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Abstract
Schizophrenia patients’ perceptual organization abilities were assessed with a psychophysically well-controlled
measure of contour integration. Compared with psychiatric and staff controls, schizophrenia patients were less able
to detect contours comprising Gabor elements as the detection of these contours relied increasingly on long-range
spatial interactions. Impaired task performance was also found to correlate significantly with higher levels of
disorganized symptomatology. These data provide further evidence for impaired perceptual grouping in schizophrenia.
In addition, the findings support the hypothesis that a common cortical processing algorithm involving contextual
coordination is impaired in schizophrenia, leading to reduced binding of object features in vision, and reduced
contextual disambiguation of linguistic information during thought and speech. © 2000 Elsevier Science B.V. All
rights reserved.
Keywords: Context processing; Contour integration; Disorganization syndrome; Perceptual organization; Visual information
processing
0920-9964/00/$ - see front matter © 2000 Elsevier Science B.V. All rights reserved.
PII: S0 9 2 0 -9 9 6 4 ( 9 9 ) 0 0 18 0 - 2
12 S.M. Silverstein et al. / Schizophrenia Research 43 (2000) 11–20
regarding the ability of schizophrenia patients to A second goal of the study was to examine the
process configural stimuli made up of nonconti- relationship between perceptual organization abil-
guous elements (Cox and Leventhal, 1978; ity and the disorganization syndrome. In two
Rabinowicz et al., 1996; Silverstein et al., 1998b). previous studies, abnormalities in perceptual
While some studies of the latter issue suggest that organization in schizophrenia were associated with
patients are impaired in this function, there has greater disorganized (but not positive, negative, or
been no strong test of this hypothesis, as all past general ) symptoms ( Knight and Silverstein, 1998;
studies have had a number of methodological and Silverstein et al., 1998a). In a third study ( Knight
conceptual weaknesses. For example, in Cox and and Silverstein, 1998), abnormal perceptual organ-
Leventhal’s (1978) visual suffix study, ease of ization was related to increased disorganized and
grouping was manipulated across several condi- associative thought disturbance, but not combina-
tions, but only overall, between-group accuracy tory or idiosyncratic thought disturbance in schizo-
rates (collapsed across condition), and not diag- phrenia. These data support the hypothesis that
nostic group by condition interactions, were abnormal perceptual organization in schizophrenia
reported. Thus, no conclusions could be drawn is one manifestation of a larger disturbance in the
about differential responsivity of the diagnostic combining of context-related stimuli (Carr and
groups to the perceptual organization manipula- Wale, 1986; Silverstein and Schenkel, 1997). In
tions. Moreover, Silverstein et al. (1998b) found a this view, perceptual organization in vision is seen
normal between-condition performance pattern as a form of ‘object thinking’ (Glezer, 1995) involv-
among schizophrenia patients using the visual ing the binding of image elements into a context-
appropriate coherent whole, where the context can
suffix task. In Cox and Leventhal’s (1978) two
be seen as the other elements that combine to
other studies, perceptual grouping was required
make up the line, curve, or object (Lamme, 1995;
within the context of texture discrimination and
Kovács, 1996; Phillips and Singer, 1997). This is
numerosity tasks. These visual search tasks made
seen as analogous to the binding of words or
heavy demands on processes other than perceptual
concepts into coherent thought and linguistic struc-
organization, so although schizophrenia patients
tures, except that in these cases, the binding is
performed more poorly than controls, these data
based on context-appropriate meaning (Logan and
are not straightforward evidence of perceptual
Zbrodoff, 1999). Indeed, several investigators have
organization impairment. Similarly, Rabinowicz hypothesized that the formation of propositional
et al. (1996) reported that when the task was to visual representations (i.e., those that represent the
determine the shape implied by sparse dot patterns, spatial relationships between object components)
schizophrenia patients performed more poorly is necessary to process visual images, and that
than other groups. This finding, however, may these are structurally similar to the propositional
simply reflect a generalized performance deficit. representations underlying thought and language
Moreover, because schizophrenia patients (Chechile et al., 1996; Glezer, 1995; Logan and
improved at the same rate as controls as more Zbrodoff, 1999). Further evidence for a common
elements were added to displays, the authors noted mechanism underlying linguistic and visual repre-
that they were able to process stimulus form. In sentations comes from studies of individuals with
