Skip to main content
    • Aa
    • Aa

The neuropsychology of schizophrenia: relations with clinical and neurobiological dimensions

  • Rebecca Elliott (a1) and Barbara J. Sahakian (a1)

It is now beyond question that the symptoms observed in schizophrenia include a range of cognitive neuropsychological deficits that may be more enduring than psychotic symptoms (Cassens et al. 1990; Goldberg et al. 1993) Goldberg et al. (1993) found that a group of patients treated with clozapine whose psychotic symptoms improved significantly over a 15 month study period showed no improvement in cognitive impairments. He argued that the enduring cognitive deficits are responsible for failure of patients to rehabilitate socially even when psychotic symptoms are in remission. Clearly an understanding of neuropsychological deficits is Important from a clinical as well as a theoretical viewpoint. There is, however, still much debate about the nature of these deficits and how they related to the psychotic symptoms of schizophrenia and also to the neurobiological substrate of this disorder.

Corresponding author
1 Address for correspondence: Dr Barbara J. Sahakian, Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ.
Hide All
Addington J. (1987). Cognitive functioning and positive and negative symptoms in schizophrenia. Ph.D. thesis. University of Calgary, Alberta.
Albert M. S., Feldman R. G. & Willis A. L. (1974). The subcortical dementia of progressive supranuclear palsy. Journal of Neurology, Neurosurgery and Psychiatry 37, 121130.
Alexander G. E., DeLong M. & Strick P. E. (1986). Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience 9, 357381.
Allen H. A., Liddle P. F. & Frith C. D. (1993). Negative features, retrieval processes and verbal fluency in schizophrenia. British Journal of Psychiatry 163, 769775.
Andreasen N. (1984 a). Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.
Andreasen N. (1984 b). Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City.
Andreasen N. C., Rezai K., Alliger R., Swayze Y. W., Flaum M., Kirschner P., Cohen G. & O'Leary D. S. (1992). Hypofrontality in neuroleptic-naive patients and in patients with chronic schizophrenia. Archives of General Psychiatry 49, 943958.
Baddeley A. D. (1986). Working Memory. Clarendon: Oxford.
Bech P. (1992). Symptoms and assessment of depression. In Handbook of Affective Disorders, 2nd edn (ed. Paykel E. S.). Churchill Livingstone: Edinburgh.
Benes F. M. (1993). Neurobiological investigations in cingulated cortex of schizophrenic brain. Schizophrenia Bulletin 19, 537549.
Berman K. F. & Weinberger D. R. (1990). The prefrontal cortex in schizophrenia and other neuropsychiatric disorders: in vivo physiological correlates of cognitive deficits. Progress in Brain Research 85, 521536.
Bleuler E. (1913). Dementia Praecox or the Group of Schizophrenias. (Translated 1950 by Zinkin J..) International University Press: New York.
Bornstein R. A., Nasrallah H. A., Olsen S. C., Coffman J. A., Torello M. & Schwartzkopf S. (1990). Neuropsychological deficit in schizophrenic subjects: paranoid, non-paranoid and schizoaffective subgroups. Psychiatry Research 31, 1524.
Breier A., Wolkowitz O. M. & Pickar D. (1991). Stress and schizophrenia. Advances in Neuropsychiatry and Psychopharmacology, 1, 141152.
Breier A., Buchanan R. W., Elkashef A., Munson R. C., Kirkpatrick B. & Gellad F. (1992). Brain morphology and schizophrenia. Archives of General Psychiatry 49, 921926.
Breslin N. A. & Weinberger D. R. (1990). Schizophrenia and the normal functional development of the prefrontal cortex. Developments in Psychopathology 2 409424.
Buchsbaum M. S., Haier R. J., Potkin S. G., Nuechterlein K., Bracha H. S., Katz M., Lohr J., Wu J., Lottenberg S., Jerabek P. A., Trenary M. M., Tafalla R., Reynolds C. & Bunney W. E. (1992). Frontostriatal disorder of cerebral metabolism in never-medicated schizophrenics. Archives of General Psychiatry 49, 935942.
