Academic journal article Indian Journal of Psychiatry

Wisconsin Card Sorting Test Performance Impairment in Schizophrenia: An Indian Study Report

Academic journal article Indian Journal of Psychiatry

Wisconsin Card Sorting Test Performance Impairment in Schizophrenia: An Indian Study Report

Article excerpt

Byline: Shailja. Singh, Tapas. Aich, Raju. Bhattarai

Aim: The present study attempted to find out the relationship between positive and negative clinical symptoms and Wisconsin Card Sorting Test (WCST) performance in a group of schizophrenia patients. Methodology: Fifty schizophrenia patients were assessed using the Positive and Negative Syndrome Scale (PANSS) by a trained psychiatrist (TKA) and two groups, each of 25 positive symptom and 25 negative symptom schizophrenia patients were formed. On these fifty patients with schizophrenia and 15 normal control groups, WCST measures were applied by a clinical psychologist (SS) who remained blind to the PANSS score. Results: Schizophrenia diagnosis significantly affects WCST performances. One-way analysis of variance (ANOVA) revealed schizophrenia patients showed a significant impairment on all WCST indices compared with normal subjects except versus total number of correct responses. Post hoc comparison (Tukey HSD Test) between means revealed that negative schizophrenia patients showed significantly worse performance on most WCST performance parameters: percent errors, perseverative responses, percent perseverative responses, perseverative errors, percent perseverative errors, and conceptual level responses. Conclusions: Both positive and negative symptom schizophrenia patients have some distinct WCST measures deficits.


Cognitive impairment in schizophrenia has been reported across all cognitive domains.[sup][1],[2],[3] Three core cognitive functions commonly attracted a great deal of interest and appeared to have neurobiological significance for understanding of schizophrenia: attention, memory, and executive functions.[sup][1],[4],[5] Neuropsychological studies or cognitive tests' performances measuring primary frontal cortex functions are Wisconsin Card Sorting Test (WCST), Continuous Performance Test (CPT), trail making test and measures of verbal fluency, Tower of Hanoi test besides others described in literature.[sup][4],[6],[7]

WCST is the commonly and widely used neuropsychological test measures of executive function in terms of concept formation, planning and cognitive flexibility, visual spatial working memory, deductive reasoning, problem solving, and set shifting ability.[sup][8],[9],[10] Although schizophrenia patients have consistently been shown to perform worse than normal controls on the WCST, research relating WCST performance to symptom dimensions has produced inconsistent results.[sup][11] Many authors reported predominantly negative symptoms are related to poor performance.[sup][12],[13],[14] The relation of WCST performance to positive symptomatology is less clear, with inconsistent findings varying from better to worse performance on the WCST.[sup][15],[16]

Studies on WCST in schizophrenia patient population are rare from India. Hence, we tried to investigate this relationship between the WCST performance and schizophrenic illness with a specific emphasis on the positive and negative dichotomy.


The study was conducted at the Central Institute of Psychiatry, Kanke, Ranchi, in the state of Jharkhand, India. Study sampling was purposive, comprised fifty schizophrenia patients, diagnosed according to the International Classification of Diseases, Tenth Edition (ICD-10), and fulfilling our inclusion and exclusion criteria. Inclusion criteria were male schizophrenia inpatients in the age group of 18–45 years and having a minimum education up to 8[sup]th standard. Exclusion criteria were evidence of organicity either from history or clinical examination, any comorbid major psychiatric disorder or mental retardation, any history of alcohol or drug dependence, being treated with electroconvulsive therapy in the preceding 12 months, and patients who did not give consent to participate in the study.

Fifteen age- and education-matched subjects, who were unrelated to the patients and did not have any history of substance abuse or mental illness, were taken up as control for the present study. …

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