VOL. 11, NO.
3, 1985
by Barbara A. Cornblatt, Mark
F. Lenzenweger, Robert H.
Dworkln, and L. Erlenmeyer-
Kimllng
Positive and Negative
Schizophrenic Symptoms,
Attention, and Information
Processing
Abstract
This study was concerned with the
relationship between attentional and
information-processing deficits and
positive vs. negative symptoms in
schizophrenia. Sixteen schizophrenic
patients, rated for extent of positive
and negative symptomatology, 17
depressed patients, and 31 normal
control subjects were tested on a
measure of distractibility and ability
to process under information
overload. To establish the validity of
our measures, schizophrenic patients
were compared with depressed
patients and with normal control
subjects. Lowered processing capacity
appeared to be specific to schizo-
phrenia, although the specificity of
differential distractibility was less
dear. For schizophrenic patients,
positive symptoms were related to
distractibility, whereas negative
symptoms were associated with
lowered processing capacity. These
findings were interpreted as
supporting Crow's (1981) hypothesis
that the two clinical syndromes
reflect independent pathological
processes.
Positive and negative symptom
dimensions have figured prominently
in recent discussions of the patho-
genesis and course of schizophrenia
(Strauss, Carpenter, and Bartko
1974; Bowers 1980; Crow 1980,
1981, 1983; Andreasen and Olsen
1982; Crow et al. 1982). The
negative-positive distinction, first
introduced into the psychiatric liter-
ature by Strauss, Carpenter, and
Bartko (1974), has been further
developed by Crow (1980, 1981,
1983), who has proposed that there
are two clinical syndromes involved
in schizophrenia—one characterized
by florid positive symptomatology
(e.g., hallucinations and delusions)
and by disturbances in dopaminergic
397
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transmission, and the other charac-
terized by enduring negative
symptomatology (e.g., apathy and
flattened affect) and structural abnor-
malities of the brain. Crow further
maintains that while the two
syndromes reflect separate patho-
logical processes, they do not
constitute separate diseases, since
they commonly occur together, either
simultaneously or at different time
points, with early positive episodes
typically progressing to the more
incapacitating negative defect state.
Support for the relative
independence of the positive-negative
symptom clusters is based on neuro-
chemical-morphological differences,
response to treatment, and long-term
nature of the symptomatology.
Neuropharmacological studies have
consistently shown positive
symptoms to be more responsive
than negative symptoms to treatment
with neuroleptics (Johnstone et al.
1978a; Angrist, Rotrosen, and
Gershon 1980; Crow et al. 1982).
This finding has, in turn, been inter-
preted to suggest a relationship
between positive symptoms and
disturbed dopamine transmission,
since neuroleptics act as dopamine
antagonists (e.g., Crow et al. 1982).
By contrast, the morphological •
findings reported by Johnstone et al.
(1976, 1978fc) and by Andreasen et
al. (1982) relating negative symptoms
to abnormally large ventricles
support Crow's notion of a structural
loss of brain cells underlying the
negative symptom syndrome. Thus,
recent neuropathological and
biochemical findings are quite
compatible with the widespread
clinical impression (e.g., Jackson
Reprint requests should be sent to
Dr. B. Cornblatt, Dept. of Medical
Genetics, New York State Psychiatric
Institute, 722 W. 168th St., New York,
NY 10032.
398
1931; Strauss, Carpenter, and Bartko
1974) that positive symptoms are
associated with a relatively favorable
prognosis whereas negative
symptoms are indicative of a more
chronic course.
Despite the apparent validity of
positive vs. negative symptoms in
predicting prognosis and response to
treatment, however, the etiological
significance of this distinction is
unclear. One important question still
to be answered is whether the two
symptom dimensions represent
independent processes (Strauss,
Carpenter, and Bartko 1974; Crow
1980, 1981, 1983), opposite ends of
the same dimension of pathology as
proposed by Mackay (1980), or,
possibly, genetically different
components of the illness (Dworkin
and Lenzenweger 1984).
In the current study, we regard the
relationship between positive-
negative symptomatology and atten-
tional processing as one way of
clarifying such issues. There is
considerable evidence indicating that
attentional dysfunctions are core
features of the schizophrenic process.
