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Trial-History Effects During WCST in Treatment-Resistant Schizophrenia
Ryo Sawagashira1,2, Atsuhito Toyomaki1, Hayato Watanabe3
1Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Neuropsychopharmacology Reports
|August 4, 2026
Summary
Treatment-resistant schizophrenia (TRS) patients showed altered response adjustment on the Wisconsin Card Sorting Test (WCST). Dynamic trial-level analysis, unlike conventional methods, suggested differences in how recent outcomes influenced behavior in TRS versus non-TRS individuals.
Area of Science:
- Neuroscience
- Cognitive Psychology
- Psychiatry
Background:
- Treatment-resistant schizophrenia (TRS) is a subtype of schizophrenia with poorly understood cognitive deficits.
- Executive dysfunction is common in schizophrenia, often assessed using the Wisconsin Card Sorting Test (WCST).
- Conventional WCST analyses may miss subtle cognitive adaptations based on recent performance.
Purpose of the Study:
- To investigate cognitive differences between TRS and non-TRS patients during the WCST.
- To determine if recent trial outcomes modulate subsequent responses differently in TRS patients.
- To explore the utility of trial-level analysis for characterizing cognitive heterogeneity in schizophrenia.
Main Methods:
- Analyzed WCST data from 41 schizophrenia outpatients (13 TRS, 28 non-TRS).
- Compared conventional indices (perseveration, reaction time adjustment) between groups.
- Employed trial-level linear mixed-effects models to analyze reaction time (RT) based on previous trial correctness and treatment resistance.
Main Results:
- No significant group differences were found using conventional WCST summary analyses.
- Trial-level analysis revealed that previous trial correctness significantly modulated subsequent RT.
- A trend indicated smaller RT adjustments to recent outcomes in TRS patients compared to non-TRS patients, though not statistically significant in sensitivity analyses.
Conclusions:
- Conventional WCST metrics do not differentiate TRS from non-TRS patients.
- Trial-level modeling suggests potential alterations in outcome-dependent response adjustment in TRS.
- Dynamic behavioral analysis may complement standard neuropsychological tests for schizophrenia, requiring larger validation studies.
