Remediation of Wisconsin Card Sorting Test performance in schizophrenia. A controlled study

Previous studies have shown encouraging plasticity in some schizophrenic patients' Wisconsin Card Sorting Test (WCST) performance while receiving detailed specific instructions on task and reinforcement. The present study examines the efficacy of a modified procedure for WCST administration that bound schizophrenic patients to use a conceptually driven cognitive strategy without instruction or reinforcement. The schizophrenics' results were also compared to those obtained with the same procedure from a matched control sample. By using this procedure, 63.2% of WCST schizophrenic poor performers dramatically improved their results. Schizophrenic poor performers who did not achieve remediation were of a younger age at onset and had more negative symptoms. This pattern was strictly associated with more perseverative errors on WCST that increased even more when the conceptually driven processing was forced. Our findings could have important implications for our understanding of the underlying cognitive deficit of the poor neuropsychological performance and allow the distinction of schizophrenic subtypes who show peculiar features that probably reflect a different pathophysiology and would potentially benefit from different modalities of treatment and rehabilitation.