Letter and category fluency in patients with frontal lobe lesions.

This study examines the hypothesis that patients with frontal lobe lesions are impaired on tests of letter but not category fluency. This hypothesis was proposed by Moscovitch (1994), based on a series of cognitive studies with young, normal participants. A group of patients with lateral prefrontal lesions and age-matched controls were tested on 2 tests of verbal fluency, the FAS task and a category fluency task that used semantic categories as cues (e.g., animals). Patients with frontal lobe lesions generated fewer items than controls on both letter and category fluency. This effect did not interact with the type of fluency test, suggesting that the frontal lobes are more generally involved in verbal fluency. Moreover, this pattern of findings, along with previous results of impaired free recall and remote retrieval in this patient group, suggests that patients with frontal lobe lesions do not efficiently organize and develop retrieval strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal fluency deficits in geriatric and nongeriatric chronic schizophrenic patients

This study examined age-related differences and correlates of deficits on phonological and category fluency tasks performed by schizophrenic patients. Equal numbers (n = 41) of geriatric (age > 64) and nongeriatric chronically hospitalized schizophrenic patients were examined with tests of phonological and category fluency, verbal learning and delayed recall, confrontation naming, and reading, as well as overall estimates of cognitive impairment. Both types of fluency tests were performed very poorly by both groups. Age-related differences were found to be statistically significant. In both groups, category fluency impairments were correlated with deficits in naming, while phonological fluency deficits were best predicted by memory impairments. These data suggest that category fluency impairments are part of a general profile of impaired semantic functioning, whereas phonological fluency deficits may be induced by alterations in information processing capacity.     

Impairment in category fluency in ischemic vascular dementia.

The underlying mechanisms for impaired output on letter (F, A, and S) and category (e.g., animal) word list generation (WLG) tasks in subcortical ischemic vascular dementia (IVD) were investigated. Normal control (NC) and Alzheimer's disease (AD) participants were also studied. IVD and NC participants performed better on category than letter WLG tasks, whereas the opposite was observed among AD participants. IVD participants produced fewer responses than AD participants on letter WLG tasks, but there was no difference between AD and IVD participants on the "animal" WLG task. AD participants scored lower than IVD and NC participants on animal WLG indexes measuring semantic knowledge. There were few differences between IVD and NC participants. The reduced output on the animal WLG task for IVD participants is consistent with search-retrieval deficits. The reduced output of AD participants may be caused by degraded semantic knowledge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of category and letter fluency in Alzheimer's disease and Huntington's disease.

44 patients with dementia of the Alzheimer type (DAT), 44 elderly normal control (ENC) Ss demographically matched to the DAT group, 42 patients with Huntington's disease (HD), and 42 middle-aged normal control (MNC) Ss demographically matched to the HD group were administered letter and category fluency tasks. DAT patients showed an overproportional impairment on category than on letter fluency tasks, whereas HD patients were equally impaired. Analyses based on receiver operating characteristic curves revealed that category fluency correctly classified significantly more DAT and ENC Ss than did letter fluency, whereas the 2 fluency tasks did not differ in this respect for HD and MNC Ss. Results suggest that HD patients' failures on fluency tasks are caused by impaired initiation/retrieval capacities. In contrast, DAT patients' greater category than letter fluency deficits are primarily due to a breakdown in the structure of semantic knowledge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal fluency deficits in patients with schizophrenia: Semantic fluency is differentially impaired as compared with phonologic fluency.

Patients with schizophrenia show deficits in phonologic (ability to name words that begin with a specific letter, e.g., F) and semantic (ability to name members of a category, e.g., "animals" fluency.) Whereas the former deficit has been presumed to reflect a dysfunction of the frontal lobe, the latter has been linked to frontal and temporoparietal brain areas. These 2 verbal fluency measures were studied in a sample of 27 schizophrenia patients and 24 normal controls who were matched on age and a putative measure of premorbid intellectual ability. A 2-min production task of switching between letters and between categories measured demand for flexibility. On switching and nonswitching tasks controls produced more words during semantic versus phonologic fluency. Conversely, schizophrenia patients produced more words for letters than for categories, suggesting dysfunction of the frontal and temporoparietal areas of the brain. Furthermore, the greater impairment of semantic fluency may be related to a breakdown of semantic information processing beyond "executive" search and retrieval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disparate letter and semantic category fluency deficits in autopsy-confirmed frontotemporal dementia and Alzheimer's disease.

