Perceptualand Motor Skills, 1992, 75, 747-753.
63 Perceptual and Motor Skills 1992
ABNORMALITIES O F PSYCHOMOTOR DEVELOPMENT IN SCHIZOPHRENIA: A REHABILITATION PERSPECTIVE ' MARCELLA PROVENZA, SIMONA D I ROSA, PAOLO CAVEDINI, FRANCESCA TOSONI, MONICA ALIETTI, LUIGINA ROVEY, AND SILVIO SCARONE
Rehabilitation Unit, Psychiatric Branch Department of Biomedical and Technological Sciences University of Milan Medical School and IRCCS H S Raffaele, Milano Summary.-This study was an evaluation of the psychomotor profiles of 22 schizophrenic patients, investigated by means of a test battery developed for the assessment of psychomotor profiles of 10- to 12-year-old children. Analysis indicates that abnormal psychomotor development is an inherent fearure of the disease and probably is antecedent to a full psychopathological picture.
Several lines of research in clinical psychology and psychopathology suggest that schizophrenia is frequently associated with highly disparate neurofunctional disabilities underlying different maladaptive social behaviors (Brenner, Kraemer, Hermanutz, & Hodel, 1990). Among other things, psychomotor impoverishment (Liddle & Barnes, 1990) has been critically associated with schizophrenic chronicity and, in some way, inherent in the negative aspects of the disease. More interestingly, a rehabilitation suggested that impaired psychomotor functioning is a critical determinant in the maintenance of psychotic disabilities (Ciompi, 1989). Further, from a neurofunctional viewpoint, several recent findings indicate the presence of early disturbances in the motor development of chronic schizophrenics (Fish, 1975). In addition, about 20% of the chddren who will develop schizophrenia in adult life show some defects in their psychomotor abilities as compared to 10% of controls (Ricks & Nameche, 1966). Children of schizophrenics also show a higher incidence of motor coordination deficit and in the interhemispheric neurofunctional integration (Marcus, 1970). The aim of this study was to evaluate the psychomotor profile for a group of noninstitutionalized young schizophrenic patients and to compaie that profile with one for a group of age- and sex-matched normal controls. For this reason the subjects were evaluated on a psychomotor battery developed for the assessment of the psychomotor profile among children 6 to 12 years old. We reasoned that, if the patients showed some evidence of psychomotor defect having occurred in early development, this would be better detected with an instrument specifically designed for detection of such neurofunctional disability. 'Address correspondence to Silvio Scarone, M.D., Rehabilitation Unit, Psychiatric Branch, Department of Biomedical and Technological Sciences, University of W a n Medical School and IRCCS H S Raffaele, Via Prinetri 29, 20127 Milano, Italia.
748
M. PROVENZA, ETAL
Subjectr Twenty-two schizophrenic patients (14 men, 8 women, with mean age of 29.8 yr. 8.7, with mean age at onset of 22.3 yr. 5.8, with mean education of 10.6 yr. 2.8) together with 2 1 sex- and age-matched controls (14 men, 7 women with mean age of 29.6 yr. 9.2, with mean education of 14.4 yr. + 2.2) took part in this study. Education was significantly higher for controls than among patients ( t test with 40 df = 4.94, p < .01). The diagnosis of schizophrenia, the subtype classification, and the evaluation of chronicity were made using DSM-111-R criteria (APA, 1987) by two senior psychiatrists. At the time of administration of the test, the patients had been taking low doses of neuroleptics for at least 1 month (mean Chlorpromazine doseequivalent of 200 to 300 mglday). Seventeen patients had also been taking an hypnotic at bedtime, with a mean FlurazePam dose-equivalent of 15 mg.
