from patients themselves. The purpose of this review is to 1) describe visual impairments that manifest in patients with schizophrenia, 2) examine the relationship between visual dysfunction, assessed by laboratory tests, and the experiences of patients themselves, and 3) describe real-life experiences related to visual function in this population. In this review, the impairments of motion and color perception, perceptual organization, and scan paths are summarized, along with the relationship between laboratory findings and patients' real-world subjective experiences related to visual function.

Behavioural and computational varieties of response inhibition in eye movements

Response inhibition is the ability to override a planned or an already initiated response. It is the hallmark of executive control as its deficits favour impulsive behaviours, which may be detrimental to an individual's life. This article reviews behavioural and computational guises of response inhibition. It focuses only on inhibition of oculomotor responses. It first reviews behavioural paradigms of response inhibition in eye movement research, namely the countermanding and antisaccade paradigms, both proven to be useful tools for the study of response inhibition in cognitive neuroscience and psychopathology. Then, it briefly reviews the neural mechanisms of response inhibition in these two behavioural paradigms. Computational models that embody a hypothesis and/or a theory of mechanisms underlying performance in both behavioural paradigms as well as provide a critical analysis of strengths and weaknesses of these models are discussed. All models assume the race of decision processes. The decision process in each paradigm that wins the race depends on different mechanisms. It has been shown that response latency is a stochastic process and has been proven to be an important measure of the cognitive control processes involved in response stopping in healthy and patient groups. Then, the inhibitory deficits in different brain diseases are reviewed, including schizophrenia and obsessive-compulsive disorder. Finally, new directions are suggested to improve the performance of models of response inhibition by drawing inspiration from successes of models in other domains.This article is part of the themed issue 'Movement suppression: brain mechanisms for stopping and stillness'.

The Study of the Antisaccade Performance and Contingent Negative Variation Characteristics in First-Episode and Chronic Schizophrenia Patients

The study tested whether the antisaccade (AS) performance and Contingent Negative Variation (CNV) measures differed between the first-episode and chronic patients to provide the evidence of PFC progressive functional deterioration. Subjects included 15 first-episode and 20 chronic schizophrenic patients (with the duration of illness more than 5 years), and 21 control subjects. The first-episode and chronic patients had significantly elevated error percent (p < .05, effect size 1.10 and p < .001, effect size 1.25), increased AS latencies (p < .01, effect size 1.18 and p < .001, effect size 1.69), and increased latencies variability (p < .01, effect size 1.52 and p < .001, effect size 1.37) compared to controls. Chronic patients had marginally significant increase of the response latency (p = .086, effect size .78) and latency variability (p < .099, effect size .63) compared to first-episode ones. Results of CNV analysis revealed that chronic patients only exhibited robustly declined frontal CNV amplitude at Fz (p < .05, effect size .70), F3 (p < .05, effect size .88), and F4 (p < .05, effect size .71) sites compared to controls. The obtained results might be related to specific changes in prefrontal cortex function over the course of schizophrenia.

Insights to the schizophrenia continuum: A systematic review of saccadic eye movements in schizotypy and biological relatives of schizophrenia patients

Myles, J.B., S. Rossell, A. Phillipou, Thomas, E and C. Gurvich. A systematic review of saccadic eye movements across the schizophrenia continuum: Characterisation, pathophysiology and genetic associations. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2015. One of the cognitive hallmarks of schizophrenia is impaired eye movements, particularly for the antisaccade task. Less saccade research has been conducted in relation to the broader schizophrenia continuum, that is, people with high schizotypy or first-degree relatives of people with schizophrenia. This systematic review sought to identify, collate and appraise prosaccade, antisaccade and memory-guided saccade studies involving behavioural, neuroimaging and genetic data published between 1980 and September 2016 in individuals with high schizotypy and first-degree relatives. A systematic literature search was conducted, using Ovid MEDLINE, PsycINFO, PubMed and SCOPUS databases. Of 913 references screened, 18 schizotypy, 29 family studies and two schizotypy and relatives articles studies were eligible for inclusion. Antisaccade error rate was the most consistent deficit found for high schizotypy. Relatives had intermediate antisaccade error rates between patients and healthy controls. Results from the limited genetic and neuroimaging studies echoed schizophrenia findings. Confounds were also identified. It was concluded that future research is required to refine the saccade endophenotype and to expand genetic and neuroimaging research.

Shared and distinct oculomotor function deficits in schizophrenia and obsessive compulsive disorder

Detailed analysis of oculomotor function phenotypes in antisaccade, smooth eye pursuit, and active fixation tasks was performed in a sample of 44 patients with schizophrenia, 34 patients with obsessive compulsive disorder (OCD), and 45 matched healthy controls. A common pattern of performance deficits in both schizophrenia and OCD emerged including higher antisaccade error rate, increased latency for corrective antisaccades, as well as higher rates of unwanted saccades in smooth eye pursuit compared to healthy controls. This common pattern could be related to the dysfunction of a network of cognitive control that is present in both disorders, including the dorsolateral prefrontal cortex, the posterior parietal cortex, and the anterior cingulate cortex. In contrast, only patients with schizophrenia showed a specific increase for correct antisaccade mean latency and the intrasubject variability of latency for error prosaccades as well as a decrease in the gain for smooth eye pursuit, suggesting a specific deficit in saccadic motor control and the frontal eye field in schizophrenia that is not present in OCD. A specific deficit in fixation stability (increased frequency of unwanted saccades during active fixation) was observed only for OCD patients pointing to a deficit in the frontostriatal network controlling fixation. This deficit was pronounced for OCD patients receiving additional antipsychotic medication. In conclusion, oculomotor function showed shared and distinct patterns of deviance for schizophrenia and OCD pointing toward shared and specific neurobiological substrates for these psychiatric disorders.

Memory-guided saccades in youth-onset psychosis and attention deficit hyperactivity disorder (ADHD)

AIM

Working memory deficits have been shown to be present in children and adolescents with schizophrenia and attention deficit hyperactivity disorder. Considering the differences in clinical characteristics between these disorders, it was the goal of this study to assess differences in the specific components of working memory in children and adolescents with psychosis and attention deficit hyperactivity disorder.

