Patterns of dysfunction in schizophrenic patients on an aphasia test battery.

PATTERNS OF DYSFUNCTION IN SCHIZOPHRENIC PATIENTS ON AN APHASIA TEST BATTERY

Frank G. DiSimoni Pocono Hospital, East Stroudsburg, Pennsylvania

Frederic L. Darley and Arnold E. Aronson Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Twenty-seven schizophrenic patients free of any known neurologic deficit were tested with an aphasia test battery. The objective of the research was to derive a profile of schizophrenic language performance to permit its comparison with the profiles characteristic of aphasia, apraxia of speech, generalized intellectual impairment, and confused language. Results indicate that schizophrenic patients exhibit a profile of language performance distinctive from those found in aphasia, apraxia of speech, confusion, or generalized intellectual impairment and demonstrate that the disruption of language in schizophrenia is not aphasic in nature.

PROBLEM

AND

PURPOSE

T h e research herein reported concerns language function in schizophrenia, an illness widely reported to have communicative dysfunction as one of its frequent components. One need not look deeply in professional literature to find innumerable references to the odd, bizarre, disjointed, disturbed, or "fruit salad" language performances of schizophrenic patients. In the present study, the language behavior of schizophrenic patients was investigated using an aphasia battery of the type previously utilized by Halpern, Darley, and Brown (1973) for their examination of the differential language capabilities of patients with aphasia, apraxia of speech, generalized intellectual dysfunction, and confusion. It was hoped that tabulation of the responses of schizophrenic patients to test items would yield information which would be helpful in differentiating these patients from other groups of communicatively impaired patients, and also that the nature of the defective process or processes affecting their language performance could be clarified. Such an undertaking seemed desirable because mild speech symptoms may be among the first detectable signs of the presence of some disease or destructive process. Thus, the speechlanguage pathologist, having information about language characteristics of 498

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DISIMONI, DARLEY, ARONSON: Schizophrenic Patients 499

different patient groups, might evaluate patients' communicative status for the purpose of supplying information that could be helpful in the differential diagnosis. BACKGROUND

Schizophrenia is one of a group of psychotic reactions that affects the person's total functioning, his behavior, mood, and thought. Not all symptoms are manifested by any given patient, and symptoms vary with time. Mosher and Feinsilver (1971) stated that, despite decades of effort, schizophrenia continues to defy adequate description and classification. According to Arieti (1959), schizophrenia often begins after adolescence or in young adulthood and is characterized by fundamental disturbances in reality relationships and concept formations, with associated affective, behavioral, and intellectual disturbances in varied degrees and mixtures. These reactions are marked by withdrawals from reality, inappropriate moods, unpredictable disturbances in stream of thought, regressive tendencies to the point of deterioration, and often hallucinations and delusions. Investigators have studied in detail various aspects of schizophrenic language and made the following observations and hypotheses: 1. The language of schizophrenic patients does not fulfill normal communicative function because it is not used primarily for informational purposes (Raven, 1958; Feldstein and Jaffe, 1962; Chan et al., 1971). 2. Schizophrenic speech may be abnormal in prosody, closely mirroring the behavioral characteristics of the specific schizophrenic disorders in which it may occur (Eisenson, 1938; Newman and Mather, 1938; Goldfarb, Braunstein, and Lorge, 1956; Ostwald, 1963). 3. Schizophrenic language differs from normal language in terms of the themes patients talk about (White, 1949). Further, patients may be preoccupied with certain themes (Raven, 1958; Chan et al., 1971) and show perseveration of ideas and rigidity (Vetter, 1969) from one context to another in writing or speaking. 4. Language function in schizophrenic patients varies with the mode of stimulus presentation (Hambidge and Gottschalk, 1956; Gottschalk et al., 1961; Gottschalk and Gleser, 1964) and with the amount of stress associated with the situation being described (Miller, Johnson, and Richmond, 1965). 5. Schizophrenic language generally may be differentiated from nonschizophrenic language by the percentages of words of various grammatical classes used (Southard, 1916a, b; Busemann, 1925). Type-token ratios and word counts have been used extensively to document and expand earlier findings (Fairbanks, 1944; Johnson, 1944; Mann, 1944; Brengelmann, 1961; Feldstein and Jaffe, 1962; Reynolds and Pylyshyn, 1970). 6. Schizophrenic patients may show disordered syntax in speaking or writing and often demonstrate structurally vague or stylized constructions with a telescoping of ideas (Raven, 1958). 7. In their speech and writing, schizophrenic patients show fewer word associations and more idiosyncratic word associations and associatively linked words than do normal subjects (Raven, 1958; Laffal, 1965; Vetter, 1969). Cloze techniques have further substantiated this finding (Salzinger, Portnoy, and Feldman, 1964; Moroz and Fosmire, 1966). Such results are interpreted as demonstrating the bizarre na-