Patients with autopsy-confirmed frontotemporal dementia (FTD; n = 16) and Alzheimer's disease (AD; n = 32) were compared on first-letter and semantic category fluency tasks. Despite being matched on age, education, and dementia severity, FTD patients performed worse overall and showed similar impairment in letter and semantic category fluency, whereas AD patients showed greater impairment in semantic category than letter fluency. A measure of the disparity between letter and semantic category fluency (the semantic index) was effective in differentiating FTD from AD patients, and this disparity increased with increasing severity of dementia. These unique patterns of letter and semantic category fluency deficits may be indicative of differences in the relative contribution of frontal-lobe-mediated retrieval deficits and temporal-lobe-mediated semantic deficits in FTD and AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commonalities and differences in the working memory components underlying letter and category fluency tasks: A dual-task investigation.

This study used a dual-task interference paradigm to test the hypothesis that different subcomponents of working memory differentially contribute to performance on letter fluency and category fluency tasks. College students (N = 96) performed each type of verbal fluency task in isolation and concurrently with I of 3 secondary tasks. The secondary tasks were chosen for their putative involvement in different working memory subcomponents. Two subsystems of working memory, the phonological loop and the visuospatial sketchpad, were identified as important contributors to fluency performance, especially to performance on letter fluency and category fluency tasks, respectively. Moreover, the results also suggest that the executive function, mental set shifting, may be deployed to perform both letter fluency and category fluency tasks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workplace in fluency management: factoring the workplace into fluency management

This article addresses competency-based standards and guidelines for the involvement of speech-language pathologists in the workplace of clients who stutter. It advocates broadening customary practices in stuttering treatment and suggests that speech-language pathologists should extend their scope of service delivery to the workplace. It presents a sequence for the collaborative involvement of the employer and other workplace members and proposes strategies for evaluating workplace based fluency programs. Issues of fluency management, transfer, maintenance, and efficacy are discussed in the workplace context. Also addressed is workplace communication as well as such factors as stereotypes, discrimination, and resistance to change which may impinge on workplace intervention. It is argued that structured intervention, transfer, and generalization within a collaborative workplace framework facilitates best practice for the fluency clinician and more appropriate outcomes for the diversity of clients who stutter.     

Prefrontal dysfunction in young acute neuroleptic-naive schizophrenic patients: a resting and activation SPECT study

Regional cerebral blood flow (rCBF) was measured with single photon emission computed tomography (SPECT) in six neuroleptic-naive, young, acute schizophrenic patients and six normal control subjects. We evaluated rCBF changes in prefrontal areas at rest and during a prefrontal activation task, the Wisconsin Card Sorting Test (WCST). Schizophrenic patients had significantly higher prefrontal blood flow than did control subjects during the resting conditions. During activation, the control group showed significant increases in prefrontal blood flow, whereas the schizophrenic group did not. These results suggest that at rest there is no evidence of hypofrontality, whereas hyperfrontality seems to be the most frequent pattern in our selected sample of young acute neuroleptic-naive schizophrenic patients. Furthermore, schizophrenic patients seem to be unable to increase prefrontal blood flow under conditions that challenge the prefrontal cortex.     

Clinical and neurocognitive effects of clozapine and risperidone in treatment-refractory schizophrenic patients: a prospective study