short, while studies of schizophrenia patients’ abil- parietal lobe damage, where deficits in both the
ity to perceptually organize configural arrange- ‘comprehension’ of spatial relations (i.e., percep-
ments of noncontiguous elements suggest that they tual organization) and the comprehension of logi-
are impaired in this function, strong evidence for cal relations are commonly observed (Glezer,
this is minimal. Therefore, one goal of this study 1995). There is now growing support for the
was to test this issue using a straightforward existence of common cortical processing algo-
but psychophysically well-controlled procedure rithms (Grossberg, 1999; Phillips and Singer,
wherein degree of perceptual grouping could be 1997), as well as evidence that contextual coordi-
formally specified, and where task performance nation operates across domains to implement pro-
was not confounded by other cognitive factors. cesses such as perceptual grouping in vision, lexical
S.M. Silverstein et al. / Schizophrenia Research 43 (2000) 11–20 13
disambiguation in language comprehension and included individuals with different diagnoses, pri-
speech production, and selective attention. All of marily schizoaffective disorder, bipolar disorder,
these functions are impaired in schizophrenia (Carr and personality disorder due to a general medical
and Wale, 1986; Silverstein et al., 1996a,b, 1998a; condition.
Cohen and Servan-Schreiber, 1992; Cohen et al., DSM-IV (American Psychiatric Association,
1999; Patterson et al., 1986). If, indeed, visual 1994) diagnoses of schizophrenia were confirmed
perception and thinking share some common at the time of the study by thorough chart reviews,
organizational principles, then a disruption in a consultations with the treating psychiatrist, and,
common cortical processing algorithm might lead where patient cooperation allowed, the Structured
to impairments involving lack of organization in Clinical Interview for DSM-IV Diagnosis —
both visual and conceptual processing, and these Patient Edition (SCID-I/P, Version 2.0; First et al.,
deficits could be expected to covary. 1995). SCID interviews were conducted by the
first author, who had previously established reli-
ability on SCID interviews with the Diagnostic
2. Method and Psychopathology Unit of the UCLA Clinical
Research Center for Schizophrenia and Psychiatric
2.1. Subjects Rehabilitation (mean kappa=0.82, mean sensitiv-
ity=0.77, mean specificity=0.88).
Three groups of subjects participated in the In order to test the hypothesis that abnormal
study: (1) 23 chronic schizophrenia patients from perceptual organization would be related to the
inpatient programs at a state psychiatric center [17 disorganization syndrome, individuals in the
men, 6 women; mean length of stay during the schizophrenia group were rated on two related
current admission of 97.52 months (SD=103.52)]; symptom dimensions using the Positive and
(2) 19 nonschizophrenia psychiatric controls, who Negative Syndrome Scale (PANSS; Kay et al.,
were also patients at the state hospital [12 men, 7 1987). One was the Cognitive component, which
women; mean length of stay during the current overlaps considerably with the concept of the
admission of 37.53 months (SD=53.78)]; and (3) disorganization syndrome (Liddle, 1987). This
17 staff controls (3 men, 14 women). Demographic factor, part of the five-factor solution of
data are listed in Table 1. The groups did not differ Lindenmayer et al. (1994), consists of the symp-
in age. There was a significant difference in educa- toms poor attention, mannerisms and posturing,
tion level, F(2,56)=14.29, p<0.0001, with the conceptual disorganization, difficulty in abstract
staff control group having a higher level than thinking, and disorientation. In addition to this
either of the patient groups. Potential subjects with component, we rated participants with schizo-
histories of vision disorders, closed head injury, phrenia on the item inappropriate affect (Cuesta
mental retardation, or neurologic syndromes (e.g., and Peralta, 1995) which allowed for a score on
epilepsy, cerebral palsy) were excluded from the the Disorganization factor, which includes the items
schizophrenia group. The nonschizophrenia group poor attention, conceptual disorganization, and
Table 1
Demographic and performance data
Schizophrenia (n=23) 0.84 (0.12) 6.06 (2.69) 44.00 (7.95) 10.81 (2.79) 55.77 (34.87) 55.00 (33.91)
Psychiatric control (n=19) 0.76 (0.07) 7.79 (1.32) 42.53 (17.16) 11.74 (1.88) 52.78 (23.40) 47.50 (22.57)
Staff control (n=17) 0.74 (0.07) 8.24 (1.39) 40.89 (10.72) 14.59 (2.27) 34.71 (13.52) 31.76 (9.18)
14 S.M. Silverstein et al. / Schizophrenia Research 43 (2000) 11–20
2.2. Stimuli
Fig. 2. Examples of Gabor-defined contours with different D values ( left: D=1.4, right: D=0.85.). In the bottom panels, Gabor
elements were replaced by disks. Without orientation cues, the contour remains invisible at D<1, and this is the range where
perceptual organization depends on long-range spatial interactions.