*
*
*
Psychomotor Evaluation The profile of psychomotor development was summarized as the mean scores, expressed as the subject's developmental age, on the following seven tests selected from the literature specialized in the field of the child psychomotor evaluation (Table 1). TABLE 1 PSYCHOMOTOR TEST BATTERY: F U N C ~ O NAND S PROCEDURES Function
Procedure
Dynamic coordination of hands
Manual ability and throwing-catching exercises
Dynamic general coordination
Run and jump exercises of increasing difficulty which are articulated and differentiated
Equilibration
Static coordination exercises which consist of maintaining different positions, also with eyes closed
Check of upper and lower'lirnbs
Oscillation and relaxing exercises of the upper limbs alternating with volunrary movement of the lower limbs Recognition exercises (left and right) on themselves and others
Spacial organization Space-time structure
Exercises in reproducing rhythms and transcriprion of space-time structures
Lateraliry
Preference exercises in use o l the hands, dominance of eyes and feet
1. Dynamic coordination of hands.-The task corresponds to the second performance derived from the Oseretzky-Guilmain Battery (Oseretzky, 1937) and consists of motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years.
SCHIZOPHRENIA: PSYCHOMOTOR DEVELOPMENT
749
2. Dynamic general coordination.-This measure corresponds to the third performance derived from the Oseretzky-Guilmain Battery (Oseretzky, 1937) and includes motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years. 3. Equilibration.-The test corresponds to the first performances derived from the Oseretzky-Guilmain Battery (Oseretzky, 1937) and presented as motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years. 4. Check of upper and lower limbs.-This measure was based on motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years (Picq & Vayer, 1968). 5. Spatial organization.-Performance on a series of tests, readapted from Piaget-Head Battery by Gulifret-Granjon (Gulifret-Granjon, 1951), of increasing difficulty weighted for six levels of age from 6 to 12 years. 6. Space-time structure.-This measure was a series of tests from the Stamback Battery (Stamback, 1951) weighted for six levels of age from 6 to 12 years. 7. Latera1ity.-Tests 2, 8, and 11 from Harris' Battery (Picq & Vayer, 1968) were given. According to the theory of the physiological development of psychomotor maturation in children, at the end of primary school (from 6 to 10 years) maturation is at its fullest (see for a review Turkewitz, 1977). What thls represents is the integration, at the level of the association functions, of motor abilities that are mainly dependent on a normal functioning of the neuromuscular system and of more complex functions (motor coordination, equihbrium, spatial orientation) specifically devoted to spatial and social adaptation. These functions were administered individually by a child physiotherapist trained in the procedure. Statistical Analysis Exploratory factor analysis was performed to identify patterns related to the structure of the psychomotor battery (SPSS, 1988). The factor analysis as a first step involved constructing a correlation matrix to examine a set of initial factors often accomplished by the method of principal components. We chose to use a minimum eigenvalue of at least 1.0 and a principal component extraction method. Despite the fact that the initial factors provided a useful first impression, they are usually difficult to interpret directly without some further manipulation. Consequently, another step which entails rotation usually is required to achieve conceptual meaningfulness: to this purpose we performed an oblique rotation. We selected the oblique rotation because it is more flexible; in fact, the factor axes need not be orthogonal, which is more realistic because the theoretically important underlying dimensions are not assumed to be unrelated to each other. Three factors were extracted, factor
750
M. PROVENZA, ET AL.
scores representing the weight of each subject in determining each factor. The resulting factor scores in the schizophrenic patients and normal controls were then analyzed by means of t ratio to check significance of mean differences between the two groups.