Attentional deficits have been consis-
tently found in schizophrenic
patients, during both overt psychotic
states (McGhie and Chapman 1961;
Chapman and McGhie 1962;
Kornetsky and Mirsky 1966; Orzack
and Kornetsky 1966; Lawson,
McGhie, and Chapman 1967;
Rappaport 1967; Nachmani and
Cohen 1969; Neale 1971; Kornetsky
1972; Saccuzzo, Hirt, and Spencer
1974; Hemsley and Richardson 1980;
Pogue-Geile and Oltmanns 1980) and
while in remission (Wohlberg and
Kornetsky 1973; Asarnow and
MacCrimmon 1978), as well as in
clinically unaffected first-degree
relatives of schizophrenics (Holzman
et al. 1974, 1978; Holzman, Levy,
and Proctor 1978) and in children at
risk for schizophrenia (Gnmebaum et
al. 1974; Asarnow, Steffy, and
MacCrimmon 1977, 1978;
Rutschmann, Cornblatt, and
Erlenmeyer-Kimling, 1977, 1980;
Erlenmeyer-Kimling and Cornblatt
1978; Oltmanns et al. 1978;
Erlenmeyer-Kimling, Cornblatt, and
Fleiss 1979; Harvey et al. 1981;
Erlenmeyer-Kimling, Cornblatt, and
Golden 1983; Nuechterlein 1983;
Cornblatt and Erlenmeyer-Kimling
1984a; Nuechterlein and Dawson
1984). Moreover, attentional
processing has been shown to involve
a genetic component in a sample of
clinically normal families (Cornblatt
and Erlenmeyer-Kimling 1984b).
However, not all schizophrenic
patients or children at risk display
such attentional deficits. Orzack and
Kornetsky (1971), for example,
reported that only about 40 percent
of the schizophrenic patients tested in
their study displayed attentional
deficits, while Cornblatt and
Erlenmeyer-Kimling (in press)
similarly found that only a subgroup
of the children at risk for schizo-
phrenia with adolescent behavioral
disturbances were also characterized
by attentional impairments in early
childhood. Consequently, attentional
deficits appear to be characteristic of
a particular form of schizophrenia.
This is consistent with the view of
schizophrenia as a heterogeneous
disorder, with the different subtypes
reflecting different biobehavioral
dysfunctions. It thus follows that if
the positive-negative symptom
dimensions involve distinctly
different pathological processes, then
different patterns of attentional
deficits may be associated with each
syndrome. Specifically, we
hypothesize that positive symptoms
will be related to abnormal distract-
ibility and impaired selective
attention while negative symptoms
will be associated with more complex
cognitive processing deficits.
SCHIZOPHRENIA BULLETIN
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In the case of positive symptom-
atology, our hypothesis is based on
converging lines of evidence
suggesting that: (1) dopamine trans-
mission is related to attentional
processing in normal individuals as
well as in schizophrenic patients
(Matthysse 1977, 1978; Buchsbaum et
al. 1978; Crow et al. 1982); (2) drugs
reducing clinical symptoms in
patients also improve attentional
processing in the same patients
(Kornetsky 1972; Oltmanns,
Ohayon, and Neale 1978; Orzack,
Kornetsky, and Freeman 1967); and
(3) the symptoms that improve with
neuroleptic treatment are positive
symptoms (Johnstone et al. 1978a;
Crow et al. 1982). Therefore, it
appears quite likely that a dopamine
imbalance is in some way related to
both positive symptomatology and
disturbances in attentional
processing; consequently, positive
symptomatology should be
associated with attentional
dysfunctions.
The hypothesized relationship
between negative symptoms and a
global processing deficit is based
primarily on the association between
negative features of schizophrenia
and impaired cognitive functioning
that has recently been reported in
several studies (Johnstone et al.
1978a; Owens and Johnstone 1980;
Andreasen et al. 1982; Andreasen
and Olsen 1982). It is also consistent
with the view that the negative
schizophrenic syndrome is similar in
many respects to the dementias and
involves diffuse and principally
atrophic brain abnormalities
(Andreasen et al. 1982).
Thus far, only two studies have
looked directly at the relationship
between symptomatology and atten-
tional processing, and these have
yielded contradictory results. Allen
(1982) reported no differences
between negative and positive
VOL 11, NO. 3, 1985
symptom schizophrenic patients on a
dichotic listening task involving
focused and divided attention. Frith
(1977), on the other hand, found
that, on a feature selection task,
negative symptom patients selected
usual features but displayed an
extreme lack of persistence, whereas
positive symptom patients selected
unusual features but displayed a
normal degree of persistence.