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ture of the language of schizophrenic patients as well as their reported poverty of expression (Raven, 1958). Schizophrenic patients may exhibit in their language a disorientation of time, place, or person (Weinstein, 1956; Raven, 1958; Chan et al., 1971). Moreover, patients may confabulate and present fictitious versions of past events (Weinstein, 1956). Schizophrenic patients are deficient in self-monitoring (Goldfarb and Braunstein, 1956), in short-term memory (Hagen, Winsberg, and Wolff, 1968), and in distractability, which varies inversely with scores on language tests (Blum, Livingston, and Shader, 1969). The language of groups of patients with chronic schizophrenia does not differ from that of patients with chronic brain syndrome in terms of content (Elmore and Gorham, 1957; Gottschalk et al., 1961), word- and letter-prediction scores (Andreev and Aminev, 1968), or type-token ratios (Reynolds and Pylyshyn, 1970). Schizophrenic patients have more difficulty in performing language tests as the level of abstraction of the test material is raised (Elmore and Gorham, 1957; Tutko and Spence, 1962; Salzman et al., 1966). The language of some schizophrenic patients is paraphasic (Weinstein, 1956) and neologistic (Whitehorn and Zipf, 1943; Weinstein, 1956), thus resembling the language of aphasic patients.

In a recent paper that discusses the differential diagnosis between aphasic and schizophrenic speech disorders, Benson (1973) stated that most often the diagnosis is clear and that differentiation is not usually a serious problem, although more sophisticated diagnostic techniques might be necessary in some cases. He recommended a relatively simple group of language function tests to appraise: (1) ability to converse, (2) ability to comprehend spoken language, (3) ability to repeat, (4) ability to name on confrontation, and (5) ability to read and write. Essentially, he suggested that the performance of schizophrenic patients on these tests would differ from that of aphasic patients. However, other writers on the subject of differential diagnosis, notably C h a p m a n (1966), Fish (1957), and R u m k e and Nijdam (1958), apparently do not share Benson's view. They insist that a true aphasia exists in schizophrenia and therefore predict that the errors shown by schizophrenic patients on language tasks would be similar to those of aphasic patients. Kleist (1960) has taken another viewpoint, insisting that schizophrenia is not a single disease but a group of diseases whose etiology is not only psychogenic. He maintains that symptoms of gross brain diseases, especially those associated with focal lesions, will be found on closer examination. According to Kleist, altered states of thought and speech deterioration with "paralogic and paraphasic lapses," "ethical flattening," and "affective blunting" are more distinctively schizophrenic, while states of disordered consciousness, waking, memory, orientation, and recollection belong to the "gross-organic traumatic, and symptomatic (toxic-infective) psychoses."



MATERIALS

AND

METHODS

Subjects T h e subjects in this study were patients with chronic schizophrenia at Rochester State Hospital, Rochester, Minnesota. Patients were screened by one of the examiners (FGD) for inclusion in the study on the basis of their extensive medical histories. This screening took place after they were referred by ward psychiatrists, who had been asked by the director of clinical services to submit a list of patients who were "unmistakably schizophrenic." Patients were excluded from the study if they had any known organic neurologic focal lesions or degenerative neurologic or systemic diseases. On the basis of this procedure, 27 patients were selected and tested. Of the 27 subjects, nine were males and 18 were females with various types of schizophrenia (Table 1). Data on patients' ages, educational levels, duration of illness, and age at onset of illness are shown in T a b l e 2.

TABLE 1. Distribution of 27 schizophrenic subjects according to type of schizophrenia and sex.

