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Am J Psychiatry 1992; 149:62-67
Copyright © 1992 by American Psychiatric Association
Wisconsin Card Sorting Test performance in schizophrenia: remediation of a stubborn deficit
MF Green, P Satz, S Ganzell and JF Vaclav
UCLA Research Center, Camarillo State Hospital 93011.
OBJECTIVE: Schizophrenic patients typically perform poorly on the Wisconsin
Card Sorting Test, which is a putative index of prefrontal functioning. The
authors attempted to remediate the deficits of schizophrenic patients on
this measure by giving detailed instructions and monetary reinforcement.
METHOD: Forty-six inpatients with chronic schizophrenia and 20 control
subjects with other psychiatric illnesses were given the Wisconsin Card
Sorting Test under four conditions that varied in monetary reinforcement
and level of instructions. The schizophrenic patients were given the Brief
Psychiatric Rating Scale (BPRS) and three information processing measures
(the Continuous Performance Test, Span of Apprehension, and Pin Test).
RESULTS: Schizophrenic patients performed worse than psychiatric control
subjects across most conditions. Monetary reinforcement had little effect
on performance, but detailed instructions significantly improved the scores
for both groups. When instructions were withdrawn and monetary
reinforcement was maintained, both groups continued to show improved
performance over baseline. Symptoms were not significantly associated with
Wisconsin Card Sorting Test performance. One measure (the Pin Test)
correlated significantly with performance on the Wisconsin Card Sorting
Test. CONCLUSIONS: The results suggest the importance of combining
motivational with instructional factors for training psychiatric patients
in problem solving.
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