Neuropsychology of schizophrenia, what are the

implications of intellectual and experiential abnormalities

for the neurobiology of schizophrenia?
Article Critique

Abstract

The article discusses how the diagnosing procedure is done for schizophrenia, which
focuses mainly on signs and symptoms, not relying on biological markers despite of the
research supporting a biological basis for this neurological condition. The author also
argues that it is difficult for neuropsychologists to diagnose schizophrenia because
different patients present different behaviours. The main focus on the paper is on the
relationship between low IQ and schizophrenia. The article presents a number of
studies that support the idea that a decline in intelligence is linked with schizophrenia
but omits studies which found the contrary. Cognitive impairment is also shown to be
present in many cases of schizophrenia but recent experiments have shown variability
and flexibility in this function. An alternative approach to understanding schizophrenia is
proposed but not many details are provided. Although there are some reasonable ideas
discussed in this paper, there is substantial evidence that goes against it.
Introduction

This article by Frith (1996) covers the diagnostic criteria for schizophrenia. It is
relatively easy to provide a valid diagnostic when dealing with large sample sizes of
patients with schizophrenia (Pihlajamaa et al., 2008) however on an individual basis, it
becomes more difficult and requires more improvement in the diagnostic procedures.
Patients with intellectual disabilities have a higher risk of developing schizophrenia
which would suggest that low IQ can be a predictor for schizophrenia (Cookson and
Dickson, 2010).

Recent research by Yelmo-Cruz, Morera-Fumero and Abreu-Gonzalez (2013) found that

patients with schizophrenia have higher S100B levels, a calcium-binding protein linked
with astrocyte activation and brain dysfunction, than healthy individuals. This new
finding shows that a biological marker for the diagnosis of schizophrenia may exist and
can be used.

Although the DSM-IV was the most used standard, now the DSM-V, for diagnosing
mental illness, Jakobsen et al. (2005) show that the ICD-10 is highly reliable for
schizophrenia diagnosis, focusing on psychotic and affective illness, age was also
considered in regards to the time of reporting hallucinations, bizarre behaviour and
delusions.

There are also other predictors used for diagnosing schizophrenia, such as low
education level, cognitive impairment, repeated hospitalisations and a long duration of
untreated psychosis (Lang et al., 2013).
Article Summary

This article explored the diagnosis of schizophrenia and the problems that might occur
when following the DSM-IV definition of this neurological condition. The author
considered that the American Psychiatric Association's definition of schizophrenia relies
mostly on the patient's delusions in his or her thoughts, hallucinations, disorganized
speech and behavioural problems. This article explained the difficulties that
neuropsychologists are faced with when attempting to accurately diagnose
schizophrenic patients because some of the individuals do not present any
hallucinations or delusions therefore the clinicians must use observation and perform
experiments for the diagnostic. Two approaches were mentioned, the first focusing on
intellectual impairment and the second one relying on particular signs and symptoms
connected with schizophrenia.

Four studies were presented in support of the idea that intellectual functioning is
significantly lower in schizophrenic patients than in healthy individuals. The article
continued by addressing the relationship between specific impairment and certain brain
areas. Cognitive impairment was identified in an experiment where schizophrenic
showed slower responses than healthy participants. The article also considered
perseveration, how schizophrenic individuals are unable to follow changed rules in a
cognitive task.

The relationship between intellectual impairments and schizophrenic syndromes was

also discussed, poverty of speech, actions and thoughts, incoherence of speech and
hallucinations and delusions were linked with low IQ in schizophrenic patients. Other
studies presented did not reveal this link however the current mental state of
schizophrenic patients was expected to change simultaneously with the symptoms but a
study mentioned in this article disproved the hypothesis.

The article criticizes the studies mentioned as being correlational and not providing
much information about the cause. A new method, which uses cognitive mechanisms, is
proposed, involving the development of observational experiments, and comparing the
symptoms between schizophrenic and normal participants.