Type Paranoid Simple Undifferentiated Schizo-affective Hebephrenic Catatonic Process Total

Males

Females

Total

8 0 0 0 0 0 1 9

8 2 3 2 2 1 0 18

16 2 3 2 2 1 1 27

TABLE 2. Age, education, duration of illness, and age at onset for 27 schizophrenic subjects. ]rear5

Age at time of testing Education Duration o f illness Age at onset of illness

Mean

Range

SD

36.3 11.3 11.5 24.4

20-67 5-16 1-29 16-60

13.2 2.6 7.6 8.0

All but four subjects had had shock therapy, the four being among those with the shortest duration of illness (mean = 3.8 years). Of the 27 subjects, none was reported to have any peripheral hearing or visual problem, although six had a speech or language problem on admission; four had some difficulty under-


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standing commands, one m u m b l e d "as in a foreign dialect," and one spoke with jerky prosody. Intelligence test data were available for only 20 of the 27 subjects. I Q scores ranged from 69 to 130. At the time of testing, only two subjects had some difficulty in articulation, which was rated mild in both patients. One subject had a hoarse voice diagnosed as secondary to vocal polyps. Many subjects spoke with low intensity, but most responded appropriately when asked to speak louder. Several subjects had difficulty in understanding. Procedure

Subjects were tested with an extensive standard language battery. T h e tests involved reading, writing, speaking, and listening and were previously used to reveal patterns of dysfunction (Halpern et al., 1973) which differentiate among groups of patients with various types of cerebral involvement. Although the battery of tests w a s s i m i l a r to that used by Halpern et al. (1973), it was not identical. In our test battery, 10 categories of intellectual and language function were evaluated by 26 subtests: 1. The auditory retention span category (four subtests) consisted of auditory recognition of single words, pointing to series of two and three pictured items named by the examiner, repeating words and sentences, and repeating digits forward and backward. 2. The auditory comprehension category (six subtests) consisted of carrying out oral directions of increasing complexity to manipulate utensils and indicate body parts and objects in the environment, answering questions about a 150-word paragraph read aloud by the examiner, and retelling the story. 3. The reading comprehension category (three subtests) consisted of responding to printed yes-no and multiple-choice questions and answering four questions about a 58-word paragraph read silently by the patient. 4. The naming category (three subtests) consisted of counting and naming days of the week and months of the year upon request, completing sentences, and giving the names of 12 pictures and 20 objects and body parts. 5. The writing category (three subtests) consisted of writing to dictation six words of increasing difficulty, writing five sentences, and spontaneous writing of three sentences. 6. The arithmetic category (two subtests) consisted of mental calculation of 14 simple problems involving addition, subtraction, multiplication, and division and written calculation of four somewhat more difficult problems, one involving each mathematical process. Five subtests required oral expression of ideas: defining seven words, explaining the general meaning of three proverbs, telling three things that every good citizen should do, reporting three things about a picture taken from the Schuell Short Test for Aphasia (Schuell, 1957), and after being shown a picture of the Paul Revere ride, telling about what is taking place in the picture. These tests are more qualitative, but error criteria were established by Halpern et al. (1973, p. 165). T h e criteria permit quantitative scoring of the responses in terms of four characteristics, defined as follows:



7. Syntax. Two types of errors are included: use of improper grammatical inflection, such as tense or number, and addition or deletion of, or substitution for, syntactic words. 8. Adequacy. Erroneous responses are substitution, deletion, and addition of substantive words. The degree of elaboration of the response also enters into the judgment of adequacy. 9. Relevance. Errors in this category are bizarre responses that appear unrelated to the stimulus. 10. Fluency. Errors in this category are excessive hesitation and spareness in responses. In addition, part V of the T o k e n Test, a taxing test of auditory comprehension (DeRenzi and Vignolo, 1962), the W o r d Fluency Test, requiring the patient to think of as many words as he can which begin with each of four letters (Borkowski, Benton, and Spreen, 1967), the General Information Test, and the T e m p o r a l Orientation Test (Benton, Van Allen, and Fogel, 1964) were administered. None of these tests was in the original battery used by H a l p e r n et al. (1973). Tabulation and Reliability Checks. For most subtests of this battery, responses were evaluated on a percentage-of-error basis so that subjects' responses on different subtests with various numbers of items could be compared. In the subtests reported in this way, errors were tallied, summed, and divided by the total n u m b e r of items each contained. In reporting subjects' performances on some other subtests, particularly tho~,e for which norms exist for subjects of different ages--a significant consideration in this s t u d y - i t seemed more appropriate to compare performance in terms of standard scores than to compare the raw scores with those of normal subjects. Test comparisons that were of this type involved the T o k e n Test, the W o r d Fluency Test, and the T e m p o r a l Orientation Test. T h e responses to the subtest items requiring oral expression of ideas were tape-recorded for 23 of the 27 subjects. Four of the subjects would not permit tape recordings to be made, so their responses were written verbatim, following procedures outlined by H a l p e r n et al. (1973). One of the speech-language pathologist raters (FGD) listened to or read each sample twice and scored it. His self-agreement was 97% overall. RESULTS