METHODS

Children and adolescents (age range 8-20 years) with either a non-affective psychotic disorder (n = 25), attention deficit hyperactivity disorder (n = 33) and controls (n = 58) were administered an oculomotor delayed-response task using both a recall and a control condition. Memory-guided saccades were measured during delay periods of 2, 8 and 20 s.

RESULTS

Although both clinical groups were less accurate than controls, there was no evidence of a disproportionate impairment in recall. In addition, there was no evidence of a delay-dependent impairment in psychosis; however, there was a delay-dependent impairment in attention deficit hyperactivity disorder when corrective saccades were included. Speed of information processing was correlated with distance errors in psychosis, suggesting that speed of encoding the stimulus location may have constrained the accuracy of the saccades.

CONCLUSIONS

Our findings support impairments during encoding in the psychosis group and a delay-dependent deficit in the attention deficit hyperactivity disorder group.

Antisaccade performance in schizophrenia: a neural model of decision making in the superior colliculus

Antisaccade performance deficits in schizophrenia are generally interpreted as an impaired top–down inhibitory signal failing to suppress the erroneous response. We recorded the antisaccade performance (error rates and latencies) of healthy and schizophrenia subjects performing the mirror antisaccade task. A neural rise-to-threshold model of antisaccade performance was developed to uncover the biophysical mechanisms giving rise to the observed deficits in schizophrenia. Schizophrenia patients displayed greater variability in the antisaccade and corrected antisaccade latency distributions, increased error rates and decreased corrected errors, relative to healthy participants. Our model showed that (1) increased variability is due to a more noisy accumulation of information by schizophrenia patients, but their confidence level required before making a decision is unaffected, and (2) competition between the correct and erroneous decision processes, and not a third top-down inhibitory signal suppressing the erroneous response, accounts for the antisaccade performance of healthy and schizophrenia subjects. Local competition further ensured that a correct antisaccade is never followed by an error prosaccade.

"To see or not to see: that is the question." The "Protection-Against-Schizophrenia" (PaSZ) model: evidence from congenital blindness and visuo-cognitive aberrations

The causes of schizophrenia are still unknown. For the last 100 years, though, both “absent” and “perfect” vision have been associated with a lower risk for schizophrenia. Hence, vision itself and aberrations in visual functioning may be fundamental to the development and etiological explanations of the disorder. In this paper, we present the “Protection-Against-Schizophrenia” (PaSZ) model, which grades the risk for developing schizophrenia as a function of an individual's visual capacity. We review two vision perspectives: (1) “Absent” vision or how congenital blindness contributes to PaSZ and (2) “perfect” vision or how aberrations in visual functioning are associated with psychosis. First, we illustrate that, although congenitally blind and sighted individuals acquire similar world representations, blind individuals compensate for behavioral shortcomings through neurofunctional and multisensory reorganization. These reorganizations may indicate etiological explanations for their PaSZ. Second, we demonstrate that visuo-cognitive impairments are fundamental for the development of schizophrenia. Deteriorated visual information acquisition and processing contribute to higher-order cognitive dysfunctions and subsequently to schizophrenic symptoms. Finally, we provide different specific therapeutic recommendations for individuals who suffer from visual impairments (who never developed “normal” vision) and individuals who suffer from visual deterioration (who previously had “normal” visual skills). Rather than categorizing individuals as “normal” and “mentally disordered,” the PaSZ model uses a continuous scale to represent psychiatrically relevant human behavior. This not only provides a scientific basis for more fine-grained diagnostic assessments, earlier detection, and more appropriate therapeutic assignments, but it also outlines a trajectory for unraveling the causes of abnormal psychotic human self- and world-perception.

Effects of adjunct valproic acid on clinical symptoms and saccadic eye movements in schizophrenia

OBJECTIVE

Valproic acid (VPA) has been suggested as a potential adjunct therapy in schizophrenia for the treatment of clinical symptoms and cognitive deficits. Here, we investigate the effects of VPA on clinical symptoms and saccadic eye movements while controlling for multiple medication effects.

METHODS

Remitted and first-episode schizophrenia patients taking haloperidol were given adjunct VPA for approximately 2 weeks and tested using a measure of clinical symptoms (Positive and Negative Syndrome Scale) and saccadic eye movement tasks over three testing periods. The effects of VPA were compared with schizophrenia patients medicated with equivalent doses of haloperidol alone (HAL group) and normal controls.

RESULTS

Schizophrenia patients had higher error rates on the antisaccade task (AS task) compared with normal controls. Adjunct VPA did not affect AS task error rates but was associated with an increase in response times for both saccade and AS tasks, with a significantly greater and dose-dependent increase in response times for the AS task. There were no differences in clinical improvement between VPA and HAL schizophrenia patient groups when controlling for haloperidol medication state.

CONCLUSIONS

These results suggest that adjuvant VPA therapy results in both sensorimotor and cognitive slowing but does not either help or further impair inhibitory control in schizophrenia, as measured by the elevated AS task errors.

Saccadic latency in hepatic encephalopathy: a pilot study

Hepatic encephalopathy is a common complication of cirrhosis. The degree of neuro-psychiatric impairment is highly variable and its clinical staging subjective. We investigated whether eye movement response times-saccadic latencies-could serve as an indicator of encephalopathy. We studied the association between saccadic latency, liver function and paper- and pencil tests in 70 patients with cirrhosis and 31 patients after liver transplantation. The tests included the porto-systemic encephalopathy (PSE-) test, critical flicker frequency, MELD score and ammonia concentration. A normal range for saccades was established in 31 control subjects. Clinical and biochemical parameters of liver, blood, and kidney function were also determined. Median saccadic latencies were significantly longer in patients with liver cirrhosis when compared to patients after liver transplantation (244 ms vs. 278 ms p < 0.001). Both patient groups had prolonged saccadic latency when compared to an age matched control group (175 ms). The reciprocal of median saccadic latency (μ) correlated with PSE tests, MELD score and critical flicker frequency. A significant correlation between the saccadic latency parameter early slope (σ(E)) that represents the prevalence of early saccades and partial pressure of ammonia was also noted. Psychometric test performance, but not saccadic latency, correlated with blood urea and sodium concentrations. Saccadic latency represents an objective and quantitative parameter of hepatic encephalopathy. Unlike psychometric test performance, these ocular responses were unaffected by renal function and can be obtained clinically within a matter of minutes by non-trained personnel.