Burns A., Jacoby R. & Levy R. (1990). Psychiatric phenomena in Alzheimer's disease. British Journal of Psychiatry 157, 7286.
Calev A. (1984). Recall and recognition in chronic nondemented schizophrenics: use of matched tasks. Journal of Abnormal Psychology 93, 172177.
Calev A., Berlin H. & Lerer B. (1987). Remote and recent memory in long-hospitalised chronic schizophrenics. Biological Psychiatry, 22, 7985.
Cassens G., Inglis A. K., Appelbaum P. S. & Gutheil T. G. (1990). Neuroleptics: effects on neuropsychological function in chronic schizophrenic patients. Schizophrenia Bulletin 16, 477499.
Clare L., McKenna P. J., Mortimer A. M. & Baddeley A. D. (1993). Memory in schizophrenia: what is impaired and what is preserved? Neuropsychologia 31, 12251241.
Crawford J. R., Obonsawin M. C. & Bremner M. (1993). Frontal lobe impairment in schizophrenia: relationship to intellectual functioning. Psychological Medicine 23, 787790.
Crow T. J. (1985). The two syndrome concept: origins and current status. Schizophrenia Bulletin 11, 471486.
Cummings J. L. (1986). Subcortical dementia: neuropsychology, neuropsychiatry and pathophysiology. British Journal of Psychiatry, 149, 682697.
Cutting J. (1985). The Psychology of Schizophrenia. Churchill Livingstone: Edinburgh.
Damasio A. R., Tranel D. & Damasio H. (1990). Individuals with sociopathic behaviour caused by frontal damage fail to respond autonomically to social stimuli. Behavioural Brain Research 41, 8194.
Davison K. & Bagley C. R. (1969). Schizophrenia-like psychoses associated with organic disorders of the central nervous system: a review of the literature. In Current Problems in Neuropsychiatry: Schizophrenia, Epilepsy and the Temporal Lobe (ed. Herrington R. N.), pp. 113189. Headley: Ashford, Kent.
Dolan R. J., Bench C. J., Liddle P. F., Friston K. J., Frith C. D., Grasby P.M. & Frackowiak R. S. J. (1993). Dorsolaleral prefrontal cortex dysfunction in the major psychoses: symptom or disease specificity? Journal of Neurology, Neurosurgery and Psychiatry 56, 12901294.
Duncan D. E., Criswell H. E., McKown T. J., Paul I. A., Mueller R. A. & Breese G. R. (1987). Behavioral and neurochemical responses to haloperidol and SCH-23390 in rats treated neonatally or as adults with 6-hydroxydopamine. Journal of Pharmacology and Experimental Therapeutics 243, 10271034.
Early T. S., Reiman E. R., Raichle M. E. & Spitznagel E. L. (1987). Left globus pallidus abnormality in never-medicated patients with schizophrenia. Proceedings of the National Academy of Sciences, USA 84, 561563.
Elliott R., McKenna P. J., Robbins T. W. & Sahakian B. J. (1995). Neuropsychological evidence for frontostriatal dysfunction in schizophrenia. Psychological Medicine (in the press).
Forstl H. & Sahakian B. J. (1991). A psychiatric presentation of abulia – three cases of left frontal lobe ischaemia and atrophy. Journal of the Royal Society of Medicine 84, 8991.
Frith C. D. (1987). The positive and negative symptoms of schizophrenia reflect impairments in the perception and initiation of action. Psychological Medicine 17, 631648.
Frith C. D. (1992). The Cognitive Neuropsychology of Schizophrenia. Lawrence Erlbaum Associates: Hove, UK.
Frith C. D. & Done D. J. (1989). Experiences of alien control in schizophrenia reflect a disorder in the central monitoring of action. Psychological Medicine 19, 359363.