General Characteristics. One of the objectives of this study was to identify language characteristics of schizophrenic patients that might help to differentiate them from other groups of language-impaired persons. While there was great variability within our test group on most subtests, some u n i q u e characteristics became immediately evident. Most of our schizophrenic subjects had no difficulty making their wishes known. T h e y communicated readily with the examiner and were talkative, although a few subjects, even after much coaxing, confined their comments to two- and three-word sentences. T h e subjects, as a group, were suspicious, asking repeatedly who requested


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the tests and how the results were to be used. Despite reassurances, several subjects refused to cooperate for fear that the replies would be put in their records and, as one patient put it, used against them. There was a tenuousness to the rapport. Although each subject willingly cooperated, the examiner had the feeling that at any moment during testing a subject might refuse to continue. Several, in fact, indicated that they wished to stop. Most of the subjects made numerous extraneous comments throughout the test periods, indicating anxiety. The most common question, asked often by the same subjects after each three or four items, was "Are we almost finished?" Another frequent question was "How was that?," asked after performance of some task. A few subjects requested that the door to the testing room remain open during testing, while one subject repeatedly threatened to vomit but never did. Also prominent in the subjects' speech were a variety of "tag questions" (Bellugi, 1972) and comments tacked to the ends of statements they made in reply to questions. Such sentence fragments as "or did he?," "doesn't it?," won't it?," "isn't that right?," and "or s9mething '' were commonly used in the spontaneous speech of this group. Although the examiner stopped keeping a record of their occurrence, he considered these sentence fragments a general characteristic of the speech of the group. Patients engaged in much extraneous conversation during the tests. They frequently expressed their preoccupations and often carried them over into their test replies. For instance, one subject who was concerned about his diet when asked to tell three things every good citizen should do, replied, "Eat, sleep, and if a fly lands in your milk, don't drink it." Frequently, questions precipitated egocentric responses. For example, another male subject replied to the same question by saying, "Am I a citizen? . . . I dcm't know if I can answer that because I don't think I'm a citizen anymore." Only two subjects had a noticeable articulation problem. In contrast, a relatively high incidence of dysarthria or apraxia of speech (or both) is found in focal and even diffuse neurologic disease. Despite a mean duration of illness of 11.5 years in this group, articulatory dysfunction could not be demonstrated. Moreover, the absence of physical disability (not a criterion for subject selection) should be noted. None exhibited any limb paralysis. No muscle weaknesses or aberrant reflexes were noted in the histories nor were there any facial palsies or asymmetries. Distribution of Impairments. T h e mean percentage of impairment obtained in this test battery for each of the 10 subtests is shown in Table 3. We were told by staff psychiatrists at Rochester State Hospital, who knew of the goals of the study, that in their experience schizophrenic patients have no significant trouble in understanding or speaking. T h e data of Table 3 partially substantiate that view, particularly in the mild impairment demonstrated in the last four language categories. T h e percentages of items failed (impairment) obtained in this study are shown in Table 4 together with the data of Halpern et al. (1973). Categories



TABLE 3. Rank order of the percentage of impairment demonstrated by 27 schizophrenic subjects in the 10 language subtest areas.