Catechol-O-methyltransferase Val 158 Met polymorphism and antisaccade eye movements in schizophrenia

The catechol-O-methyltransferase (COMT) enzyme catabolizes dopamine. The val(158)met single nucleotide polymorphism (rs4680) in the COMT gene has received considerable attention as a candidate gene for schizophrenia as well as for frontally mediated cognitive functions. Antisaccade performance is a good measure of frontal lobe integrity. Deficits on the task are considered a trait marker for schizophrenia. The aim of this study was to investigate the association of COMT val(158)met polymorphism with antisaccade eye movements in schizophrenia patients and healthy controls. Schizophrenia patients (N = 105) and healthy controls (N = 95) underwent infrared oculographic assessment of antisaccades. Subjects were genotyped for COMT val(158)met and divided into 3 groups according to genotype (val/val, val/met, and met/met). Patients displayed significantly more reflexive errors, longer and more variable latency, and lower amplitude gain than controls (all P < 0.02). A greater number of val(158) alleles was associated with shorter (P = 0.045) and less variable (P = 0.028) antisaccade latency and, nonsignificantly, with lower reflexive error rate (P = 0.056). None of these variables showed a group-by-genotype interaction (P > 0.1). There were no significant associations of genotype with measures of amplitude gain or spatial error (P > 0.2). The results suggest that COMT val(158) carrier status is associated with better performance on the antisaccade task. Possible explanations of this finding are discussed.

Neuropsychological correlates of eye movement abnormalities in schizophrenic patients and their unaffected relatives

Impairments on neuropsychological and eye movement tasks have been demonstrated in schizophrenic patients and also reported in their unaffected relatives. However, it is not clear to what extent these phenotypes overlap. This study examined the relationship between specific eye movement and neuropsychological measures. The relationship between performance on eye movement and neuropsychological tasks was measured in 79 schizophrenic patients (63% from multiply affected families), 129 of their healthy first-degree relatives, and 72 normal controls. Antisaccade scores were correlated with most measures of neurocognitive functioning, and this correlation was strongest in schizophrenic patients in all cases. In the schizophrenic patients, but not their relatives or controls, the antisaccade distractibility error (ADE) score correlated significantly with current intelligence, verbal memory (immediate and delayed recall), and associative learning. In the case of crystallised IQ and delayed verbal memory, smaller correlations were present in unaffected relatives, although neither survived Bonferroni correction. Smooth pursuit performance was unrelated to any neuropsychological measure. Our study suggests that antisaccade errors are likely to represent part of a generalized neuropsychological deficit in schizophrenia.

Response switching in schizophrenia patients and healthy subjects: effects of the inter-response interval

Schizophrenia patients show impaired saccadic response switching, pointing to action control deficits at the level of response selection. Previous studies on healthy subjects suggested that response switch effects might decrease if the prior response is longer ago, reflecting a slow dissipation of the response program persisting from the previous trial. The present study aimed at directly investigating whether response switch effects in schizophrenia patients and healthy subjects depend on the inter-response interval (IRI). Effects of response switching on pro- and antisaccade performance were analyzed in 19 schizophrenia patients and 19 healthy controls at 3 different IRIs (2,500, 3,000, 4,000 ms). Response switch effects of healthy subjects did not vary with the IRI, suggesting that the previous response program persists as long as no contrary response program is activated. In schizophrenia, response switch deficits were replicated at an IRI of 3,000 ms, whereas at IRIs of 2,500 and 4,000 ms, effects of response switching did not significantly differ from healthy subjects. This might suggest that there is a specific IRI range particularly sensitive to response switch deficits in schizophrenia. However, effects of response switching at different IRIs remain to be consolidated.

Cognitive control of saccadic eye movements

The saccadic eye movement system provides researchers with a powerful tool with which to explore the cognitive control of behaviour. It is a behavioural system whose limited output can be measured with exceptional precision, and whose input can be controlled and manipulated in subtle ways. A range of cognitive processes (notably those involved in working memory and attention) have been shown to influence saccade parameters. Researchers interested in the relationship between cognitive function and psychiatric disorders have made extensive use of saccadic eye movement tasks to draw inferences as to the cognitive deficits associated with particular psychopathologies. The purpose of this review is to provide researchers with an overview of the research literature documenting cognitive involvement in saccadic tasks in healthy controls. An appreciation of this literature provides a solid background against which to interpret the deficits on saccadic tasks demonstrated in patient populations.

The tell-tale tasks: a review of saccadic research in psychiatric patient populations

This review focuses on saccade research with adult psychiatric patients. It begins with an introduction of the various types of saccades and the tasks used to evoke them. The functional significance of the different types of eye movements is briefly discussed. Research findings regarding the saccadic performance of different adult psychiatric patient populations are discussed in detail, with particular emphasis on findings regarding error rates, response latencies, and any specific task parameters that might affect those variables. Findings regarding the symptom, neurocognitive, and neural correlates of saccadic performance and the functional significance of patients' saccadic deficits are also discussed. We also discuss the saccadic deficits displayed by various patient groups in terms of circuitry (e.g. cortical/basal ganglia circuits) that may be implicated in the underlying pathophysiology of several of these disorders. Future directions for research in this growing area are offered.

Effects of second-generation antipsychotic medication on smooth pursuit performance in antipsychotic-naive schizophrenia

CONTEXT

Analyses of smooth pursuit eye movement parameters in patients with schizophrenia provide information about the integrity of neural networks mediating motion perception, sensorimotor transformation, and cognitive processes such as prediction. Although pursuit eye tracking deficits have been widely reported in schizophrenia, the integrity of discrete components of pursuit responses and the effect of second-generation antipsychotic medication on them are not well established.