RESULTS AND DISCUSSION Table 2 shows means and standard deviations of function scores for patients and controls expressed as age. Table 3 shows means and standard deviations of laterality scores for patients and controls expressed as developmental age. TABLE 2 FUNCTIONSCORESFOR SCI-IIZOIII-IRENICS A N D CONTROLS: MEANSA N D STANDARD DEVIATIONS Function
Schizophrenics M SD
Dynamic coordination of hands Dynamic general coordination Equilibration Check of upper and lower limbs Spatial organization S ~ a c e - t i m estructure
LATERALITYSCORESFOR PATENTS Function Laterality in use of hands Laterality in use of feet Laterality in use of eyes
9.65 9.59 8.00 6.94 8.72 9.27
1.46 2.32 0.41 1.05 1.48 1.95
Controls
M
SD
11.61 11.61 10.33 9.80 11.61 11.42
0.66 0.92 0.85 1.50 0.48 0.81
TABLE 3 CONTROLS: MEANSA N D STANDARD DEVIATIONS
AND
Schizophrenics
Controls
M
SD
M
SD
1.54 1.63 1.54
1.10 1.13 0.91
1.19 1.19 2.04
0.87 0.87 1.46
Three factors were extracted. Factor 1 (eigenvalue = 4.31) explained
43.1% of the total variance, Factor 2 (eigenvalue = 1.85) explained 18.5% of the total variance, and Factor 3 (eigenvalue = 1.05) explained 10.5% of the total variance. Table 4 shows the pattern matrix after oblique rotation, i.e., the factor loadings for each test of the psychomotor battery. Factor 1 was loaded mainly with Equilibration, Space-time Structure, Spatial Organization, and Check for the Upper and Lower Limbs. Factor 2 was loaded by Laterality of Hands and Feet and Factor 3 by Laterahty of Eyes. Table 5 shows the mean factor scores for each factor in groups of schizophrenics and controls. The schizophrenics were significantly different from controls only on Factor 1. To the best of our knowledge, this is the first study which explored the characteristics of psychomotor patterns in schizophrenia by means of a bat-
75 1
SCHIZOPHRENIA: PSYCHOMOTOR DEVELOPMENT TABLE 4 FACTORANALYSIS: ROTATED LOADINGS FOR THREEFACTORS Measure
Factor 2
Factor 1
Factor 3
Equilibrat~on Space-time structure Spacial organization Check of upper and lower limbs Dynamic coordination of hands Laterality in use of hands Lateralitv in use of feet Laterality in use of eyes
tery of tests which are utilized for assessing psychomotor development in children. By factor analysis three factors were extracted. Factor 1 was loaded by the majority of the psychomotor tests but not the tests of laterahation. TABLE 5 FACTOR ANALYSIS: FACTORSCORESFORPATIENTS AND CONTROLS: MEANSAND STANDARD DEV~A~ONS Group
Factor 1 -
Schizophrenics Controls
Factor 2
Factor 3
M
SD
M
SD
M
SD
-0.82* 0.71
0.81
0.22
1.36
0.85
0.47
-0.18
0.57
-0.14 0.12
-
1.16
We can therefore say that Factor 1 is an indicator of general C.N.S. structural organization, not specifically related to a particular function or C.N.S. neurofunctional area. The statistically significant difference between schizophrenics and controls found on Factor 1 scores suggests that the pattern of psychomotor organization is critically affected by schizophrenia. Much experimental data from the neuropsychological (Coger & Serafetinides, 1990; Behni, Abbruzzese, Gambini, Rossi, Stratta, & Scarone, 1991) (Buchsbaum, 1990; Gambini, Colombo, Macciardi, and ne~roph~siological Locatelli, Calabrese, Sacchetti, & Scarone, 1990) literature have shown various degrees of neurofunctional impairment in schizophrenia. Recently it was proposed that cognitive impairment in schizophrenia is dependent on neurodevelopmental abnormalities that appear during the neonatal or preadolescent periods (Murray, Lewis, Owen, & Foster, 1988). Further, there is evidence of abnormal neuromotor development in infants who are later diagnosed as schizophrenics (Fish, 1975). Our data appear consistent with these hypotheses and make reasonable the hypothesis that abnormal psychomotor development is an inherent feature of schizophrenia and probably is antecedent to a full psychopathological picture. Factors 2 and 3 load with test batteries of laterality. They explain a small part of the vari-
752
M.PROVENZA, ETAL.