Frith C. D., Leary J., Cahill C. & Johnstone E. C. (1991). Performance on psychological tests. Demographic and clinical correlates of the results of these tests. In Disabilities and Circumstances of Schizophrenic Patients: A Follow-up Study (ed. Johnstone E. C.). British Journal of Psychiatry 159, supplement 13, 2629.
Goldberg T. E., Kelsoe J. R., Weinberger D. R., Pliskin N. H., Kirwin P. D. & Berman K. F. (1980). Performance of schizophrenic patients on putative neuropsychological tests of frontal lobe function. International Journal of Neuroscience 42, 5158.
Goldberg T. E., Weinberger D. R., Berman K. F., Pliskin N. H. & Podd M. H. (1987). Further evidence for a dementia of the prefrontal type in schizophrenia? A controlled study of teaching the Wisconsin Card Sorting Test. Archives of General Psychiatry, 44, 10081014.
Goldberg T. E., Weinberger D. R., Pliskin N. H., Berman K. F. & Podd M. H. (1989). Recall memory deficit in schizophrenia: a possible manifestation of prefrontal dysfunction. Schizophrenia Research 2 251287.
Goldberg T. E., Saint-Cyr J. A. & Weinberger D. R. (1990). Assessment of procedural learning and problem solving in schizophrenic patients by Tower of Hanoi type tasks. Journal of Neuropsychiatry and Clinical Neuroscience 2, 165173.
Goldberg T. E., Greenberg R. D., Griffin S. J., Gold J. M., Kleinman J. E., Pickar D., Schultz C. & Weinberger D. R. (1993). The effect of clozapine on cognition and psychiatric symptoms in patients with schizophrenia. British Journal of Psychiatry 162, 4348.
Goldman-Rakic P. S. (1987). Circuitry of the frontal cortex and the regulation of behavior by representational knowledge. In Handbook of Physiology, vol. 5 (ed. Plum F. and Mountcastle V.), pp. 373417. American Psychological Society: Bethesda, MD.
Grace A. A. (1991). Phasic versus tonic dopamine release and the modulation of dopamine system responsivity: an hypothesis for the aetiology of schizophrenia. Neuroscience 41, 124.
Gruzelier J., Seymour K., Wilson L., Jolley A. & Hirsch S. (1988). Impairments of neuropsychological tests of temporohippocampal and frontohippocampal functions and word fluency in remitting schizophrenia and affective disorders. Archives of General Psychiatry 45, 623629.
Heaton R. K. (1981). Wisconsin Card Sorting Test Manual. Psychological Assessment Resources: Odessa, FL.
Jaskiw G. E. & Weinberger D. R. (1992). Dopamine and schizophrenia – a cortically corrective perspective. Seminars in the Neurosciences 4, 179188.
Kolb B. & Whishaw I. Q. (1983). Performance of schizophrenic patients on tests sensitive to left or right frontal, temporal or parietal function in neurological patients. Journal of Nervous and Mental Disease 171, 435443.
Kraepelin E. (1913). Dementia Praecox and Paraphrenia. (Translated 1919 by Barclay R. M..) Livingstone: Edinburgh.
Liddle P. F. (1987). Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine 17, 4957.
Liddle P. F. & Crow T. J. (1984). Age disorientation in chronic schizophrenia is associated with global intellectual impairment. British Journal of Psychiatry 144, 193199.
Liddle P. F., Friston K. J., Frith C. D., Hirsch S. R., Jones T. & Frackowiak R. S. J. (1992). Patterns of cerebral blood flow in schizophrenia. British Journal of Psychiatry 160, 179186.
Lishman A. W. (1987). Organic Psychiatry, 2nd edn.Blackwell Scientific Publications: Oxford.
McKeith I. G., Perry R. H., Fairbairn A. F., Jabeen S. & Perry E. K. (1992). Operational criteria for senile dementia of the Lewy body type (SDLT). Psychological Medicine 22, 911922.