OBJECTIVE

To examine different components of smooth pursuit performance in antipsychotic-naive patients with schizophrenia before and after treatment with second-generation antipsychotic medication.

DESIGN, SETTING, AND PARTICIPANTS

Thirty-three antipsychotic-naive patients with schizophrenia performed 3 different smooth pursuit paradigms designed to evaluate specific components of the pursuit response. All of the patients were retested after 6 weeks of treatment with risperidone or olanzapine. Testing was also performed with 39 matched healthy individuals. Thirteen patients and 21 healthy participants were retested after 26 and 52 weeks.

MAIN OUTCOME MEASURES

Pursuit initiation, maintenance gain (ratio of eye velocity over target velocity), and frequency of catch-up saccades during pursuit maintenance.

RESULTS

Prior to treatment, pursuit gain when tracking less predictable ramp targets tended to be reduced, latency of pursuit initiation was speeded, and catch-up saccade frequency was increased during predictive pursuit. After antipsychotic treatment initiation, pursuit gain decreased with ramp targets, indicating treatment-emergent impairments in sensorimotor processing. No changes were observed for predictive pursuit. Exploratory analyses in the subgroup with follow-up to 1 year revealed that these effects continued through long-term follow-up with some partial normalization at 1 year. Deficits were unrelated to drug dosage and clinical ratings.

CONCLUSIONS

Impaired sensorimotor function was observed after initiation of second-generation antipsychotic medications, which may be explained by their serotonergic antagonism of brainstem sensorimotor systems. Predictive mechanisms supported by frontostriatal-cerebellar circuitry were not affected by treatment initiation and appear able to compensate for treatment-emergent sensorimotor impairments during predictive tracking.

Eye movement deficits in schizophrenia: investigation of a genetically homogenous Icelandic sample

BACKGROUND

Deficits in antisaccade (AS) and smooth pursuit eye movements (SPEM) are promising endophenotypes in genetic studies of schizophrenia. The Icelandic population lends itself ideally to genetic studies due to its ethnic homogeneity and well-documented genealogy. The primary aim of this study was to assess AS and SPEM performance in a large Icelandic sample. Additional aims were to investigate the relationship between AS and SPEM task performance and to assess internal consistency, within-session performance changes and effects of SPEM target velocity on performance.

METHOD

Patients with schizophrenia (N = 118) and healthy controls (N = 109) matched for age and gender underwent infrared oculographic assessment of AS and SPEM (at target velocities of 12 degrees , 24 degrees and 36 degrees /s).

RESULTS

On the AS task patients displayed significantly more reflexive errors, longer latency, increased intra-individual latency variability, and reduced amplitude gain compared to controls. On the SPEM task, patients had significantly lower velocity gain and more frequent saccades during pursuit at all velocities, but group differences in velocity gain increased with increasing target velocity. Internal consistency of performance was high for all variables in both groups (Cronbach's alpha >0.77 for AS and >0.85 for SPEM) except for AS spatial error in patients (alpha = 0.38). A moderate association was found between AS and SPEM performance. By and large, patients and controls showed similar patterns of systematic within-session performance changes.

CONCLUSIONS

Our findings confirm the existence of robust eye movement deficits in schizophrenia in a large sample. These measures may be studied as endophenotypes in future studies of potential schizophrenia risk genotypes in the genetically homogenous Icelandic population.

Memory-guided saccade abnormalities in schizophrenic patients and their healthy, full biological siblings

BACKGROUND

Ocular-motor inhibition errors and saccadic hypometria occur at elevated rates in biological relatives of schizophrenic patients. The memory-guided saccade (MS) paradigm requires a subject to inhibit reflexive saccades (RSs) and to programme a delayed saccade towards a remembered target.

METHOD

MS, RS, and central fixation (CF) tasks were administered to 16 patients who met the criteria for DSM-IV schizophrenia, 19 of their psychiatrically healthy siblings, and 18 controls.

RESULTS

Patients and siblings showed elevated MS error rates reflecting a failure to inhibit RSs to a visible target, as required by the task. In contrast to controls, prior errors did not improve MS accuracy in patients and siblings.

CONCLUSIONS

The specific characteristics of the elevated MS error rate help to clarify the nature of the disinhibition impairment found in schizophrenics and their healthy siblings. Failure to inhibit premature saccades and to improve the accuracy of subsequent volitional saccades implicates a deficit in spatial working-memory integration, mental representation and/or motor learning processes in schizophrenia.

Saccade generation and suppression in schizophrenia: effects of response switching and perseveration

Poor antisaccade performance is a reliable index of action control deficits in schizophrenia. To further elucidate the underlying cognitive impairments, the current study aimed to confirm effects of switching the response direction on saccadic performance and to investigate whether response switch effects relate to perseveration. Fourteen schizophrenia patients and 14 healthy controls performed sequences of 1 to 3 simple volitional saccades to one direction and a subsequent volitional saccade with distractor to the same or the opposite direction. Response switches increased error rates in schizophrenia if they followed 3 saccades to the opposite side, suggesting that response switching affects performance on conditions of strong persisting response programs. The increase of response switch error rates with multiple repetitions of the prior response points to a relationship between perseveration and response selection.

Physiology and pathology of eye–head coordination

Human head movement control can be considered as part of the oculomotor system since the control of gaze involves coordination of the eyes and head. Humans show a remarkable degree of flexibility in eye-head coordination strategies, nonetheless an individual will often demonstrate stereotypical patterns of eye-head behaviour for a given visual task. This review examines eye-head coordination in laboratory-based visual tasks, such as saccadic gaze shifts and combined eye-head pursuit, and in common tasks in daily life, such as reading. The effect of the aging process on eye-head coordination is then reviewed from infancy through to senescence. Consideration is also given to how pathology can affect eye-head coordination from the lowest through to the highest levels of oculomotor control, comparing conditions as diverse as eye movement restrictions and schizophrenia. Given the adaptability of the eye-head system we postulate that this flexible system is under the control of the frontal cortical regions, which assist in planning, coordinating and executing behaviour. We provide evidence for this based on changes in eye-head coordination dependant on the context and expectation of presented visual stimuli, as well as from changes in eye-head coordination caused by frontal lobe dysfunction.