ance, and the means of the scores for these two factors are not significantly different between the two groups. Therefore, it seems that, consistent with a part of the literature, laterality patterns are not criticdy affected by the disease and do not constitute a possible antecedent for the development of schizophrenia (Taylor, Dalton, & Fleminger, 1980; Wale & Carr, 1988; Faustam, Moses, & Csernansky, 1988). I n the opinion of the investigators the present results must be considered as preliminary because the sample i s relatively small and, most important, because all the patients were on neuroleptic medications when their psychomotor evaluations were made. Moreover, if confirmed for a larger sample of unmedicated patients, these results would stress the importance of a rehabilitative approach which takes into account techniques devoted to the improvement of the impaired psychomotor abilities. REFERENCES AMEMCANPSYCHIATRIC ASSOCIATION.Diagnostic and sfatistical manual o/ mental disorders. (3rd ed., Rev.) Washington, DC: Author, 1987. BELLINI,L., A B B R U ~ ~ EM., S E ,GAMBINI,O., ROSSI,A , , STRATA, l?, & SCARONE, S. Frontal and caUosal neuropsycholo ical performances in schizophrenia: further evidence of possible attention and mnesic &functions. Schizophrenia Research, 1991, 5 , 115-121. BRENNER, H. D., KRAEMER, S., H E R ~ ~ A N UM., T Z ,& HODEL,B. Cognitive treatment in schizophrenia. In E. R. Straube & K. Haldweg (Eds.), Schizophrenia: concepts, vulnerability, and intervention. Berlin: Springer-Verlag, 1990. Pp. 161-191. BUCHSBAUM, M. Frontal lobes, basal ganglia, temporal lobes: three sites for schizophrenia. Schizophrenio Bulletin, 1990, 16, 377-378. CIOMI>I, L. The dynamics of complex biological-psychosocial systems. British Journal of Psychiatry, 1989, 155(Suppl. 5), 15-21. Cocex, R. W., & SERAFETINIDES, E. A. Schizophrenia, corpus cdosum and interhemispheric communication: a review. Psychiatry Research, 1990, 36, 163-184. F n u s r m , W. O., MOSES,J. A,, & CSEKNANSKY, J. G . Luria-Nebraska performance and symptomatology in unmedicated schizophrenic patients. Psychiatry Research, 1988, 7, 47-54. FISH, B. Biologic antecedents of psychosis in children. In D. X. Freedman (Ed.), Biology ofthe major psychoses. New York: Raven, 1975. Pp. 49-84. GAMBINI,O., COLOMBO, C., ~ C C I M D F., I , LOCATELLI, M., CALABRESE, G., SACCI-IET~I, E., & SCAKONE, S. EEG power spectrum profile and structural CNS characteristics in schizophrenia. Biological Psychiatry, 1990, 27, 1331-1334. GULIFRET-GRANJON, N. Le probleme de I'organisation spatiale dans les dyslexics d'ivolution. En/ance, 1951, 5, 134-145. LIDDLE,P. F., & BARNES,T. R . E. Syndromes of chronic schizophrenia. British Journal of Psychiatry, 1990, 157, 558-561. MARCUS,J. Neurological and physiological characteristics of the children of schizophrenic at ents. Paper presented at the 7th Congress of the Inrernational Association of ~ f i l d Psychiatry and Allied Professions, Jerusalem, August 4, 1970. MURRAY, R. M., LEWIS, S. W., OWEN, M. J., & FOSTER,A. The neurodevelopmental origins of dementia mecox. In l? Bebbington & l? McGuffin (Eds.), Schizophrenia: the major issues. oxfor$ UK: Heinemann, 1988. Pp. 90-106. NORUSIS,M. J. SPSSIPC V2.0, base manual. Chicago, IL: SIJSS, Inc., 1988. OSERETZKY,N. Psychomotor~k Methoden zzrr Unterszrchung der Moforik. Leipzig: Johann Ambrosius Barth, 1937. PICQ, L., & VAYER,I? Education psycho-motrice et arrzeration mentale. Paris: Doin, 1968. RICKS, D. F., & NAMECI-IE, G. Symbiosis, sacrifice and schizophrenia. Mental Hygiene, 1966, 9 , 541-551.
SCHIZOPHRENIA: PSYCHOMOTOR DEVELOPMENT
753
STAMBACK, M. Le probltme du rhythme dans le developpement de I'enfant et dans les dyslexies d'evolution. Enfance, 1951, 5, 224-227. TAYLOR, P. J . , DALTON,R., & F L ~ G E JR. J., Handedness in schizophrenia. British Jozrrnal of Psychiatry, 1980, 136, 375-383. TUKKEWITZ,G. The development of lateral differentiation in the human infant. In S. . Diamond & D. A. BLizard (Eds.), Evolution and Iateralization of [he brain. New Yor : New York Academy of Sciences, 1977. Pp. 309-318. WALE,J., & CARR,V. Dichotic listening asymmetries and psychotic symptoms in schizophrenia: a preliminary report. Psychiatry Research, 1988, 25, 31-39.
h
Accepfed August 4, 1992.