McKenna P. J., Tamlyn D., Lund C. E., Mortimer A. M., Hammond S. & Baddeley A. D. (1990). Amnesic syndrome in schizophrenia. Psychological Medicine 20, 967972.
Malenka R. C., Angel R. W., Hampton B. & Berger P. A. (1982). Impaired central error correcting behaviour in schizophrenia. Archives of General Psychiatry 39, 101107.
Martinot J. L., Paillere-Martinot M. L., Loc'h C., Lecrubier Y., Dao-Castellana M. H., Aubin F., Allilaire J. F., Mazoyer B., Mazière B. & Syrota A. (1994). Central D2 receptors and negative symptoms of schizophrenia. British Journal of Psychiatry, 164, 2734.
Milner B. (1964). Some effects of frontal lobectomy in man. In The Frontal Granular Cortex and Behaviour (ed. Warren J. M. & Akert K.), pp. 313331. McGraw-Hill: New York.
Morice R. (1990). Cognitive inflexibility and pre-frontal dysfunction in schizophrenia and mania. British Journal of Psychiatry 157, 5054.
Morrison-Stewart S. L., Williamson P. C., Corning W. C., Kutcher S. P., Snow W. G. & Merskey H. (1992). Frontal lobe and non-frontal lobe neuropsychological test performance and clinical symptomatology in schizophrenia. Psychological Medicine 22, 353359.
Murphy E. & Macdonald A. (1992). Affective disorders in old age. In Handbook of Affective Disorders, 2nd edn (ed. Paykel E. S.), pp. 601618. Churchill Livingstone: Edinburgh.
Neary D. M., Snowden J. S., Northern B. & Goulding P. (1988). Dementia of the frontal lobe type. Journal of Neurology, Neurosurgery and Psychiatry 51, 353361.
Nelson H. E., Pantelis C., Carruthers K., Speller J. Baxendale S. & Barnes T. R. E. (1990). Cognitive functioning and symptomatology in chronic schizophrenia. Psychological Medicine 20, 357365.
Orrell M. W. & Sahakian B. J. (1991). Dementia of the frontal lobe type. Psychological Medicine 21, 553556.
Orrell M. W., Sahakian B. J. & Bergmann K. (1989). Self-neglect and frontal lobe dysfunction. British Journal of Psychiatry 155, 101105.
Owen A. M., Downes J. D., Sahakian B. J., Polkey C. E. & Robbins T. W. (1990). Planning and spatial working memory following frontal lobe lesions in man. Neuropsychologia 28, 10211034.
Owen A. M., Roberts A. C., Polkey C. E., Sahakian B. J. & Robbins T. W. (1991). Extra-dimensional versus intradimensional set shifting performance following frontal lobe excisions, temporal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia, 29, 9931006.
Owen A. M., Roberts A. C., Hodges J. R., Summers B. A., Polkey C. E. & Robbins T. W. (1993). Contrasting mechanisms of attentional set-shifting in patients with frontal lobe damage or Parkinson's disease. Brain 116, 11591175.
Owens D. G. C. & Johnstone E. C. (1980). The disabilities of chronic schizophrenia: their nature and the factors contributing to their development. British Journal of Psychiatry 136, 384393.
Pantelis C., Barnes T. R. E., Nelson H. E. & Robbins T. W. (1991). The nature of dementia in schizophrenia. Abstracts of the Royal College of Psychiatrists Annual Meeting 2–6 July, 1991. Psychiatric Bulletin of the Royal College of Psychiatrists 15 (supplement 4), 6364.
Pantelis C., Barnes T. R. E. & Nelson H. E. (1992). Is the concept of fronto-subcortical dementia relevant to schizophrenia? British Journal of Psychiatry 160, 442460.