Schizophrenia patients show impaired response switching in saccade tasks

Action control deficits of schizophrenia patients result from frontostriatal brain abnormalities and presumably reflect an impairment of selective cognitive processes. This study aimed at dissociating two different levels of action control in saccades toward and away from visual stimuli (pro- and antisaccades). Results of previous studies suggested that task switch effects (between pro- and antisaccades) reflect the persistence of a task-specific production rule and refer to the level of task selection, whereas response switch effects (between leftward and rightward saccades) point to the persistence of a specific response program, referring to the level of response selection. In the present study, task switching and response switching were investigated in 20 schizophrenia patients and 20 control subjects. Groups did not differ concerning task switch effects. In contrast, response switching entailed a stronger enhancement of error rates in patients, suggesting a specific deficit on the level of response selection in schizophrenia. The deficit was associated with spatial working memory capacities, confirming and specifying existing hypotheses on a relationship between working memory and action control.

Brain potentials indicate poor preparation for action in schizophrenia

Impaired antisaccade performance in schizophrenia (SZ) may originate from poor task preparation, suggested by low amplitudes of the contingent negative variation (CNV) before antisaccades. To dissociate components of preparation we measured the CNV in standard pro- and antisaccades and a stimulus preceding negativity (SPN) in delayed pro- and antisaccades. In healthy controls the SPN had lower amplitudes than the CNV, reflecting mere stimulus expectation in SPN and combined stimulus expectation and action readiness in CNV. SZ patients had lower CNV amplitudes than controls, but there was no reliable indication of a general SPN reduction, suggesting a particular impairment of action readiness. The CNV and SPN amplitudes of controls were larger if tasks had incongruent (anti) compared to congruent (pro) S-R mappings. This difference was absent in SZ patients, suggesting a failure to activate specific resources for incongruent S-R mappings.

Impaired action control in schizophrenia: The role of volitional saccade initiation

Schizophrenia patients show prefrontal cortex dysfunctions of neurodevelopmental origin, but the cognitive implications of these dysfunctions are not yet understood. This study used experimental variations of oculomotor tasks to evaluate the relative roles of volitional action initiation and the inhibition of reflexive behavior. Thirty schizophrenia patients and 30 control participants performed standard prosaccades (SP), standard antisaccades (SA), delayed prosaccades (DP), and delayed antisaccades (DA). The delayed tasks allowed separating the inhibition of erroneous prosaccades and the initiation of volitional saccades, which coincide in the SA task. Arrow-cued (AC) saccades were used to evaluate initiation without any inhibitory component. Erroneous prosaccades were less frequent in the delayed tasks than in the SA task. Error rates were generally larger in schizophrenia patients than in control participants, but the deficit was smaller in the delayed tasks than in the SA task. Correct saccade latencies of schizophrenia patients were normal in the SP task, but not on conditions of volitional saccade initiation (all other tasks). Volitional saccade latencies were positively correlated with error rates in the schizophrenia group. These results confirm that schizophrenia patients have a specific deficit in initiating volitional action, which may also contribute to the increased error rates.

Neurophysiological endophenotypes of schizophrenia: the viability of selected candidate measures

In an effort to reveal susceptibility genes, schizophrenia research has turned to the endophenotype strategy. Endophenotypes are characteristics that reflect the actions of genes predisposing an individual to a disorder, even in the absence of diagnosable pathology. Individual endophenotypes are presumably determined by fewer genes than the more complex phenotype of schizophrenia and would, therefore, reduce the complexity of genetic analyses. Unfortunately, despite there being rational criteria to define a viable endophenotype, the term is sometimes applied indiscriminately to characteristics that are deviant in affected individuals. Schizophrenia patients exhibit deficits in several neurophysiological measures of information processing that have been proposed as candidate endophenotypes. Successful processing of sensory inputs requires the ability to inhibit intrinsic responses to redundant stimuli and, reciprocally, to facilitate responses to less frequent salient stimuli. There is evidence to suggest that both these processes are "impaired" in schizophrenia. Measures of inhibitory failure include prepulse inhibition of the startle reflex, P50 auditory evoked potential suppression, and antisaccade eye movements. Measures of impaired deviance detection include mismatch negativity and the P300 event-related potential. The purpose of this review is to systematically evaluate the endophenotype candidacy of these key neurophysiological abilities. For each candidate, we describe typical experimental procedures, the current understanding of the underlying neurobiology, the nature of the abnormality in schizophrenia, the reliability, stability and heritability of the measure, and any reported gene associations. We conclude with a discussion of the few studies thus far that have employed a multivariate approach with these candidates.

Reduced size of the pre-supplementary motor cortex and impaired motor sequence learning in first-episode schizophrenia

Increasing evidence suggests that schizophrenia is associated with various morphological and functional abnormalities of the frontal cortex. So far research has concentrated on the dorsolateral and orbitofrontal cortex. Behavioral evidence suggests however that regions responsible for higher motor control are compromised in schizophrenia as well. The current study assessed volumes of the anterior supplementary motor area (pre-SMA) and implicit motor sequence learning in 15 subjects with first-episode schizophrenia and 15 healthy matched controls. Pre-SMA volumes were assessed by three-dimensional structural magnetic resonance imaging (3D-MRI) and manual parcellation according to an established protocol. Implicit motor sequence learning was assessed using the Serial Reaction-Time Task (SRTT). Compared with control subjects, schizophrenia subjects had significantly smaller volumes of the left pre-SMA (16%). Subjects with schizophrenia were severely impaired on sequence-specific implicit motor learning. Size of the left pre-SMA of schizophrenia subjects was significantly related to impaired implicit learning. We conclude that subjects with first-episode schizophrenia have a morphological abnormality of the left pre-SMA that might predispose them to develop disturbances of higher motor control during acute episodes of psychosis. These structural and behavioral abnormalities might be conceptualized within a broader model that views schizophrenia as a disorder of disturbed coordination of thought and action.

