Visual scanning deficits in schizophrenia and their relationship to executive functioning impairment

Abnormal visual scanning of faces, objects, and line drawings has been observed in patients with schizophrenia and is thought to reflect neurocognitive impairment. In this study, a simultaneous measurement approach was used to assess whether schizophrenia patients demonstrate restricted visual scanning when confronted with a complex problem-solving stimulus, and whether visual scanning deficits are predictive of inflexible thinking. Thirty-eight schizophrenia patients and 30 comparison participants were presented with Rorschach inkblots while eye movements were monitored and verbal responses to the stimuli were recorded and scored for inflexible thinking using the Rorschach Repetition and Perseveration Scale. Schizophrenia patients demonstrated fewer and longer visual fixations and shorter total scanpath relative to comparison participants but did not differ on mean scanpath length. Among patients, fewer fixations were associated with a higher frequency of verbal perseverations. Correlations between scanning measures and symptoms showed that negative symptoms were related to a minimal scanning or "staring" approach. Results support previous findings of restricted visual scanning in schizophrenia patients, are consistent with previously observed relationships between visual scanning and symptom profiles, and suggest that visual organizational deficits during complex problem-solving tasks may be related to cognitive inflexibility and frontal-executive dysfunction.