However, the implications of these
results are unclear, since in both
studies only late middle-aged to
elderly chronic institutionalized
patients were used. Deficiencies in
attentional processing due to age
alone could thus confound the
patterns of deficits associated with
the two clinical syndromes.
Furthermore, the division of patients
in these two studies into either
negative or positive types may be an
oversimplification of the negative-
positive distinction, if these
syndromes reflect two independent
dimensions of symptoms that may or
may not coexist in the same patient.
In the current study, we have
examined the relationship between
positive and negative symptoms and
attentional processes within the same
individuals. Furthermore, the patients
tested were considerably younger
than those included in either the Frith
or Allen study. We present here
attentional data obtained from the
Information Overload Task (IOT),
one of three multilevel measures of
attention administered to the subjects
included in this study. The
Information Overload Task has been
shown to be sensitive to attentional
deficits in children at risk for schizo-
phrenia relative to normal
comparison children (Cornblatt and
Erlenmeyer-Kimling 1984a) but has
not been established previously as
appropriate for adult patients. The
first part of this report, therefore,
will focus on an assessment of the
validity of the Information Overload
Task as a measure of disturbed atten-
tional processing in adult subjects.
The performances of schizophrenic
patients will be compared with the
performances of depressed patients
and of normal controls. The second
part of the report will examine the
relationships between negative and
positive symptoms and IOT
performance within the schizophrenic
group alone.
Methods
Subjects. The complete sample
consisted of 33 adult psychiatric
patients (25 inpatients and 8
outpatients) and 31 normal adults.
All of the patients were in treatment
at the New York State Psychiatric
Institute in New York City. The
patients who participated in the
present study were consecutive
admissions to a psychiatric service.
Of the 34 patients initially selected
for this study, only one schizophrenic
subject was unable to complete the
testing procedures and, consequently,
was dropped from the patient
sample. Two of the remaining 33
patients were tested across two
testing sessions; all others completed
the testing in one session. No
distinction was made between
inpatients and outpatients, since t-
test comparisons indicated that there
were no significant differences in
attentional performance as a function
of patient status in either the schizo-
phrenic or depressed groups.
Informed consent from the study
participants was obtained after the
research procedures were fully
explained. Social history, mental
status examination, and structured
interview data served as the basis for
diagnosis by DSM-III (American
Psychiatric Association 1980)
criteria. Diagnosis was done by
supervised psychiatric residents or by
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a clinical psychologist. The sample
consisted of 16 schizophrenic patients
(10 paranoid, 4 undifferentiated, and
2 disorganized) and 17 depressed
patients (11 major depression, 2
bipolar-depressed, 3 atypical
depression, and 1 dysthymic
disorder). Patients with a history of
alcoholism, attention deficit
disorders, or other functional
psychoses (e.g., paranoia) were
excluded from the study. Normal
control subjects were recruited from
the staff of New York State Psychi-
atric Institute and were paid for
participation in the study.
Table 1 provides a summary of
age, educational level, and sex for
the entire sample as well as
medication status, age at onset of
disorder (i.e., first inpatient hospital-
ization), duration of disorder, and
time spent in the hospital before
testing procedures for the two patient
groups. There were no significant age
differences between groups. Normal
controls were significantly better
educated than depressed patients
(t = 2.89, p < .01) but were not
better educated than schizophrenic
patients. The schizophrenic and
depressed patients did not differ
significantly in duration of illness
and time in hospital before testing.
Schizophrenic patients were,
however, significantly younger in age
at the onset of their illness than
depressed patients (t •» 2.82,
p < .01).