sentations of the same stimuli, indicating the con- mented as having normal or corrected-to-normal
tour integration effect is perceptual and not due vision.
to higher level cognitive factors.
2.4. Contour integration task
2.3. Acuity testing
After the visual acuity check, subjects completed
After signing an informed consent form, sub- the contour integration task. Cards were presented
jects were administered a standard visual acuity binocularly from a distance of 1 m on a flat table-
examination (Snellen chart), which involved exam- top. The subjects were allowed to scan the cards
ining acuity monocularly in each eye, and then for up to 30 s, until they were able to make a
binocularly. Four out of 59 subjects refused to decision about the location of the contour. The
complete the acuity testing due to delusional ide- contour was either positioned in the center, shifted
ation concerning bodily integrity changes that to the left, or shifted to the right within the
might occur if their eyes were covered. All of these rectangular arrays. The subject’s task was to iden-
subjects had had ophthalmologic examinations tify the contour by pointing to its location on the
within the past 2 years, however, and were docu- card, and then tracing the outline with their index
16 S.M. Silverstein et al. / Schizophrenia Research 43 (2000) 11–20
finger. Each correct localization and tracing was disorganization factors, [rs(21)=−0.47 and
considered one correct response, leading to a maxi- −0.48 respectively, p values <0.025], indicating
mum score of 10, or D value of 0.65. that schizophrenia patients who had poorer con-
tour integration abilities also had higher levels of
disorganized symptoms.
3. Results
4. Discussion
There was a significant main effect of group in
the contour integration task, F(2,56)=7.84, p= These data are further evidence for a perceptual
0.001. Post-hoc Scheffé tests indicated that the organization dysfunction in schizophrenia. More
schizophrenia group scored significantly lower specifically, they suggest that schizophrenia
than both the psychiatric control and staff control patients are impaired in their ability to detect
groups, who did not differ from each other. grouping among noncontiguous elements compris-
Because there was a significant difference in vari- ing a closed (i.e., circular) contour. The data are
ance between the groups, group means were also consistent with previous data in indicating that
compared using the nonparametric Kruskal–Wallis schizophrenia patients’ perceptual organization
test. This also revealed a significant group differ- abilities break down as the elements to be grouped
ence, x2(2)=10.18, p<0.01. become either less symmetrical or are spatially
There was also a significant main effect of group separated (Silverstein et al., 1998a,b). In general,
for visual acuity: left eye F(2,52)=4.50, p<0.025; these data have been interpreted as indicating
right eye F(2,52)=3.91, p<0.05. Post-hoc Scheffé reduced top-down influences to perceptual group-
tests indicated that while the staff group had ing in schizophrenia ( Knight and Silverstein, 1998;
superior visual acuity compared with the two Silverstein et al., 1996a,b, 1998b). In the present
patient groups, the two patient groups did not study, however, it is considered unlikely that top-
differ. Due to differences in variance, these means down factors could have played a role in the type
were also compared using Kruskal–Wallis tests, of contour integration under investigation.
