Attentional characteristics of schizophrenia patients differing in learning proficiency on the Wisconsin Card Sorting Test

Abstract

The Wisconsin Card Sorting Test (WCST), a test of concept formation, was given to 49 schizophrenia inpatients in three blocks of 64 cards each with the second block comprising special instructions and trial-by-trial feedback. With the help of a psychometric algorithm based on linear regression analysis, the patients were classified according to their response to these specific interventions. Results yielded 15 high scorers, 23 learners, and 11 nonlearners. This a priori classification was confirmed by cluster analysis. Next, these groups were further analyzed with the Degraded Stimulus Continuous Performance Test (DS-CPT), a test of target discrimination, and the Test of Attentional Style (TAS), which assesses habitual, subjectively experienced attentional problems. A significant difference between high scorers and nonlearners was found for discriminative sensitivity (d'), with the learners achieving intermediate scores. Results for only the DS-CPT response criterion (beta) and a TAS subscale (Distractibility) tended to be significant. Discriminant analysis also revealed that d' is the most powerful variable for discriminating among the subgroups. The article also addresses baseline versus dynamic assessment, specific rehabilitation needs in subgroups of schizophrenia patients different in learner status, and the neurocognitive characteristics of the subgroups.