Approximately 48 percent
(n = 16) of the patients were
medicated at the time they were
tested. The proportions of medicated
patients in the two patient groups did
not differ significantly (x1 ~ -700;
df - 1,33; NS). Among the
depressed patients, four were
receiving tricyclic antidepressants,
two were receiving monoamine
oxidase inhibitors, and one was
receiving a phenothiazine. Six of the
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Table 1. Characteristics of study subjects asked to point to one of four pictures
which corresponds to a word dictated
Group by a tape recording. The stimulus
words are presented at a constant but
Schizophrenic Depressed Normal very slow rate so that speed of
Variable (n = 16) (n o 17) (n - 31) processing is not a factor in this
Age (years) procedure. The overall test is divided
Mean 30.38 35.12 32.23 into three conditions. The target
SD 7.87 10.04 6.82 stimuli are first presented in a no-
distraction condition to establish a
Education (years) baseline (B) level of performance,
Mean 13.75 12.88 15.45 and then in the presence of two
SD 2.77 2.76 3.04 different kinds of distraction. The
Sex first distraction condition, distraction
Male 9 3 8 1 (Dl), involves amplitude-
Female compressed, undifferentiated
7 14 23
background noise, derived from
Medication recording sound in a school cafeteria
(% of group) 56 41 (overall sound pressure level = 90
dB). This condition is essentially a
Age at onset of
quasi-masking perceptual task. The
Illness (years)
background distraction requires no
Mean 22.69 31.12 —
processing other than to be filtered
SD 6.02 10.45
from attention. However, in some
Duration of illness instances, distractors (e.g., cash
before testing registers ringing and coins dropping)
(years) overlap with the critical stimuli,
' Mean 7.78 4.14 — making the target words difficult to
SD 7.08 6.02 hear and somewhat ambiguous.

Time In hospital In the second distraction condition,

before testing
(days)
Mean 41.15
SD 47.90
schizophrenic patients were receiving
phenothiazines, two were receiving a
butyrophenone, and one a thioxan-
thene. The attentional performance
of medicated and nonmedicated
patients within each diagnostic group
was compared using f tests. Although
there was a mild trend for
nonmedicated schizophrenic patients
to perform somewhat better than
medicated schizophrenic patients,
these differences were not significant,
and no consistent differences were
found between medicated and
35.53 — which varies in level of loudness,
36.15
nonmedicated patients in the
depressed group. It was therefore not
considered necessary to control for
medication in the current analyses.
Measures. The Information Overload
Task (IOT) ' is a simple auditory-
visual task in which a subject is
1
The IOT was adapted from the
commercially available Goldman-Fristoe-
Woodcock tests of auditory selective
attention (Goldman, Fristoe, and
Woodcock 1974) and auditory discrimi-
nation (Goldman, Fristoe, and Woodcock
distraction 2 (D2), a male voice
recites a story in the background
while the target words spoken in a
female voice remain at a constant
auditory level. In contrast with Dl,
D2 requires some cognitive
1970). The two tests were combined and
substantially modified into the IOT
format described in Methods.
In previous publications (e.g., Cornblatt
and Erlenmeyer-Kimling 1984a), the three
pointing-task conditions and the overload
task were referred to, respectively, as
follows:
Current name Previous name
Baseline
condition (B) Quiet condition
Distraction 1 (Dl) Noise condition
Distraction 2 (D2) Voice condition
Overload Task (OT) Story condition
 VOL. 11, NO. 3, 1985 401

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processing, since subjects are told
that they will be asked questions
about the content of the background
story as soon as the pointing task is
completed. Perceptually, however,
D2 is less demanding than Dl, since
the story narrative does not in any
way override or "mask" the recited
target words.
The final condition of the IOT is
essentially a recall task which
consists of multiple-choice questions
asked about the background story
presented during the D2 condition.
This condition, referred to as the
Overload Task, is considered to be
an index of a subject's ability to
process two types of information
simultaneously, and thus the subject's
tolerance for processing information
under relatively overloaded
conditions.
There are 30 trials in the baseline
condition and 33 in each of the
distraction conditions. The overload
task consists of 12 multiple choice
questions. Performance was
measured by the proportion of
correct picture identifications for
each of the three basic conditions
(i.e., B, Dl, and D2) and proportion
of correct answers on the overload
task. Subjects were tested by
experienced research assistants in a
quiet, conventionally lighted
laboratory room. The testers were
blind as to symptomatology and
medication status of the patients. The
positive schizophrenic symptom-
atology from case history
information (Dworkin and
Lenzenweger 1984), was used to rate
symptomatology for each subject in
the schizophrenic sample. The
manual describes five categories of
negative symptoms (affective
flattening, alogia, avolition-apathy,
asociality-withdrawal, attentional
impairment) and five categories of
positive symptoms (delusions,
hallucinations, positive formal
thought disorder, catatonic motor
phenomena, bizarre behavior). All
case histories were edited for
diagnostic, medication, and
identifying information. The histories
of the schizophrenic and depressed
patients were randomly intermixed to
provide a range and diversity of
psychopathology for the rater.