which were also significant for both eyes: left Previous studies of grouping of Gabor elements
x2(2)=13.02, p<0.01; right x2(2)=9.55, p<0.01. into contours hypothesized that the grouping pro-
Correlations between contour task score and cess involved long-range spatial interactions
left eye and right eye visual acuity revealed trends between receptive fields ( Field et al., 1993).
towards significant relationships [r values (53) Therefore, our data indicate that bottom-up mech-
left=−0.24, p<0.09, right=−0.26, p<0.06 ]. anisms of perceptual grouping may also be
Contour task score correlated significantly with impaired in schizophrenia, and that this may reflect
education level [r(57)=0.38, p<0.005], which an abnormality in the formation of long-range
reflected the typical lower educational level among spatial interactions. It is also worth noting that
chronic schizophrenia subjects, who also per- the performance level of the chronic schizophrenia
formed more abnormally on the contour task. patients in this study is similar to that demon-
Contour task performance was not significantly strated by 5–6 year old children in past research
related to either age (r(57)=−0.20, p>0.13), or, ( Kovács et al., 1999). In those cases, performance
among patients, length of hospital stay (r(40)= level was attributed to late maturation of neural
−0.06, p>0.71). connections at a very early level in the ventral
As expected, due to symptom overlap, the stream of visual pathway. While this similarity
PANSS Cognitive and Disorganization factors may simply be a product of independent factors
were positively and significantly correlated in the leading to reduced scores in both children and
sample of schizophrenia patients, r(21)=0.84, disabled adults (e.g., Chapman and Chapman,
p<0.001. Score on the contour integration task 1973), it is also possible that a neurodevelopmental
correlated significantly with both the cognitive and abnormality exists in schizophrenia that is produc-
S.M. Silverstein et al. / Schizophrenia Research 43 (2000) 11–20 17
of reduced contextual coordination in this To provide further evidence for this model,
disorder. clearer a priori examples are needed, across
Data from this study support previous evidence multiple domains, of what is meant by disorganiza-
( Knight and Silverstein, 1998; Silverstein and tion. These domains can go beyond perception
Schenkel, 1997; Silverstein et al., 1998a) of rela- and thought, and include motor functioning as
tionships between abnormal perceptual organiza- well (Carr and Wale, 1986). Studies that examine
tion and other aspects of disorganization in the relationships between hypothesized aspects of
schizophrenia. This is now our fourth study to impaired contextual coordination across levels,
demonstrate this effect, with no negative findings and between these phenomena and presumed bio-
obtained to date. Such data support models logical underpinnings (e.g., NMDA receptor hypo-
wherein: (1) perceptual organization impairment function) have yet to be carried out. Also needed
is seen as one manifestation of a broader deficit in are experimental techniques that bridge multiple
the coordination of contextually related stimuli levels (e.g., behavioral, cognitive, biological ). The
(Carr and Wale, 1986; Silverstein and Palumbo, use of, or natural observation of the effects of,
1995; Silverstein and Schenkel, 1997); (2) percep- chemical agents that should theoretically increase
tual grouping is viewed as a concrete form of (e.g., glycine) or decrease (e.g., ketamine, PCP)
context processing (Grossberg et al., 1997; Phillips contextual coordination in clinical and nonclinical
and Singer, 1997); and (3) sentence comprehension populations, and observation of the covariance of
and the production of coherent verbal output are sequelae at multiple levels would assist in testing
viewed as examples of context processing in the the hypothesis of an impairment in a common
sense that early sentence components establish cortical processing algorithm in schizophrenia.
contextual constraints on the interpretation of later
sentence components (in comprehension) or on
the choice of words that are subsequently gener- Acknowledgements
ated to be spoken (Patterson et al., 1986). Other
data supporting this view come from studies dem- We thank the Scottish Rite Schizophrenia
onstrating relationships between context process- Research Program, NMJ, USA, and the
ing deficits and disorganized (but not positive, Committee to Aid Research to End Schizophrenia
negative, or general ) symptoms (Cohen et al., (CARES ) for their contributions to this research.
1999), and between context processing deficits and
formal thought disorder ( Kuperberg et al., 1997)
in schizophrenia. In those studies, the nature of
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