BACKGROUND: Few controlled studies have compared the efficacy of clozapine and risperidone in treatment-refractory schizophrenic patients. The present study investigates the efficacy of both clozapine and risperidone on psychopathologic and neurocognitive measures in a prospective 12-week open-label trial in treatment-refractory schizophrenic patients from state psychiatric hospitals. METHOD: Thirty-five DSM-IV schizophrenic patients with a documented history of nonresponse to typical neuroleptics were treated with either clozapine or risperidone. Response was assessed every 2 weeks by independent raters with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) scale, neurologic rating scales, and plasma drug levels. Neurocognitive tests were administered at baseline and week 12. RESULTS: Both clozapine and risperidone brought about significant (p < .003) overall improvement in psychopathology. However, clozapine was numerically superior to risperidone on PANSS total scores and PANSS positive, negative, excitement, and cognitive factors. Extrapyramidal side effects were minimal for clozapine, whereas some were present for risperidone. Patients taking risperidone improved significantly in the beginning stages of the study and remained stable thereafter. Patients taking clozapine showed a gradual improvement that occurred over the entire length of the trial. Neurocognitive measures showed minimal improvement and did not differentiate between the 2 medication groups. CONCLUSION: Both clozapine and risperidone were comparably effective across a wide spectrum of psychopathologic measures. While the efficacy of clozapine was only numerically superior to that of risperidone, it was associated with fewer extrapyramidal side effects and with progressive improvement over the 12-week treatment period, suggesting that in longer trials clozapine may prove to be superior to risperidone in neuroleptic-refractory patients.     

Shape constancy in schizophrenic patients.

Shape constancy in visual perception of schizophrenic patients was studied. 40 chronic schizophrenic, 40 acute schizophrenic, 40 nonschizophrenic mental patients, and 40 normal controls were used as Ss. Ss matched the shape of a standard object (circle) inclined at an angle. 2 angles of inclination, 30° and 60°, were used. It was found that shape constancy was lower in schizophrenic patients than in controls when the stimulus object was inclined 60° from the horizontal plane. When the angle of inclination was 30° there was no difference between the groups. The chronic schizophrenic patients displayed greater response variability than the other groups. The relation of these findings to the theory of assimilation of percepts to the perceptual schemata in schizophrenic patients was discussed. (23 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brain evoked potential in schizophrenic patients

The authors reviewed the literature on evoked potentials in mentally ill patients, with particular emphasis on schizphreniacs. The commonly observed abnormalities were as follows: 1) higher SEPs amplitudes with less waveshape variability during first 100 ms in non-depressed chronic, paranoid or undifferentiated patients with florid psychotic symptoms; normal SEPs amplitudes in acute or latent schizophrenics and in chronic depressed schizophrenics but without florid psychotic symptoms; 2) reduced SEPs and VEPs amplitude recovery and faster latency recovery; 3) reduced AEPs amplitude and latency; 4) greater VEPs waveshape variability and tendency to be "reducers" in hallucinating patients; reduced amplitude and latency recovery; prolonged latencies in patients with positive family history (schizophrenia or affective disorders in close relatives); prolonged N2 latency in motor responses to "easy" and "difficult" stimuli; reduced activity of "late potentials"; 5) greater waveshape variability in all modalities in chronic schizophrenics, abnormal P300 (reduced amplitude, lack of P300 or negative "effect of uncertainty") and abnormal CNV (less "readiness" potential, prolonged negativity with motor responses).     

Sexual dysfunction in male schizophrenic patients

BACKGROUND: Neuroleptic treatment in schizophrenic patients is associated with sexual dysfunction. However, it is not clear to what extent the psychiatric disorder and/or the pharmacologic treatment are responsible for the sexual impairment. The aim of the present study was to evaluate the sexual function of untreated and treated male schizophrenic patients in comparison with healthy subjects. METHOD: Participants included 122 male subjects: 20 drug-free schizophrenic patients, 51 neuroleptic-treated (depot form) schizophrenic patients, and 51 normal controls. A detailed structured interview was used to quantitatively and qualitatively assess sexual function. RESULTS: A high frequency of sexual dysfunction was reported by both schizophrenic groups of patients. Impairments in arousal items (erection) and orgasm during sex were reported mainly by the treated patients. Desire parameters were reduced in both schizophrenic groups, but reduction in the frequency of sexual thoughts was confined to the untreated one. The schizophrenic patients were more involved in masturbatory activity in comparison with the control subjects. Treated patients disclosed dissatisfaction with their sexual function. CONCLUSION: Untreated schizophrenic patients exhibit decreased sexual desire. Neuroleptic treatment is associated with restoration of sexual desire yet it entails erectile, orgasmic, and sexual satisfaction problems. Clinicians' awareness and open discussion of sexual problems with patients may improve comprehension and compliance.     