The dual origin hypothesis: An evolutionary brain-behavior framework for analyzing psychiatric disorders

According to the dual origin hypothesis, the cerebral cortex of higher mammals evolved from two primordial brain structures, the amygdala and hippocampal formation. This developmental process defines the orderly principles of cortical connectivity and gives rise to functionally distinct ventral and dorsal systems within the cerebrum. This paper reviews the basic features of the dual origin theory. This model is then applied to understanding symptom production in a number of psychiatric illnesses, with particular reference to recent structural and functional imaging studies. In this paper I propose that psychiatric symptoms can be conceptualized as arising from abnormal processing within dorsal (time-space-motility) or ventral (meaning-motivation) systems, or from a disturbance in the functional interaction/balance between them. Within this framework, one can identify symptom-specific correlations that cross-traditional diagnostic boundaries, as well as potential mechanisms that may explain biologically valid diagnostic entities. Integrating evolutionary, connectional and functional bases across multiple species, the dual origin hypothesis offers a powerful neural systems model to help organize our understanding of psychiatric illness, therein suggesting novel approaches to diagnosis, prevention and treatment.

Saccadic eye movement task identifies cognitive deficits in children with schizophrenia, but not in unaffected child relatives

BACKGROUND

The delayed oculomotor response (DOR) task requires response inhibition followed by movement of gaze towards a known spatial location without a current stimulus. Abnormalities in response inhibition and in the spatial accuracy of the eye movement are found in individuals with schizophrenia and in many of their relatives, supporting the use of these saccadic abnormalities as endophenotypes in genetic studies. It is unknown whether school-age children, either with psychosis or as relatives of a schizophrenic proband, can be included.

METHOD

One hundred eighty-seven children, ages 5.8-16.0 years - 45 children with childhood-onset schizophrenia, 64 children with a first-degree relative with schizophrenia, and 84 typically developing children - completed DOR tasks with 1 and 3 second delays.

RESULTS

Children with childhood-onset schizophrenia demonstrated impaired response inhibition and impaired spatial accuracy compared to both relatives and typicals; however, relatives and typicals did not differ from each other.

CONCLUSIONS

Children with childhood-onset schizophrenia have saccadic abnormalities similar to those found in adults with schizophrenia, supporting the continuity of executive function deficits in childhood-onset with adolescent and adult-onset schizophrenia. However, saccadic tasks are not sensitive to genetic risk in non-psychotic children and 6-15-year-old children should not be included in genetic studies utilizing this endophenotype.

Poor antisaccade performance in schizophrenia: an inhibition deficit?

The antisaccade task appears to be particularly suitable for analyzing processes involved in executive control of action. Schizophrenic patients show enhanced rates of erroneous reflexive saccades in this task. This is commonly interpreted as a failure of inhibitory mechanisms. The role of volitional saccade generation is largely neglected in these accounts. In this study, experimental variations of the antisaccade task were applied to manipulate the contribution of volitional processes on antisaccade performance. Fifteen patients with a diagnosis of schizophrenia and 15 healthy control participants performed antisaccade tasks requiring them to look to the mirror location of a peripheral visual stimulus at the onset of this stimulus (standard antisaccade task) or after a brief delay (delayed antisaccade task). As expected, schizophrenic patients showed more reflexive saccade errors than controls. In the delay conditions, reflexive errors decreased, and this effect was significantly stronger in schizophrenic patients. Latencies of correct antisaccades tended to be longer in patients than in control participants. The results suggest that the generation of voluntary saccades is at least in part responsible for the antisaccade deficit in schizophrenic patients. More comprehensive models to account for executive deficits in the antisaccade task must be considered.

Functional Neuroanatomy of Anticipatory Behavior: Dissociation between Sensory-driven and Memory-driven Systems

The ability to anticipate predictable stimuli allows faster responses. The predictive saccade (PRED) task has been shown to quickly induce such anticipatory behavior in humans. In a PRED task subjects track a visual target jumping back and forth between fixed positions at a fixed time interval. During this task, saccade latencies drop from approximately 200 ms to <80 ms as subjects anticipate target appearance. This change in saccade latency indicates that subjects' behavior shifts from being sensory driven to being memory driven. We conducted functional magnetic resonance imaging studies with 10 healthy adults performing the PRED task using a standard block design. We compared the PRED task with a visually guided saccade (VGS) task using unpredictable targets matched for number, direction and amplitude of required saccades. Our results show greater activation during the PRED task in the prefrontal, pre-supplementary motor and anterior cingulate cortices, hippocampus, mediodorsal thalamus, striatum and cerebellum. The VGS task elicited greater activation in the cortical eye fields and occipital cortex. These results demonstrate the important dissociation between sensory and predictive neural control of similar saccadic eye movements. Anticipatory behavior induced by the PRED task required less sensory-related processing activity and was subserved by a distributed cortico-subcortical memory system including prefronto-striatal circuitry.

Saccadic performance in questionnaire-identified schizotypes over time

In the present study, 121 young adults (mean age=19 years), hypothesized to be at varying levels of risk for psychosis on the basis of their psychometric profiles, were administered saccadic (antisaccade and refixation) tasks at two separate assessments. At Time 1, individuals posited to be at heightened risk for the later development of schizophrenia-spectrum disorders (i.e., those individuals with elevated Social Anhedonia Scale [SAS] scores) produced significantly more antisaccade task errors than the controls. Despite apparent improvement in antisaccade task performance from initial testing to the follow-up (mean test-retest interval=59 months) across all groups, the Social Anhedonia (SocAnh) group continued to produce significantly more errors than the control group. The antisaccade task performance of the control group showed good temporal stability (Pearson's r=0.70, ICC=0.52), and the SocAnh group's performance showed excellent temporal stability (Pearson's r=0.85, ICC=0.83). The results of this investigation are twofold: First, antisaccade task performance is temporally stable, even in psychometrically identified schizotypes over long test-retest intervals; and secondly, Social Anhedonia Scale scores as well as Time 1 antisaccade task accuracy accounted for much of the variability in Time 2 antisaccade task performance. These findings add to the growing body of literature suggesting that antisaccade task deficits may serve as an endophenotypic marker of a schizophrenia diathesis.