Payne R. W. (1973). Cognitive abnormalities. In Handbook of Abnormal Psychology (ed. Eysenck H. J.), pp. 420483. Pitman: London.
Pilowsky L. S., Costa D. C., Ell P. J., Verhoeff N. P. L. G., Murray R. M. & Kerwin R. W. (1994). D2 dopamine receptor binding in the basal ganglia of antipsychotic-free schizophrenic patients. British Journal of Psychiatry 164, 1626.
Raven J. C., Court J. H. & Raven J. (1982). The Mill Hill Vocabulary Scale: 1982 Revision. H. K. Lewis: London.
Robbins T. W. (1990). The case for frontostriatal dysfunction in schizophrenia. Schizophrenia Bulletin 16, 391402.
Roth R. H., Tarn S.-Y., Ida Y., Yang J.-X. & Deutch A. Y. (1988). In The Mesocorticolimbic Dopamine System (ed. Kalivas P. W. and Nemeroff C. B.), pp. 138147. New York Academy of Sciences: New York.
Sahakian B. J., Morris R. G., Evenden J. L., Heald A., Levy R., Philpot M. & Robbins T. W. (1988). A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain 111, 695718.
Saint-Cyr J. A., Taylor A. E. & Lang A. E. (1988). Procedural learning and neostriatal dysfunction in man. Brain 111, 941959.
Sandson J. & Albert M. L. (1984). Varieties of perseveration. Neuropsychologia 22, 715732.
Saykin A. J., Gur R. C., Gur R. E., Mozley P. D., Mozley L. H., Resnick S. M., Kester B. & Stafinial P. (1991). Neuropsychological function in schizophrenia. Archives of General Psychiatry 48, 618624.
Seeman P. (1980). Brain dopamine receptors. Pharmacological Reviews 32, 229313.
Shallice T. (1982). Specific impairments in planning. Philosophical Transactions of the Royal Society B 298, 199209.
Shallice T., Burgess P. W. & Frith C. D. (1991). Can the neuropsychological case-study approach be applied to schizophrenia? Psychological Medicine 21, 661673.
Slater E., Beard A. W. & Glithero E. (1963). The schizophrenia-like psychosis of epilepsy. British Journal of Psychiatry 109, 95105.
Stuss D. T. & Benson D. F. (1983). Emotional concomitants of psychosurgery. In Neuropsychology of Human Emotion (ed. Heilman K. M. and Satz P.), pp. 111140. Guildford Press: London.
Tamlyn D., McKenna P. J., Mortimer A. M., Lund C. E., Hammond S. & Baddeley A. D. (1992). Memory impairment in schizophrenia: its extent, affiliations and neuropsychological character. Psychological Medicine 22, 101115.
Taylor M.A. & Abrams R. (1984). Cognitive dysfunction in schizophrenia. American Journal of Psychiatry 141, 186201.
Weinberger D. R. (1987). Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry 44, 660669.
Weinberger D. R. (1988). Schizophrenia and the frontal lobe. Trends in the Neurosciences 11, 367370.
Weinberger D. R., Berman K. F. & Zec R. F. (1986). Physiological significance of dorsolateral prefrontal cortex in schizophrenia. I. Regional cerebral blood flow evidence. Archives of General Psychiatry 43, 114124.
Weinberger D. R., Berman K. F., Suddath R. & Torrey E. F. (1992). Evidence of dysfunction of a prefrontal-limbic network in schizophrenia: a magnetic resonance imaging and regional cerebral blood flow study of discordant monozygotic twins. American Journal of Psychiatry 149, 890897.
Wolkin A., Sanfilipo M., Wolf A. P., Angrist B., Brodie J. D. & Rotrosen J. (1992). Negative features and hypofrontality in chronic schizophrenia. Archives of General Psychiatry 49, 959965.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 14 *
Loading metrics...

Abstract views

Total abstract views: 136 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st October 2017. This data will be updated every 24 hours.