63 Perceptual and Motor Skills 1992
ABNORMALITIES O F PSYCHOMOTOR DEVELOPMENT IN SCHIZOPHRENIA: A REHABILITATION PERSPECTIVE ' MARCELLA PROVENZA, SIMONA D I ROSA, PAOLO CAVEDINI, FRANCESCA TOSONI, MONICA ALIETTI, LUIGINA ROVEY, AND SILVIO SCARONE
Rehabilitation Unit, Psychiatric Branch Department of Biomedical and Technological Sciences University of Milan Medical School and IRCCS H S Raffaele, Milano Summary.-This study was an evaluation of the psychomotor profiles of 22 schizophrenic patients, investigated by means of a test battery developed for the assessment of psychomotor profiles of 10- to 12-year-old children. Analysis indicates that abnormal psychomotor development is an inherent fearure of the disease and probably is antecedent to a full psychopathological picture.
Several lines of research in clinical psychology and psychopathology suggest that schizophrenia is frequently associated with highly disparate neurofunctional disabilities underlying different maladaptive social behaviors (Brenner, Kraemer, Hermanutz, & Hodel, 1990). Among other things, psychomotor impoverishment (Liddle & Barnes, 1990) has been critically associated with schizophrenic chronicity and, in some way, inherent in the negative aspects of the disease. More interestingly, a rehabilitation suggested that impaired psychomotor functioning is a critical determinant in the maintenance of psychotic disabilities (Ciompi, 1989). Further, from a neurofunctional viewpoint, several recent findings indicate the presence of early disturbances in the motor development of chronic schizophrenics (Fish, 1975). In addition, about 20% of the chddren who will develop schizophrenia in adult life show some defects in their psychomotor abilities as compared to 10% of controls (Ricks & Nameche, 1966). Children of schizophrenics also show a higher incidence of motor coordination deficit and in the interhemispheric neurofunctional integration (Marcus, 1970). The aim of this study was to evaluate the psychomotor profile for a group of noninstitutionalized young schizophrenic patients and to compaie that profile with one for a group of age- and sex-matched normal controls. For this reason the subjects were evaluated on a psychomotor battery developed for the assessment of the psychomotor profile among children 6 to 12 years old. We reasoned that, if the patients showed some evidence of psychomotor defect having occurred in early development, this would be better detected with an instrument specifically designed for detection of such neurofunctional disability. 'Address correspondence to Silvio Scarone, M.D., Rehabilitation Unit, Psychiatric Branch, Department of Biomedical and Technological Sciences, University of W a n Medical School and IRCCS H S Raffaele, Via Prinetri 29, 20127 Milano, Italia.
748
M. PROVENZA, ETAL
Subjectr Twenty-two schizophrenic patients (14 men, 8 women, with mean age of 29.8 yr. 8.7, with mean age at onset of 22.3 yr. 5.8, with mean education of 10.6 yr. 2.8) together with 2 1 sex- and age-matched controls (14 men, 7 women with mean age of 29.6 yr. 9.2, with mean education of 14.4 yr. + 2.2) took part in this study. Education was significantly higher for controls than among patients ( t test with 40 df = 4.94, p < .01). The diagnosis of schizophrenia, the subtype classification, and the evaluation of chronicity were made using DSM-111-R criteria (APA, 1987) by two senior psychiatrists. At the time of administration of the test, the patients had been taking low doses of neuroleptics for at least 1 month (mean Chlorpromazine doseequivalent of 200 to 300 mglday). Seventeen patients had also been taking an hypnotic at bedtime, with a mean FlurazePam dose-equivalent of 15 mg.