Rank Order

1 2 3 4 5 6 7 8 9 10

Subtest

Relevance Arithmetic Reading comprehension Fluency Auditory comprehension Auditory retention Writing to dictation Adequacy Naming Syntax

Range ol Mean Percentage Percentages ol Impairment o] lmpairment

45 42 22 17 13 10 9 6 3 2

4-79 29--55 19-36 9-28 0--45 1-17 0--45 1-10 1- 9 0-- 5

that appear in italics are those which vary in rank order of impairment for the five groups and therefore help differentiate them. Although the schizophrenic data are reported in the same format as the Halpern data, direct comparisons cannot be made because of various potential group inequalities) including severity of communication problem and age, and also because our battery contained additional subtests. As has been pointed out by Halpern et al. (1973, p. 166), however, one can measure the relative impairment of individual language categories against each group's mean amount of impairment (which in our study as well as Halpern's happened to be near the fifth rank). Considering the data from the present study together with the data from the Halpern et al. study, the pattern of impairment of five of the language categories-reading comprehension, auditory retention span, fluency, writing to dictation, and relevance-appears to differentiate the five groups. T h e other five categories-auditory comprehension, adequacy, arithmetic, naming, and syntax - d i d not differentiate Halpern's four groups. Of these groups, the rank order in the schizophrenic group of auditory comprehension, arithmetic, naming, and syntax failed to differentiate this group from the other four groups. But the category of adequacy ranked so low in the schizophrenic group that it differentiated this group from the other four groups. T h e extremely low percentage of error of the categories of adequacy, naming, and syntax indicates virtually no deficiencies in these categories. Performance in all three is probably in the normal range and therefore may be considered as having some differential diagnostic importance. On the basis of their subjects' test battery data, Halpern et al. (1973) concluded that the percentages of impairment for the five categories which did not differentiate among various language-impaired groups reflected instead the general level of severity of their language problems. If this supposition holds true for our schizophrenic subjects as well, then the schizophrenic subjects exhibited a lesser amount of overall difficulty in language than did any of Halpern's groups, although our test battery included subtests that were more taxing than the tests utilized in the Halpern study.


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Further comparisons indicate that the patterns of language deviation shown by schizophrenic subjects and aphasic subjects are different in a number of ways. T h e schizophrenic subjects' most prominent deviation is relevance, while it is the least prominent difficulty in aphasic subjects. Conversely, adequacy ranks first in impairment in aphasic patients, while it is affected very little in schizophrenic subjects. In addition, naming and syntax are intact in schizophrenic subjects while they are disrupted to some degree in aphasic subjects. We include the following representative responses of schizophrenic subjects, given after they had been requested to describe a picture of Paul Revere alerting townsfolk; relevance, adequacy, syntax, and fluency ratings were based in part on this task. Patient ND: Well, it's PauI Revere. Wasn't he a mail carrier? Patient LW: /t looks like Paul Revere on a night horse. It looks like he's charging after the men to save their lives. Patient EJ: I believe this is John Paul Jones. No, wait a minute. Ah, not John Paul Jones . . . . Oh, I can't think. I do this. I sometimes can't remember my friends' names. Patient CC: That's from the Bible, isn't it? Looks like it. There's something wrong cause they're talking very bad or hard at someone. Of course this man (pointing) has turned around. Patient FW: They're trying to see themselves dress, not to put anything on themselves, then. That man is trying to get his pants o n . . . not get his pants on. I'm trying to see that. Also noteworthy was the relatively mild disruption of auditory retention span in these schizophrenic subjects. This category of performance was particularly impaired in Halpern's aphasic group and has been reported by Schuell, Jenkins, and Jimenez-Pabon (1964) to be a prominent area of difficulty in aphasic patients. Halpern et al. (1973, p. 169) described it as "a fundamental component of aphasia." Evaluation of patients' performances on the digit span test, Part V of the Token Test, and the Word Fluency Test revealed that approximately 70~o of the patients scored within the normal range; however, on each test the performances of patients in the remaining 30% were apparently so poor that if group means alone were obtained, each mean would be below normal range, giving a somewhat false impression of individual capabilities. Performance on the test category "General Information" was much more impaired, however, as only 25% of the patients scored above 80% or better on this relatively easy task. T h e types of errors made by subjects in writing five sentences to dictation and three sentences spontaneously after being told to write about what they saw happening in a picture are shown in Table 5. T h e errors are scored according to a scheme devised by Keenan and Brassell (1972). Also of interest are miscellaneous writing errors that differed in frequency on the dictation and spontaneous tasks (use of capital letters to begin words in the rpiddle of sentences, substitution of one pronoun for another, failure to


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TABLE 5. Types of writing errors in writing to dictation and spontaneous writing.