Ketamine-induced distractibility: An oculomotor study in monkeys

BACKGROUND

Administration of subanesthetic doses of ketamine, a noncompetitive N-methyl-D-aspartate receptor antagonist, induces a spectrum of behavioral disorders that are commonly observed in patients with schizophrenia. Although it has been demonstrated that poor antisaccade performance is a core dysfunction in schizophrenia, the ability of ketamine to induce an increased distractibility has not been demonstrated. The present study aimed to determine whether ketamine administration would reproduce the same antisaccade deficit as that observed in schizophrenic subjects.

METHODS

We studied the effect of acute ketamine or saline administration on the performance of two monkeys trained on a reflexive visually guided saccade task and an antisaccade task.

RESULTS

The main result is that ketamine administration induced a markedly increased antisaccade error rate and increased antisaccade latency, similar to that seen in schizophrenic subjects. Other impairments consisted of increased reflexive saccade latency and the presence of a gaze-evoked nystagmus.

CONCLUSIONS

This study supports the validity of ketamine as a pharmacological model of schizophrenia. Based on the known pharmacological effects of ketamine, further studies should allow the investigation of the pharmacological basis of distractibility.

Abnormalities in visually guided saccades suggest corticofugal dysregulation in never-treated schizophrenia

BACKGROUND

Previous studies have reported intact visually guided saccades in schizophrenia, but these are limited by potential acute and long-term pharmacological treatment effects, small sample sizes, and a failure to follow patients over time.

METHODS

Visually guided saccades were examined in 44 antipsychotic-naive patients experiencing their first episode of schizophrenia prior to treatment and again after 6, 26, and 52 weeks of antipsychotic treatment. Thirty-nine matched healthy individuals were followed over the same period.

RESULTS

Before treatment, patients showed faster saccade latencies to unpredictable visual targets, suggesting reduced inhibitory regulation of brainstem saccade generators by neocortical attentional systems. Risperidone treatment reduced this deficit, suggesting a facilitation of attentional function, but haloperidol treatment did not. However, there was also a modest decline in saccade accuracy after risperidone treatment. The ability to sustain fixation of static central and peripheral targets was unimpaired before and after treatment.

CONCLUSIONS

These findings provide evidence for impairments in neocortical attentional systems that cause reduced corticofugal regulation of brainstem systems in schizophrenia. This dysfunction appears to be minimized by the atypical antipsychotic risperidone but at the cost of a subtle reduction in saccade accuracy, possibly mediated via adverse effects on cerebellar vermis function.

Saccadic eye movements, schizotypy, and the role of neuroticism

We investigated the relationships of anti- and prosaccades with psychometric schizotypy. One aim was to estimate the role of negative emotionality and general psychopathology (i.e. neuroticism) in this relationship. 115 non-clinical volunteers underwent infrared oculographic assessment of antisaccades and prosaccades. Schizotypy was assessed with the Personality Syndrome Questionnaire (PSQ-80), the Rust Inventory of Schizotypal Cognitions (RISC), and Eysenck Personality Questionnaire-Revised (EPQ-R) Psychoticism. Higher positive schizotypy scores predicted increased antisaccade errors (RISC) and greater prosaccade spatial error (PSQ-80 Unreality). Greater thought disorder (PSQ-80 Activity) predicted shorter prosaccade latencies. EPQ-R Neuroticism was substantially correlated with schizotypy but was not related to saccadic measures and did not account for their relationship with schizotypy. We conclude that saccadic performance patterns in schizotypy are not due to negative emotionality or general psychopathology, but specific to schizophrenia spectrum signs and symptoms.

Do schizophrenia patients make more perseverative than non-perseverative errors on the Wisconsin Card Sorting Test? A meta-analytic study

The Wisconsin Card Sorting Test (WCST) is widely used to explore executive functions in patients with schizophrenia. Among other findings, a higher number of perseverative errors has been suggested to implicate a deficit in task switching and inhibitory functions in schizophrenia. Many studies of patients with schizophrenia have focused on perseverative errors as the primary performance index in the WCST. However, do schizophrenia patients characteristically make more perseverative than non-perseverative errors compared with healthy controls? We reviewed the literature where schizophrenia patients were engaged in the WCST irrespective of the primary goal of the study. The results showed that while both schizophrenia patients and healthy participants made more perseverative than non-perseverative errors, the contrast between perseverative and non-perseverative errors is higher in schizophrenia patients only at a marginal level of significance. This result suggests that schizophrenia patients do make a comparable number of non-perseverative errors and cautions against simplistic interpretation of poor performance of schizophrenia patients in WCST as entirely resulting from impairment in set-shifting or inhibitory functions.

Automated eye tracking system calibration using artificial neural networks

The electro-oculogram (EOG) continues to be widely used to record eye movements especially in clinical settings. However, an efficient and accurate means of converting these recordings into eye position is lacking. An artificial neural network (ANN) that maps two-dimensional (2D) eye movement recordings into 2D eye positions can enhance the utility of such recordings. Multi-layer perceptrons (MLPs) with non-linear activation functions and trained with back propagation proved to be capable of calibrating simulated EOG data to a mean accuracy of 0.33 degrees . Linear perceptrons (LPs) were only nearly half as accurate. For five subjects, the mean accuracy provided by the MLPs was 1.09 degrees of visual angle ( degrees ) for EOG data, and 0.98 degrees for an infrared eye tracker. MLPs enabled calibration of 2D saccadic EOG to an accuracy not significantly different from that obtained with the infrared tracker. Using initial weights trained on another person reduced MLP training time, reaching convergence in as little as 20 iterations.

The relationship between antisaccades, smooth pursuit, and executive dysfunction in first-episode schizophrenia

BACKGROUND

Both oculomotor and neuropsychologic deficits have been used to support the hypothesis that schizophrenia is associated with prefrontal cortex dysfunction, but studies that have specifically investigated the relationships between these deficits have produced inconsistent findings.

METHODS

We measured both smooth pursuit and antisaccade performance in a large group (n = 109) of patients with first-episode schizophrenia and a group of matched control subjects (n = 59) and investigated the relationship between performance on these tasks and performance on a range of executive tasks. We additionally explored the relationship between these variables and measures of psychopathology at presentation and duration of untreated psychosis.

