Sustained attention deficits as markers of genetic susceptibility to schizophrenia

This article reviews recent evidence regarding the potential of the visual sustained attention deficits as measured by the Continuous Performance Test (CPT) as an endophenotype of the genetic susceptibility to schizophrenia. Findings in community subjects indicate that sustained attention develops during the primary school ages, reaches its maximum around early adolescence, and declines with age after adulthood. The assertion that CPT performance deficits, and especially on the more difficult versions, are reliable and valid genetic susceptibility indicators of schizophrenia is supported by the following results: 1) CPT deficits are present in schizophrenic patients, are particularly associated with negative and disorganized symptoms, and deficits on the more difficult CPT versions are not amenable to neuroleptic treatment; 2) subjects with schizotypal personality features also exhibit CPT deficits, which are specifically associated with the negative factor of schizotypy; 3) a substantial proportion of nonpsychotic relatives of schizophrenic patients (19-34%) have CPT deficits, which can also be predicted from their probands' CPT performance. Thus, using a CPT deficits as an endophenotype of schizophrenia would not only provide a valuable measure of genetic risk, but would also greatly enhance our understanding of etiology, and may help identify susceptibility genes for schizophrenia.