Writing to Spontaneous Dictation Writing (Five Sentences) (Three Sentences)

Error Misspelled words Misused function words Omitted words W r o n g sentence Jargon-type error Nonsense or incomplete words Total

9 19 4 0 12 4 48

9 4 2 0 3 15 33

use capital letters where they should have been used, and use of contractions without apostrophes). The subjects made 15 such errors in writing five dictated sentences but made 22 such errors in spontaneous writing of only three sentences. Moreover, several subjects showed poor organization and use of writing space on the paper. Frequently, handwriting was very small, confined to one quadrant of the paper, or produced i n an unorthodox fashion, such as in ascending, or more frequently descending, steps as though each word or two were on a different line. Table 6 shows the mean percentages of correct scores and ranking of difficulty on the five speaking tasks for syntax, adequacy, relevance, and fluency. TABLv. 6. Mean percentages of correct scores and ranks for five speaking tasks rated for syntax, adequacy, relevance, and fluency.* mill

Reporting Three Things in 8chuell Test Picture (N = 23)

Paul Revere Picture (N = 24)

Defining Words (N = 26)

Proverbs (N = 26)

Good Citizen (N -" 26)

Dimension

%

Rank

%

Rank

%

Rank

%

Rank

%

Rank

Syntax Adequacy Relevance Fluency Mean rank

98 93 62 81

3 3 3 4 3.3

95 90 23 72

4 4 4 5 4.3

100 96 21 83

1 2 5 3 2.8

100 99 96 91

1 1 1 1 1

99 93 74 86

2 3 2 2 2.3

i IINN

*Different Ns are shown because some subjects would not participate in all subtests.

T h e rank of 1 was assigned to the cells that show the highest percentages of correct responses and consecutively higher numbers were assigned to the cells in each category that show progressively lower percentages. Subject performance was virtually normal in reporting three specific things happening in the test picture (Schuell, 1957), and received a rank of 1 for all four dimensions. Patients were also shown a picture of Paul Revere and told, "This is a pic-



ture of a famous event from American history. I would like you to look at it, and then tell me as much as you can about it." On this test, the instructions were less specific and the activity in the picture less varied than in the "name three things" task. This test proved to be the second easiest. In it, patients showed greatest deterioration of function along the relevance dimension, the very dimension most discriminating between schizophrenic patients and Halpern's four groups of language-impaired "cerebrally involved" patients. Telling three things a good citizen should do, defining words, and explaining proverbs (in that order) were progressively more difficult tasks for our patients. Duration of illness was negatively correlated with performance on all subtests except digit span and the T o k e n Test (Table 7), indicating that the longer the subjects had been schizophrenic, the poorer their performance in virtually every dimension tested. T h u s our few older schizophrenic subjects less closely resembled the profile sketched of them in Table 4 and tended more to resemble the subjects in Halpern's generalized intellectual impairment group. Patients' listening subtest scores vary with their reading and speaking scores although reading scores are not related to speaking scores. For this group of subjects, reading and writing scores tend to vary together as do listening and speaking scores. However, the performance on the four subtests does not vary together. T o k e n Test scores are positively correlated with scores obtained in listening and fluency subtests, indicating that schizophrenic patients who comprehend better also are more fluent. In addition, temporal orientation and general information scores relate positively to patients' listening abilities. Scores in arithmetic are also positively related to reading, writing, fluency, temporal orientation, and general information but are not related to speaking or listening test scores. Unexpectedly, they vary inversely with digit span. Whereas older patients and patients who have been ill longer perform more poorly on the W o r d Fluency Test, results indicate that it is probably a sensitive indication of generalized deficiency because scores on this test vary with every test in the battery except digit span and the T o k e n Test. T e m p o r a l orientation test scores are correlated positively with reading and listening test scores but are unrelated to writing and speaking. They also are positively correlated with arithmetic, fluency, and general information. General Information scores, like W o r d Fluency Test scores, are positively correlated with all other tests of the battery except digit span and the T o k e n Test, with which they are negatively correlated. Similar to the W o r d Fluency Test, this test is probably an indicator of general mental functioning. A separate correlation was attempted using data from the 19 subjects for whom I Q data were available, comparing their I Q scores with their test performances on the subtests of the battery. T h e only statistically significant relationships were found between I Q and reading scores and between I Q and arithmetic scores (Table 8). In view of our previous finding that most of the subjects' test scores decreased as they got older, one might hypothesize that reading and arithmetic were the areas most resistant to deterioration.