RESULTS

Antisaccade errors were significantly correlated with spatial working memory performance. Smooth pursuit gain did not correlate with any neuropsychologic measure. There were no reliable correlations between either oculomotor variables and measures of psychopathology and duration of untreated psychosis.

CONCLUSIONS

These findings suggest that in schizophrenia working memory and antisaccade performance reflect the same abnormal prefrontal substrates and that smooth pursuit is mediated by a separate neural abnormality.

Effects of amisulpride, risperidone and chlorpromazine on auditory and visual latent inhibition, prepulse inhibition, executive function and eye movements in healthy volunteers

In view of the evidence that cognitive deficits in schizophrenia are critically important for long-term outcome, it is essential to establish the effects that the various antipsychotic compounds have on cognition, particularly second-generation drugs. This parallel group, placebo-controlled study aimed to compare the effects in healthy volunteers (n = 128) of acute doses of the atypical antipsychotics amisulpride (300 mg) and risperidone (3 mg) to those of chlorpromazine (100 mg) on tests thought relevant to the schizophrenic process: auditory and visual latent inhibition, prepulse inhibition of the acoustic startle response, executive function and eye movements. The drugs tested were not found to affect auditory latent inhibition, prepulse inhibition or executive functioning as measured by the Cambridge Neuropsychological Test Battery and the FAS test of verbal fluency. However, risperidone disrupted and amisulpride showed a trend to disrupt visual latent inhibition. Although amisulpride did not affect eye movements, both risperidone and chlorpromazine decreased peak saccadic velocity and increased antisaccade error rates, which, in the risperidone group, correlated with drug-induced akathisia. It was concluded that single doses of these drugs appear to have little effect on cognition, but may affect eye movement parameters in accordance with the amount of sedation and akathisia they produce. The effect risperidone had on latent inhibition is likely to relate to its serotonergic properties. Furthermore, as the trend for disrupted visual latent inhibition following amisulpride was similar in nature to that which would be expected with amphetamine, it was concluded that its behaviour in this model is consistent with its preferential presynaptic dopamine antagonistic activity in low dose and its efficacy in the negative symptoms of schizophrenia.

Nicotine reduces antisaccade errors in task impaired schizophrenic subjects

Nicotine and/or smoking have been shown to reduce various cognitive deficits associated with schizophrenia. Here, we examine the effects of nicotine gum on repeated performance on a simple eye movement task. Eight schizophrenic subjects and eight controls participated in three days of testing on saccade (S) and antisaccade (AS) tasks. On each testing day, subjects participated in four testing sessions and received both of two nicotine gum treatments (4 and 6 mg) and both of two control conditions (placebo gum and no gum), each followed by a recovery period. Overall, schizophrenics showed significant impairments on the AS task. However, upon individual examination only four schizophrenics showed significant differences in AS errors or reaction times (RTs) when compared to controls. The other four schizophrenic subjects showed control level performance. All schizophrenic subjects showed normal and better than control level performance on the simple S task. Furthermore, no effects of nicotine were seen on the simple S task. There were significant treatment effects on the AS task. Nicotine treatment significantly decreased errors in the task impaired schizophrenic group and this effect was most pronounced at the 6 mg level. No nicotine effects were demonstrated for non-impaired schizophrenic subjects or controls. This study demonstrates a benefit of short exposure to nicotine in cognitively impaired schizophrenic subjects. These results support previous findings of cognitive benefits of nicotine in schizophrenics.

Smooth pursuit and antisaccade eye movements in siblings discordant for schizophrenia

Smooth pursuit eye movement (SPEM) and antisaccade deficits have been proposed as endophenotypes in the search for schizophrenia genes. We assessed these measures in 24 schizophrenia patients, 24 of their healthy siblings, and 24 healthy controls closely matched to the siblings. Between-group differences were assessed using a random effects regression model taking into account the relatedness between patients and siblings. Patients showed reduced SPEM gain, increased frequency of saccades during pursuit, increased antisaccade error rate, and reduced antisaccade gain compared to controls. Siblings performed intermediate, i.e. between patients and controls, on most measures, but were particularly characterised by reduced antisaccade gain. SPEM gain at one target velocity was significantly correlated between patients and siblings, highlighting the necessity of taking into account within-family correlations in the statistical analysis of between-group differences. It is concluded that subtle SPEM and antisaccade deficits are observed in clinically unaffected siblings of schizophrenia patients; these deficits may be useful markers of genetic liability to schizophrenia.

Effects of nicotine on leading saccades during smooth pursuit eye movements in smokers and nonsmokers with schizophrenia

Several studies have shown that schizophrenic patients and their biological relatives generate a greater number of leading saccades during smooth pursuit eye movement (SPEM) tasks. This abnormality may reflect a failure of cortical and/or cerebellar areas to coordinate saccadic and pursuit eye movements during visual tracking. The pharmacology of this phenomenon is not known. Here, we sought to replicate and extend the findings of Olincy et al (1998), who found that nicotine transiently reduced the number of leading saccades during SPEMs. A total of 27 subjects with schizophrenia (17 males; 14 smokers), and 25 healthy comparison subjects (nine males; 14 smokers) completed an eye-tracking task after receiving a 1.0 mg nasal spray of nicotine and during drug-free conditions. Results confirm that nicotine reduces the number of leading saccadic eye movements during visual tracking in schizophrenic patients. Baseline impairments and the beneficial effects of nicotine were not restricted to patient smokers, as nonsmoker patients exhibited the greatest number of leading saccades in the no drug condition and exhibited the most pronounced improvements after nicotine administration. Improvement in patient nonsmokers was not a function of previous smoking history. No effect of nicotine was observed in control nonsmokers. In contrast to the previous study, nicotine appeared to improve performance in control smokers. Overall, the study results support a functional role of nACh receptors in improving eye-tracking performance, and are consistent with the hypothesis, articulated by several investigators, that nACh receptor system abnormalities are responsible for a number of schizophrenia-related neurophysiological deficits.