*
*
*
Psychomotor Evaluation The profile of psychomotor development was summarized as the mean scores, expressed as the subject's developmental age, on the following seven tests selected from the literature specialized in the field of the child psychomotor evaluation (Table 1). TABLE 1 PSYCHOMOTOR TEST BATTERY: F U N C ~ O NAND S PROCEDURES Function
Procedure
Dynamic coordination of hands
Manual ability and throwing-catching exercises
Dynamic general coordination
Run and jump exercises of increasing difficulty which are articulated and differentiated
Equilibration
Static coordination exercises which consist of maintaining different positions, also with eyes closed
Check of upper and lower'lirnbs
Oscillation and relaxing exercises of the upper limbs alternating with volunrary movement of the lower limbs Recognition exercises (left and right) on themselves and others
Spacial organization Space-time structure
Exercises in reproducing rhythms and transcriprion of space-time structures
Lateraliry
Preference exercises in use o l the hands, dominance of eyes and feet
1. Dynamic coordination of hands.-The task corresponds to the second performance derived from the Oseretzky-Guilmain Battery (Oseretzky, 1937) and consists of motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years.
SCHIZOPHRENIA: PSYCHOMOTOR DEVELOPMENT
749
2. Dynamic general coordination.-This measure corresponds to the third performance derived from the Oseretzky-Guilmain Battery (Oseretzky, 1937) and includes motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years. 3. Equilibration.-The test corresponds to the first performances derived from the Oseretzky-Guilmain Battery (Oseretzky, 1937) and presented as motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years. 4. Check of upper and lower limbs.-This measure was based on motor tests of increasing difficulty weighted for six levels of age from 6 to 12 years (Picq & Vayer, 1968). 5. Spatial organization.-Performance on a series of tests, readapted from Piaget-Head Battery by Gulifret-Granjon (Gulifret-Granjon, 1951), of increasing difficulty weighted for six levels of age from 6 to 12 years. 6. Space-time structure.-This measure was a series of tests from the Stamback Battery (Stamback, 1951) weighted for six levels of age from 6 to 12 years. 7. Latera1ity.-Tests 2, 8, and 11 from Harris' Battery (Picq & Vayer, 1968) were given. According to the theory of the physiological development of psychomotor maturation in children, at the end of primary school (from 6 to 10 years) maturation is at its fullest (see for a review Turkewitz, 1977). What thls represents is the integration, at the level of the association functions, of motor abilities that are mainly dependent on a normal functioning of the neuromuscular system and of more complex functions (motor coordination, equihbrium, spatial orientation) specifically devoted to spatial and social adaptation. These functions were administered individually by a child physiotherapist trained in the procedure. Statistical Analysis Exploratory factor analysis was performed to identify patterns related to the structure of the psychomotor battery (SPSS, 1988). The factor analysis as a first step involved constructing a correlation matrix to examine a set of initial factors often accomplished by the method of principal components. We chose to use a minimum eigenvalue of at least 1.0 and a principal component extraction method. Despite the fact that the initial factors provided a useful first impression, they are usually difficult to interpret directly without some further manipulation. Consequently, another step which entails rotation usually is required to achieve conceptual meaningfulness: to this purpose we performed an oblique rotation. We selected the oblique rotation because it is more flexible; in fact, the factor axes need not be orthogonal, which is more realistic because the theoretically important underlying dimensions are not assumed to be unrelated to each other. Three factors were extracted, factor
750
M. PROVENZA, ET AL.
scores representing the weight of each subject in determining each factor. The resulting factor scores in the schizophrenic patients and normal controls were then analyzed by means of t ratio to check significance of mean differences between the two groups.