Hallucinations and delusions were also discussed; schizophrenics have difficulties self-
monitoring themselves, being unable to distinguish sounds from external or internal
sources, making false attributions.
Critique

The introduction, which does not have a clear heading, starts with the assumption that
the procedure of diagnosing schizophrenia is based on the signs and symptoms of the
patient because the author considers that a biological indicator for this neurological
condition does not exist. There is however research which indicates that schizophrenia
can be identified by protein analysis (Yelmo-Cruz, Morera-Fumero and Abreu-Gonzalez,
2013) or a blood test (Tomasik, Schwarz, Guest and Bahn, 2012).

The authors continues by stating that a number of recent studies confirm the
observation that patients with schizophrenia present a decline in their intelligence but
only two studies are mentioned. A study by McCabe et al. (2012) found that
schizophrenic patients are able to match the intellectual ability of healthy individuals
and sometimes present higher performance in tests. The author should have presented
a balanced introduction in regards to intelligence and schizophrenia.

The author makes a good point regarding the effects of medication on test
performance; this should be controlled when using cognitive testing on patients with
schizophrenia (Shah et al., 2012).

The author fails to mention studies which did not find decreased performance in
learning and memory. Research by Landra and Ueland (2008) revealed that no
differences between schizophrenics and healthy individuals were found for recognition,
retention, implicit memory and susceptibility to interference. Also no more information
is provided regarding the three domains making it slightly unclear to the reader as to
what domains and how are they related to learning and memory. Rethelyi et al (2012)
showed that schizophrenic patients possess cognitive flexibility indicating that cognitive
impairment can be both domain general and domain specific in the brain. The author
proposes the possibility that different cognitive impairments are found in different
patients, perhaps appealing to individual differences, but more clarification is needed
for this statement.

The first information about the neurobiology of schizophrenia is mentioned in the

middle part of the article where the author discusses how general cognitive
impairments are still present even when symptoms are reduced by using clozapine. This
in depth perspective on schizophrenia requires more details about what the treatment
does to which parts of the brain. Good clinical response to clozapine was found by
Rajkumar et al. (2012) indicating that there is a biological basis to schizophrenia,
despite the authors claim, and that much more research can be done on the
understanding of schizophrenia through biological factors.
Further in the article, the author makes a very reasonable statement that correlation
does not reflect causation and that schizophrenia cannot be described only by cognitive
impairment as there is substantial cognitive variability in cognitive performance which
can remain stable similarly to a control group (Pietrzak et al., 2009) also findings by
Elvevag et al. (2004) did not support the hypothesis that global impairment can be used
in identifying schizophrenia.

The author also rules out the possibility that schizophrenia will be explained genetically
or from a brain abnormality point of view however studies have identified multiple
putative schizophrenia risk genes (Haraldsson, Ettinger and Sigurdsson, 2011) and
research done on schizophrenia families revealed correlations between schizophrenia
and endophenotypes (Tarbox et al., 2012), also indicating risk factors in genes which
can be passed on.

The author considers that a better approach for understanding symptoms in the
cognitive functions can be done by designing experiments in order to show the
cognitive functions, develop methods that can change symptoms in individuals with
schizophrenia and create techniques which are able to change symptoms in healthy
individuals. MacDonald and Carter (2002) have discussed a similar method for
facilitating and enchanting the accuracy of interpreting and measuring signs and
symptoms of schizophrenia but also considering the importance of neuropsychology in
the development of this approach.

The author discusses verbal hallucinations by using self-monitoring theory as an

explanation for the false attribution that the schizophrenic patients might make
however an experiment by Johns and McGuire (1999) showed that this error is most
likely made because of bias.
Conclusion

The introduction focuses on the diagnosing techniques used for schizophrenia, mainly
the observation of signs and symptoms but does not consider the biological factors that
can predict this neurological condition. The author states that there are two
fundamental approaches, descriptive and mechanistic making it unclear as to what are
the aims of this article. There is some indication of bias in this paper, most studies are
related to correlations between schizophrenia and low IQ. The author then criticizes the
studies due to lack of consideration for causality although he uses them to support his
claims. There are some good points made on the cognitive impairment but some
evidence is omitted. The structure of the article does not follow a standardised format
and the use of jargon can be confusing at time. Overall this article has raised some
important issues but there is much research against it.
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