The rater for this study, a
psychologist with considerable
diagnostic experience on inpatient
psychiatric wards, had been trained
Table 2. Differences between groups on IOT performance
Schizophrenic
Variable (n = 16)
Baseline (B)
% Correct
Mean .866
SD .111
Standardized scores 1
to use the manual previously and
had generated reliable symptom
ratings in previous research
(Dworkin and Lenzenweger 1984).
Each of the 33 patient case histories
was rated for the presence or absence
of each of the five negative and five
positive symptoms defined in the
manual. All of the schizophrenic
patients therefore received two
scores, one for positive symptoms
and one for negative symptoms, that
could each range from zero to five.
The rater was instructed to avoid
making hypothetical inferences from
the case histories to rate symptoma-
tology; he was asked to rate as
present only those symptoms that
were clearly described. The rater was
unaware of the hypotheses under
investigation.
Results
IOT Validation: Group Differences.
Table 2 presents mean raw
Group
Depressed Normal
(n o 17) (n » 31)
.931 .934
.073 .059

IOT was administered to each subject Mean -1.380 .175 .000

following two other measures of SD 1.909 1.417 1.000
, attention—the Attention Span Task L__.O1 1 11 NS_ I
and the Continuous Performance
Task—which will not be discussed I .01 I
Distraction 1 (D1)
here. % Correct
Mean .593 .751 .838
Positive and Negative Symptom SD .208 .105 .069
Assessment. A manual, patterned Standardized scores
after Andreasen's (1982) Scales for Mean -3.682 -1.223 .000
the Assessment of Negative SD 3.126 1.637 1.000
Symptoms and developed previously I 01. I I 01_
for the assessment of negative and
I
I nnn |
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Table 2. Differences between groups on IOT performance— percentage scores (percent correct)
Continued with corresponding standardized
mean residual scores ' for each of the
Qroup three groups, and the results of f-test
comparisons between groups. Schizo-
Schizophrenic Depressed Normal phrenic patients performed signif-
Variable (n = 16) (n = 17) (n = 31) icantly more poorly than both the
Distraction 2 (D2) normal controls and the depressed
% Correct patients on the baseline condition (B)
Mean .808 .897 .932 and on both distraction conditions
SD .113 .049 .037 (Dl and D2). Although the depressed
patients did not differ from the
Standardized scores
Mean -3.808 -.916 .000 normal controls in baseline
SD 3.335 1.487 1.000 performance, they performed signif-
I 006. I I 014.—-I icantly more poorly than normal
mi controls on both distraction
| conditions.
Since the schizophrenic patients
Diff 1 (B-D1) displayed attentional deficits on the
% Correct baseline task, the relative change in
Mean .270 .181 .096 performance due to distraction was
SD .181 .077 .063 considered to be of interest and was
Standardized scores assessed by the two distraction
Mean 2.253 1.375 .000 difference scores—Diff 1 (i.e., B
SD 2.668 1.204 1.000 minus Dl) and Diff 2 (i.e., B minus
I NS_ I I 000-
-I D2).3 These scores indicate the extent
1
For each of the IOT standardized
scores, raw scores (percent correct) were
Diff 2 (B-D2) first controlled for age, sex, and age X
% Correct sex, and were then standardized on the
Mean .058 .035 .022 basis of the normal control group
SD .106 .079 .067 distribution.
3
Standardized scores Chapman and Chapman (1973, 1978)
Mean 1.667 .742 .000 have argued that tasks used to evaluate
SD 1.885 1.151 1.000 differential deficit in abilities must be
matched for true score variance and for
item difficulty level, and that such
matching should be based on a stand-
ardization group composed of normal
subjects. In the IOT, the B and Dl condi-
Overload task (OT) tions were reasonably well matched for
% Correct discriminating power. For true score
Mean .497 .607 .735 variance, B = 1.56 and Dl — 1.13, and
SD .199 .245 .178 for item difficulty, B - .93 and Dl - .84
Standardized scores among the normal control subjects. The
Mean D2 condition did not match the baseline
SD condition for true score variance (.27) but
was well matched for item difficulty (.93).