RESULTS AND DISCUSSION Table 2 shows means and standard deviations of function scores for patients and controls expressed as age. Table 3 shows means and standard deviations of laterality scores for patients and controls expressed as developmental age. TABLE 2 FUNCTIONSCORESFOR SCI-IIZOIII-IRENICS A N D CONTROLS: MEANSA N D STANDARD DEVIATIONS Function
Schizophrenics M SD
Dynamic coordination of hands Dynamic general coordination Equilibration Check of upper and lower limbs Spatial organization S ~ a c e - t i m estructure
LATERALITYSCORESFOR PATENTS Function Laterality in use of hands Laterality in use of feet Laterality in use of eyes
9.65 9.59 8.00 6.94 8.72 9.27
1.46 2.32 0.41 1.05 1.48 1.95
Controls
M
SD
11.61 11.61 10.33 9.80 11.61 11.42
0.66 0.92 0.85 1.50 0.48 0.81
TABLE 3 CONTROLS: MEANSA N D STANDARD DEVIATIONS
AND
Schizophrenics
Controls
M
SD
M
SD
1.54 1.63 1.54
1.10 1.13 0.91
1.19 1.19 2.04
0.87 0.87 1.46
Three factors were extracted. Factor 1 (eigenvalue = 4.31) explained
43.1% of the total variance, Factor 2 (eigenvalue = 1.85) explained 18.5% of the total variance, and Factor 3 (eigenvalue = 1.05) explained 10.5% of the total variance. Table 4 shows the pattern matrix after oblique rotation, i.e., the factor loadings for each test of the psychomotor battery. Factor 1 was loaded mainly with Equilibration, Space-time Structure, Spatial Organization, and Check for the Upper and Lower Limbs. Factor 2 was loaded by Laterality of Hands and Feet and Factor 3 by Laterahty of Eyes. Table 5 shows the mean factor scores for each factor in groups of schizophrenics and controls. The schizophrenics were significantly different from controls only on Factor 1. To the best of our knowledge, this is the first study which explored the characteristics of psychomotor patterns in schizophrenia by means of a bat-
75 1
SCHIZOPHRENIA: PSYCHOMOTOR DEVELOPMENT TABLE 4 FACTORANALYSIS: ROTATED LOADINGS FOR THREEFACTORS Measure
Factor 2
Factor 1
Factor 3
Equilibrat~on Space-time structure Spacial organization Check of upper and lower limbs Dynamic coordination of hands Laterality in use of hands Lateralitv in use of feet Laterality in use of eyes
tery of tests which are utilized for assessing psychomotor development in children. By factor analysis three factors were extracted. Factor 1 was loaded by the majority of the psychomotor tests but not the tests of laterahation. TABLE 5 FACTOR ANALYSIS: FACTORSCORESFORPATIENTS AND CONTROLS: MEANSAND STANDARD DEV~A~ONS Group
Factor 1 -
Schizophrenics Controls
Factor 2
Factor 3
M
SD
M
SD
M
SD
-0.82* 0.71
0.81
0.22
1.36
0.85
0.47
-0.18
0.57
-0.14 0.12
-
1.16
We can therefore say that Factor 1 is an indicator of general C.N.S. structural organization, not specifically related to a particular function or C.N.S. neurofunctional area. The statistically significant difference between schizophrenics and controls found on Factor 1 scores suggests that the pattern of psychomotor organization is critically affected by schizophrenia. Much experimental data from the neuropsychological (Coger & Serafetinides, 1990; Behni, Abbruzzese, Gambini, Rossi, Stratta, & Scarone, 1991) (Buchsbaum, 1990; Gambini, Colombo, Macciardi, and ne~roph~siological Locatelli, Calabrese, Sacchetti, & Scarone, 1990) literature have shown various degrees of neurofunctional impairment in schizophrenia. Recently it was proposed that cognitive impairment in schizophrenia is dependent on neurodevelopmental abnormalities that appear during the neonatal or preadolescent periods (Murray, Lewis, Owen, & Foster, 1988). Further, there is evidence of abnormal neuromotor development in infants who are later diagnosed as schizophrenics (Fish, 1975). Our data appear consistent with these hypotheses and make reasonable the hypothesis that abnormal psychomotor development is an inherent feature of schizophrenia and probably is antecedent to a full psychopathological picture. Factors 2 and 3 load with test batteries of laterality. They explain a small part of the vari-
752
M.PROVENZA, ETAL.