510

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AND

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TABLE8. Correlation matrix for IQ and subtest scores. N = 19; eight patients were excluded because no IQ data were available. In telligen ce Quotient

Dimension

Age Duration of illness Reading Writing Listening Speaking Digit span Token Test Word Fluency Temporal Orientation General Information Arithmetic

-- 0.42 --0.25 0.44* 0.14 0.37 0.25 -- 0.38 0.01 0.19 0.12 0.27 0.66*

ii

*Significantly different from zero (p < 0.05) (Garrett, 1948).

DISCUSSION

Analysis of test data indicated that the communication difficulties of the schizophrenic subjects are unlike those of aphasic subjects. T h e schizophrenic subjects are most deviant with regard to the relevance of their responses and reading comprehension, while naining, syntax, and the adequacy of their responses are essentially normal. Aphasic subjects given similar tests typically have far less difficulty with reading comprehension and relevance and have most difficulty with adequacy. T h e finding of impaired relevance and virtually unimpaired adequacy, naming, and syntax in schizophrenic subjects also serves to differentiate them from the other groups of patients with cerebral involvement for whom there are comparable data. Our finding that schizophrenic subjects perform more poorly in nearly all categories as the duration of their illness increases, however, suggests that as they age, their performance probably deteriorates first-i-n-the direction of the pattern shown by confused subjects and ultimately toward the pattern shown by subjects with generalized intellectual impairment. T h e discovery that reading, writing, listening, and speaking abilities are not equally impaired in schizophrenia was not unexpected. However, our finding that the relevance of speech can be impaired while other speaking functions (including syntax and naming) are virtually intact and that writing, reading, and listening functions are relatively much less disturbed than one would expect in an aphasic disorder is evidence against an aphasic or central-language impairment in schizophrenia. In addition, our correlational data showing that poorer speaking or listening scores were associated with better reading and writing scores (or vice versa) indicate the independence of these communica-


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tion modes from each other in schizophrenic language, such performance being incompatible with central-language impairment.

ACKNOWLEDGMENT T h e research reported herein was supported by Training Grant NS-5446 from the National Institutes of Health, Public Health Service. The authors wish to acknowledge the aid of Francis Tyce, superintendent of Rochester State Hospital, Rochester, Minnesota, for his assistance in the execution of this project. Requests for reprints should be addressed to Frank G. DiSimoni, Department of Physical Medicine, Division of Speech Pathology and Audiology, Pocono Hospital, East Stroudsburg, Pennsylvania 18301.

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Changing patterns of childhood aphasia.

Aging of schizophrenic patients as seen through the Rorschach test.

Effect of instructional cues on schizophrenic patients' performance on the Wisconsin Card Sorting Test.

defense test battery.

Phonological patterns in a case of aphasia.

Schizophrenic performance on form E of Cattell's 16PF test.

Left-handedness in male schizophrenic patients is associated with increased impairment on the Luria-Nebraska Neuropsychological Battery.

Dysfunction of Cognition Patterns Measured by MATRICS Consensus Cognitive Battery (MCCB) among First Episode Schizophrenia Patients and Their Biological Parents.

Recovery patterns and prognosis in aphasia.

Recovery patterns and prognosis in aphasia.

The neuropsychological assessment battery categories test as a measure of executive dysfunction in patients with Parkinson's disease and essential tremor: an exploratory study.

Development, cross-cultural adaptation, and validation of the Persian Mississippi Aphasia Screening Test in patients with post-stroke aphasia.

Test-retest reliability and effects of repeated testing and satiety on performance of an Emotional Test Battery.

The SKT neuropsychological test battery.

Bilateral tactile aphasia: a tacto-verbal dysfunction.

Specific Features of Executive Dysfunction in Alzheimer-Type Mild Dementia Based on Computerized Cambridge Neuropsychological Test Automated Battery (CANTAB) Test Results.

Challenge test battery in chronic urticaria.

[Compliance in therapy of schizophrenic patients with neuroleptics--an overview].

A possible role of hippocampal dysfunction in schizophrenic symptomatology.

Malignancies in schizophrenic patients.

Analysis of Intonation Patterns in Cantonese Aphasia Speech.

Slow cortical potentials (SCPS) in schizophrenic patients during performance of the Wisconsin card-sorting test (WCST).

Evaluation of an alternative in vitro test battery for detecting reproductive toxicants in a grouping context.

Diagnosis of schizophrenic patients.