While assessment of differential deficit is
not a primary focus of this study, these
1
Standardized scores are % correct recalculated as residual scores, controlling, (or age, sex, data may be useful in evaluating group
and age x sex, and standardized on the normal control group distribution. performance patterns associated with the
' p values for l tests (2-talled) between groups.
two distraction difference scores.
VOL. 11, NO. 3, 1985 403

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of performance deterioration
resulting from the presentation of
perceptual and cognitive distraction,
respectively. That is, the higher the
score in a positive direction, the
better baseline performance relative
to performance under distraction
and, therefore, the greater the
distractibility. The schizophrenic and
depressed patient groups both
displayed significantly greater
distractibility than did normal
controls, but did not differ from each
other on either difference score.
With respect to the overload task,
schizophrenic patients were deficient
in comparison to both the normal
and depressed groups. No difference
was found, however, between
depressed patients and normal
controls in recall of the background
material.
Positive and Negative Symptoma-
tology and IOT Performance. Table
3 presents correlations between
Table 3. Correlations1 between positive and negative
schizophrenic symptomatology and performance on the IOT
symptomatology and the major IOT
variables. The mean number of
negative symptoms in the schizo-
phrenic sample was 2.88 (SD — 1.41)
and the mean number of positive
symptoms was 4.00 (SD - 1.12). No
relationship was found between
baseline performance and either
positive or negative symptoms.
Positive symptoms were, however,
related to all four distraction indices.
That is, the trend for positive
symptoms to be associated with the
two distraction condition indices was
appreciable and was just short of
being significant at the .05 level. The
correlations between positive
symptoms and the two distraction
difference scores were significant and
sizable. No relationship was found,
however, between positive symptoms
and performance on the Overload
Task. By contrast, negative
symptoms showed no relationship
with any of the indices tapping
distraction, but were significantly
correlated with the overload index
tapping recall of the background
material.4
Discussion
IOT: Validation and Group
Differences. The results of this study
indicate that the IOT is an effective
measure of the attentional dysfunc-
tions thought to be involved in the
schizophrenic process. Schizophrenic
patients were found to be deficient in
performing a very simple
auditory/visual attentional task,
especially when some type of
background distraction was present,
relative to both normal control
subjects and depressed patients.
Schizophrenic patients were also
significantly less able to recall the
content of the distracting background
material than were subjects in either
of the two comparison groups. Triese
findings are consistent with the
deficits on the IOT reported by
Cornblatt and Erlenmeyer-Kimling
(1984a) for children at risk for
schizophrenia compared to children
at risk for depression and to normal
control children.

Symptoms It is of interest that the group

comparisons presented here suggest
Performance
measures' Positive Negative * It could be argued that relationships
between positive and negative symptoms
Baseline (B) .15 -.18 and chronicity account for the pattern of
Distraction 1 (D1) -.33 -.03 results we found for the attention and
Distraction 2 (D2) -.38 -.19 information-processing measures. To
Dlff 1 (B-D1) .49* -.11 examine this possibility, the overload and
Dlff 2 (B-D2) .564 -.10 distraction difference scores were
Overload task (OT) -.17 -.584 correlated with duration of illness; the
resulting correlations were all nonsig-
nificant. Moreover, the three significant
1
Pearson product-moment correlation coefficients; significance levels are based on 1-talled relationships between symptoms and
tests of statistical significance. cognitive measures presented in table 3
1
The higher the score on B, D1, D2, and the overload task, the better the performance; were essentially unchanged when recal-
therefore a negative correlation with these Indices Indicates that the greater the culated as partial correlations controlling
symptomatology, the worse the performance. For the 2 difference scores (Dlff 1 and Dlff 2), for duration of illness, as follows: (1)
the higher the score, the greater the deterioration due to distraction; therefore, a positive negative symptoms/overload, r — — .63
correlation Indicates that the greater the symptomatology, the greater the distractibility. (p < .01); (2) positive symptoms/diff 1,
'p<.05. r — .40 (p < .08); (3) positive
symptoms/diff 2, r - .52 (p < .03).
'p< .01.
404
that schizophrenic and depressed
patients display comparable distract-
ibility. Schizophrenic patients were
significantly impaired in their
baseline performance and in
performance on the two distraction
conditions compared to both normal
controls and to depressed patients.