Associative meaning of emotionally neutral words in a group of healthy and schizophrenic patients: a comparative study

Distributions of associational responses--to four emotionally neutral stimulus words--obtained from schizophrenic people and sane ones were compared. Significant differences in some content categories were discovered.     

Verbal and nonverbal fluency in patients with probable Alzheimer's disease.

Verbal fluency (semantic category naming and letter fluency) and nonverbal fluency (semantic category drawing and design fluency) were measured in mildly and moderately demented patients with probable dementia of the Alzheimer type (pDAT), and related to age at onset, disease duration, and disease severity. Group and individual patient analyses revealed impairments within verbal and nonverbal modalities that were most severe on semantic category fluency tasks. Detailed assessments of errors emphasized the role of compromised semantic memory in pDAT patients' impaired fluency, regardless of the modality of response. Fluency performance was related to dementia severity but not to age of onset or disease duration. It is concluded that deficits on measures of fluency in pDAT are due in large part to semantic memory impairments and that fluency may be useful for following disease progression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dextromethorphan phenotyping and haloperidol disposition in schizophrenic patients

This study examined the relationship between the metabolic ratios of dextromethorphan/dextrorphan, haloperidol disposition, and the incidence of extrapyramidal side effects in schizophrenic patients. Eighteen schizophrenic patients were phenotyped with a test dose of dextromethorphan prior to the initiation of haloperidol treatment. The metabolic ratio of dextromethorphan/dextrorphan was determined in each patient. Patients were treated with oral haloperidol 10 mg/day for 2 weeks. Blood samples for haloperidol and reduced haloperidol were obtained at week 2 of haloperidol treatment. Haloperidol and reduced haloperidol plasma concentrations were assayed by HPLC with electrochemical detection. Significant correlations of dextromethorphan/dextrorphan metabolic ratios vs. plasma haloperidol concentrations, reduced haloperidol concentrations, and reduced haloperidol/haloperidol ratios were found (r = 0.726, P = 0.0007; r = 0.782, P = 0.0001; and r = 0.619, P = 0.006, respectively). Ten patients who experienced extrapyramidal side effects had higher reduced haloperidol concentrations and reduced haloperidol/haloperidol ratios than the other patients (2.49 +/- 1.42 [S.D.] ng/ml vs. 1.10 +/- 0.46 ng/ml, P = 0.014 and 0.287 +/- 0.102 vs. 0.192 +/- 0.065, P = 0.030). The former also had a trend to have higher haloperidol concentrations and dextromethorphan/dextrorphan ratios than the latter (8.04 +/- 2.91 ng/ml vs. 5.83 +/- 1.79 ng/ml, P = 0.066 and 0.023 +/- 0.017 vs. 0.011 +/- 0.010, P = 0.077). Phenotyping patients has the potential to assist clinicians in predicting plasma drug concentrations during the subsequent neuroleptic drug treatment. Further research with phenotyping and psychotropic drug metabolism in psychiatric patients is needed.     

Overinclusive thinking and delusions in schizophrenic patients.

15 schizophrenics with paranoid delusions, 15 schizophrenics with no delusions, and a control group of 15 nonschizophrenic hospitalized patients were given the Benjamin Proverbs test, the Mill Hill Vocabulary Scale, and 3 of Babcock's psychomotor speed tests. As predicted, there was a significant relationship between the presence or absence of delusions, and overinclusive thinking, as assessed by the average number of words needed to explain the proverbs and 2 time scores. Overinclusive patients tend to have paranoid delusions. There was no significant relationship between retardation, as assessed by the Babcock tests, and the presence of delusions. This finding complements an earlier finding of Harris and Metcalfe (see 32: 719) that slowness in schizophrenic patients is specifically associated with inappropriate affect and a poor prognosis, and Payne's (see 37: 5499) finding that a group of chronic schizophrenics was not overinclusive. (PsycINFO Database Record (c) 2010 APA, all rights reserved)