Sex, symptom, and premorbid social functioning associated with perceptual organization dysfunction in schizophrenia.

Jamie Joseph,Steven M Silverstein,Grace Bae

doi:10.3389/fpsyg.2013.00547

Abstract

Impairments in visual perceptual organization abilities are a repeatedly observed cognitive deficit in schizophrenia. These impairments have been found to be most prominent among patients with histories of poor premorbid social functioning, disorganized symptoms, and poor clinical outcomes. Despite the demonstration of significant sex differences for these clinical factors in schizophrenia, the extent of sex differences for visual perceptual organization in schizophrenia is unknown. Therefore, we investigated the extent to which previously known correlates (premorbid social sexual functioning and disorganized symptoms) and a novel factor (participant sex) accounted for performance on two perceptual organization tasks (contour integration and Ebbinghaus illusion) that have previously demonstrated sensitivity to schizophrenia. We also determined the relative degree to which each of these factors predicted task scores over and above the others. Schizophrenia patients (N = 109, 43 females) from different levels of care were ascertained. Female patients demonstrated higher contour integration scores, but lower performance on the context sensitivity index of the Ebbinghaus illusion, compared to males. Contour integration performance was significantly associated with poorer premorbid adolescent social sexual functioning and higher levels of disorganized symptoms, supporting past results that indicate a relationship among poor premorbid social sexual functioning, disorganized symptoms, and visual perceptual abnormalities in schizophrenia. However, analyses of Ebbinghaus illusion performance suggests there is a complex relationship among patient sex, clinical factors and perceptual abilities with relatively intact bottom–up grouping processes in females, but greater problems, compared to males with more top–down mediated context sensitivity. Therefore, sex differences may be an important consideration for future studies of visual perceptual organization in schizophrenia.

Highlights

Schizophrenia is a serious psychiatric condition characterized by significant cognitive and perceptual impairments
The goal of this study was to determine whether sex differences on tests of perceptual organization exist in a sample of schizophrenia patients, and the extent to which these are related to other aspects of heterogeneity that have been previously linked to both variables
Female gender was associated with higher contour integration scores compared to males in a chronic schizophrenia population that included many patients who were sufficiently disabled so as to require daily partial hospital treatment

Summary

Introduction

Schizophrenia is a serious psychiatric condition characterized by significant cognitive and perceptual impairments. One phenomenon that has shown potential for reliably identifying subgroups of patients is reduced visual perceptual organization. This is defined as the processes involved in binding stimulus features into meaningful patterns, groupings or object representations. Perceptual organization impairments have been proposed to be part of a widespread impairment in binding related features, and coordinating cognitive activity, across space and time, in schizophrenia (Phillips and Silverstein, 2003, 2013). Impaired cognitive coordination is thought to be the core deficit in the disorganized syndrome of schizophrenia (Phillips and Silverstein, 2003), based on past findings of significant relationships between perceptual organizations deficits, and increased cognitive and/or behavioral disorganization but not positive or negative symptoms (Place and Gilmore, 1980; Knight, 1984; Uhlhaas and Silverstein, 2005; Silverstein and Keane, 2011)

Objectives

Methods

Conclusion