Depressed patients, in turn, did not
differ significantly from normal
controls in their baseline
performance—in fact, they were
slightly better—but their performance
on both distraction conditions was
significantly worse than that of the
normal controls.
Furthermore, as indicated by the
two distraction difference scores (Diff
1 and Diff 2), deterioration with the
onset of distraction is comparable for
the two patient groups. That is, the
performances of both schizophrenic
and depressed patients underwent a
significantly greater decline on both
distraction conditions relative to
baseline performance than was
displayed by normal control subjects,
and there was no difference in
deterioration between the two patient
groups for either distraction
condition.
These results, suggesting that some
degree of heightened distractibility is
characteristic of both depressed and
schizophrenic patients, are supported
by studies scattered throughout
research on mentally ill adults and
children at risk for adult psychosis.
Children at risk for depression have
frequently been reported to be inter-
mediate between children at risk for
schizophrenia and normal control
children in extent of attentional
impairment (Grunebaum et al. 1978;
Winters et al. 1981; Neale 1982;
Erlenmeyer-Kimling, Cornblatt, and
Golden 1983; Cornblatt and Erlen-
meyer-Kimling, in press). Similarly,
several studies of attention in adult
patients have shown deficits in both
unipolar and bipolar depressed
patients (Levy and Maxwell 1968;
Andreasen and Powers 1974;
Hemsley and Zawada 1976;
Oltmanns 1978; Bohannon and
Strauss 1983). Such findings suggest
that there may be some common
biochemical mechanism involved in
depression and in schizophrenia,
although this may be related
primarily to "state" factors in the
case of depression while being of
critical etiological significance in
schizophrenia.
By contrast with the distraction
effects, on which the depressed
patients and normal controls differed
significantly, the overload condition
showed no difference between these
subject groups. The overload task is
considered to represent the greatest
processing load, involving both the
ability to shift attention continually
between competing sources of
information and memory storage. It
is possible that a different mechanism
is responsible for this type of atten-
tional function, one which may be
more structural than biochemical and
which may be more clearly specific
to the schizophrenic process.
Positive and Negative Symptoms and
Attention in Schizophrenia. The
results of the symptomatology
analysis clearly support the
hypothesis of a relationship between
types of attentional processing and
"dimensions" of schizophrenic
symptomatology. As hypothesized,
positive symptoms appear to be
associated specifically with distract-
ibility, whereas negative symptoms
appear related only to more complex
cognitive deficits.
These findings are consistent with
previous reports indicating negative
but not positive symptoms to be
related to intellectual impairment
(Johnstone et al. 1978a; Owens and
Johnstone 1980; Andreasen and
Olsen 1982) and with the hypothe-
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sized association between
dopaminergic transmission, positive
symptomatology and attentional
disturbances discussed earlier. There
is some inconsistency in the finding
that negative symptoms are not
associated with objectively measured
attentional deficits, since attentional
impairment is considered to be a
major negative symptom by
Andreasen (1982) and by the
developers of the scale used in this
study (Dworkin and Lenzenweger
1984). This would suggest that the
attentional dysfunctions observa-
tionally defined in the clinical assess-
ments actually may be more of a
motivational problem than a
disturbance in the ability to attend to
information in the environment,
per se.
The results of the current study are
of particular significance, however,
in that the expected associations
between attentional deficits and
symptomatology hold when the two
symptom dimensions are examined in
the same patients rather than in
positive vs. negative "types" of
schizophrenic patients, as has been
the case in the few previous studies
investigating these relationships (Frith
1977; Allen 1982). The contrasting
patterns of attentional correlates
provide evidence in a nondinical
biobehavioral domain of the validity
of the distinction between positive
and negative symptoms in schizo-
phrenia.
The findings reported here can thus
be interpreted as strongly supporting
Crow's (1980) hypothesis that there
are two different disease processes
involved in schizophrenia—one
biochemical and the other structural.
Moreover, it is possible that the
biochemical disturbances leading to
positive schizophrenic symptoma-
tology may share common pathways
with other forms of mental illness,
such as schizoaffective disorders and
VOL. 11, NO. 3, 1985
possibly manic-depressive illness,
whereas the structural changes
leading to negative symptoms and
severe cognitive impairment may be
specifically schizophrenic.