ance, and the means of the scores for these two factors are not significantly different between the two groups. Therefore, it seems that, consistent with a part of the literature, laterality patterns are not criticdy affected by the disease and do not constitute a possible antecedent for the development of schizophrenia (Taylor, Dalton, & Fleminger, 1980; Wale & Carr, 1988; Faustam, Moses, & Csernansky, 1988). I n the opinion of the investigators the present results must be considered as preliminary because the sample i s relatively small and, most important, because all the patients were on neuroleptic medications when their psychomotor evaluations were made. Moreover, if confirmed for a larger sample of unmedicated patients, these results would stress the importance of a rehabilitative approach which takes into account techniques devoted to the improvement of the impaired psychomotor abilities. REFERENCES AMEMCANPSYCHIATRIC ASSOCIATION.Diagnostic and sfatistical manual o/ mental disorders. (3rd ed., Rev.) Washington, DC: Author, 1987. BELLINI,L., A B B R U ~ ~ EM., S E ,GAMBINI,O., ROSSI,A , , STRATA, l?, & SCARONE, S. Frontal and caUosal neuropsycholo ical performances in schizophrenia: further evidence of possible attention and mnesic &functions. Schizophrenia Research, 1991, 5 , 115-121. BRENNER, H. D., KRAEMER, S., H E R ~ ~ A N UM., T Z ,& HODEL,B. Cognitive treatment in schizophrenia. In E. R. Straube & K. Haldweg (Eds.), Schizophrenia: concepts, vulnerability, and intervention. Berlin: Springer-Verlag, 1990. Pp. 161-191. BUCHSBAUM, M. Frontal lobes, basal ganglia, temporal lobes: three sites for schizophrenia. Schizophrenio Bulletin, 1990, 16, 377-378. CIOMI>I, L. The dynamics of complex biological-psychosocial systems. British Journal of Psychiatry, 1989, 155(Suppl. 5), 15-21. Cocex, R. W., & SERAFETINIDES, E. A. Schizophrenia, corpus cdosum and interhemispheric communication: a review. Psychiatry Research, 1990, 36, 163-184. F n u s r m , W. O., MOSES,J. A,, & CSEKNANSKY, J. G . Luria-Nebraska performance and symptomatology in unmedicated schizophrenic patients. Psychiatry Research, 1988, 7, 47-54. FISH, B. Biologic antecedents of psychosis in children. In D. X. Freedman (Ed.), Biology ofthe major psychoses. New York: Raven, 1975. Pp. 49-84. GAMBINI,O., COLOMBO, C., ~ C C I M D F., I , LOCATELLI, M., CALABRESE, G., SACCI-IET~I, E., & SCAKONE, S. EEG power spectrum profile and structural CNS characteristics in schizophrenia. Biological Psychiatry, 1990, 27, 1331-1334. GULIFRET-GRANJON, N. Le probleme de I'organisation spatiale dans les dyslexics d'ivolution. En/ance, 1951, 5, 134-145. LIDDLE,P. F., & BARNES,T. R . E. Syndromes of chronic schizophrenia. British Journal of Psychiatry, 1990, 157, 558-561. MARCUS,J. Neurological and physiological characteristics of the children of schizophrenic at ents. Paper presented at the 7th Congress of the Inrernational Association of ~ f i l d Psychiatry and Allied Professions, Jerusalem, August 4, 1970. MURRAY, R. M., LEWIS, S. W., OWEN, M. J., & FOSTER,A. The neurodevelopmental origins of dementia mecox. In l? Bebbington & l? McGuffin (Eds.), Schizophrenia: the major issues. oxfor$ UK: Heinemann, 1988. Pp. 90-106. NORUSIS,M. J. SPSSIPC V2.0, base manual. Chicago, IL: SIJSS, Inc., 1988. OSERETZKY,N. Psychomotor~k Methoden zzrr Unterszrchung der Moforik. Leipzig: Johann Ambrosius Barth, 1937. PICQ, L., & VAYER,I? Education psycho-motrice et arrzeration mentale. Paris: Doin, 1968. RICKS, D. F., & NAMECI-IE, G. Symbiosis, sacrifice and schizophrenia. Mental Hygiene, 1966, 9 , 541-551.
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STAMBACK, M. Le probltme du rhythme dans le developpement de I'enfant et dans les dyslexies d'evolution. Enfance, 1951, 5, 224-227. TAYLOR, P. J . , DALTON,R., & F L ~ G E JR. J., Handedness in schizophrenia. British Jozrrnal of Psychiatry, 1980, 136, 375-383. TUKKEWITZ,G. The development of lateral differentiation in the human infant. In S. . Diamond & D. A. BLizard (Eds.), Evolution and Iateralization of [he brain. New Yor : New York Academy of Sciences, 1977. Pp. 309-318. WALE,J., & CARR,V. Dichotic listening asymmetries and psychotic symptoms in schizophrenia: a preliminary report. Psychiatry Research, 1988, 25, 31-39.
h
Accepfed August 4, 1992.