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Acknowledgments
This research was supported by
grants MH-34206 to Dr. Cornblatt,
MH-30906-06 to the Psychiatric
Institute's Computer Center, and by
the Department of Mental Hygiene of
the State of New York. The authors
would like to thank Jerry Skillings,
M.A., for his careful rating of the
patient symptomatology. We also
gratefully acknowledge the assistance
of Barbara Maminski and Simone
Roberts in data preparation and
analysis.
Portions of the research reported
in this article were conducted by the
second author in ongoing research to
fulfill the requirements of the
doctoral degree at Yeshiva
University.
The Authors
Barbara A. Comblatt, Ph.D., is
Senior Research Scientist, Division of
Developmental Behavioral Studies,
Department of Medical Genetics,
New York State Psychiatric Institute,
and Associate Research Scientist,
Department of Psychiatry, College of
Physicians and Surgeons, Columbia
University, New York, NY. Mark F.
Lenzenweger, M.A., is Dissertation
Research Fellow, Division of
Developmental Behavioral Studies,
Department of Medical Genetics,
New York State Psychiatric Institute,
New York, NY. Robert H. Dworkin,
Ph.D., is Assistant Professor of
Clinical Psychology, Departments of
408
Anesthesiology and Psychiatry,
College of Physicians and Surgeons,
Columbia University, New York,
NY. L. Erlenmeyer-Kimling, Ph.D.,
is Director, Division of Develop-
Proposed Art
Competition
mental Behavioral Studies,
Department of Medical Genetics,
New York State Psychiatric Institute,
and Professor, Departments of
A group of psychologists at Connec-
ticut Valley Hospital have been
discussing the possibility of a state
and national art competition among
the hospitalized mentally ill—similar
in some respects to the High School
Arts Competition sponsored by the
Congressional Arts Caucus. In most
considerations, the mentally ill are
seen primarily as needy, and rarely
do we hear of positive contributions
that they may make. Nevertheless,
we feel that they have much to offer
in the area of artistic creativity that
is unique and of interest to others.
Since 1920 the art of the mentally
ill has been recognized in Europe as a
significant cultural phenomenon. A
museum associated with the
Heidelberg Psychiatric Clinic houses
a collection of art of the mentally ill
gathered by Dr. Hanz Prinzhorn. His
book (Artistry of the Mentally III,
Springer-Verlag, New York, 1972,
originally published in 1922) remains
an outstanding source volume. Some
of the work from this museum is
scheduled to travel to the U.S. in
1984, to be shown at the Krannert
Art Museum in Illinois and other
places. The Art Brut collection,
Chateau de Beaulieu, Lausanne,
Switzerland also contains the work
of psychiatric patients, as does a
collection of the Swiss Psychiatric
Society housed in the Waldau
Psychiatric Hospital, Bern,
Switzerland.
In this country there is a growing
interest in "outsider" art—the art of
self-taught artists, and of the
mentally handicapped who are
outside the mainstream of art. We
SCHIZOPHRENIA BULLETIN
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Psychiatry and Human Genetics,
College of Physicians and Surgeons,
Columbia University, New York,
NY.
would like to capitalize on this
interest and on the pioneering work
done in Europe by throwing national
attention on the art of our publicly
institutionalized psychiatric patients.
We believe this would enhance public
interest in the welfare of such
patients and add a needed positive
note to their image.
Our plans are rudimentary as yet,
and depend a good deal on response
of those who work with the
hospitalized mentally ill. In broad
outline, we would like to see each
state or regional group of states hold
an art contest for its publicly
hospitalized psychiatric patients, with
the best pieces going into a national
exhibition in Washington, D.C.
Schizophrenia Bulletin has for
many years shown the art of
psychiatric patients on its front
cover, so its readers are aware of this
potent source of expression for
patients. The undersigned would
welcome hearing from those in public
psychiatric hospital work across the
country who would like to
participate in this project. Please
write to let us know whether within
your hospital and within your state,
an "art of the mentally ill" contest
would be feasible. We will share our
thinking further with you and work
toward consensual, practical guide-
lines to ensure an interesting
successful, and repeatable effort.
Julius Laffal, Ph.D.
Director of Research and
Psychological Services
Connecticut Valley Hospital
Muidletown, CT 06457