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Gestalt Perception in Schizophrenia Spectrum Disorders Gestalt Perception in Schizophrenia Spectrum Disorders Peter J. Uhlhaas Submitted for the Degree of Doctor of Philosophy, Department of Psychology, University of Stirling Stirling, April 2003 ProQuest Number: 13916330 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13916330 Published by ProQuest LLC(2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 ABSTRACT The research examined the hypothesis that schizophrenia spectrum disorders are characterized by impairments in Gestalt perception. Participants with elevated levels of schizotypy, acute and chronic schizophrenia patients, and non-schizophrenia psychotic disorders were assessed on three measures of Gestalt perception. The hypothesis was that schizophrenia spectrum disorders are characterized by reduced responsiveness to Gestalt properties of visual stimuli. A pattern of performance on experimental tasks was predicted that would produce both impaired and enhanced task performance in schizophrenia spectrum disorders on measures of Gestalt perception. Impairments in Gestalt perception were hypothesized to correlate with symptoms of the disorganisation syndrome and with a specific aspect of social cognition, Theory of Mind (ToM), in schizophrenia spectrum disorders. The results of the research confirmed the main hypotheses. Schizophrenia spectrum disorders displayed in all studies reduced responsiveness to Gestalt properties of stimuli. Dysfunctional Gestalt perception emerged not as general feature of schizophrenia spectrums disorders, however. Cognitive deficits were specifically related to the disorganisation syndrome and statistical comparisons between participants with elevated and reduced levels of thought disorder found that dysfunctional Gestalt perception was only present in thought disordered participants with schizophrenia spectrum disorders. Dysfunctional Gestalt perception resulted consistently in both impaired and enhanced task performance in disorganised forms of schizophrenia spectrum disorders. It is concluded that the experimental results reflect a specific deficit I in the perceptual organisation of stimuli based on context. Furthermore, the hypothesis was confirmed that dysfunctional Gestalt perception is correlated with impaired ToM in chronic and acute schizophrenia. The findings of the research are discussed from the perspective of recent models of cognition in schizophrenia spectrum disorders where impaired Gestalt perception is viewed as the result of a comprehensive impairment in the cognitive coordination of neural and cognitive activity. It is proposed that dysfunctional Gestalt perception may be related to a specific subtype of schizophrenia, neurodevelopmental schizophrenia, which is characterised by poor premorbid functioning, disorganised symptoms, and poor outcome. Further issues for research are discussed. II ACKNOWLEDGMENTS I am indebted to the many people who supported and encouraged me to carry out the research presented in this thesis. Firstly, I would like to thank Professor Bill Phillips, Department of Psychology, University of Stirling, for his enthusiasm and inspiration for encouraging me to pursue this work which may turn into a career. Although skeptical at first, I became an enthusiastic student of his ways of bridging mind and brain. Professor Steven Silverstein, New York Presbyterian Hospital, Weill Medical College of Cornell University, became a second supervisor during the course of the research, starting with emails which were answered faster than they were sent. He made it possible for me to work at New York Presbyterian where a large part of the research contained in this thesis was carried out. His deep understanding of schizophrenia allowed me to develop a keen interest in this puzzling mystery of the human mind. It is a credit to both Professor Bill Phillips and Professor Steven Silverstein that my experience of conducting the research presented in this thesis was very enriching in many ways. The Carnegie Trust for the Universities of Scotland provided me with a generous scholarship to carry out this research. I am greatly indebted to the Trust, especially as a ‘continental European’, who studied psychology in Scotland. Gordon Mitchell, Clinical Psychologist, Stratheden Hospital, Fife NHS Trust, was also a great help in this research through giving me access to his patients at Stratheden Hospital. Many thanks to Dr. Jurgen Beyer for his help in spotting many hidden and obvious mistakes in the manuscript. Ill A special thanks goes to all the patients who participated in this research. They had to endure many hours of testing which involved looking at little dots and circles. It is hoped that this research will contribute a little to the enduring mistery of this disorder. I also would like to acknowledge the generous help and support of my parents throughout the years and during the writing of the thesis. 1. INTRODUCTION 1 1.1 The Concept of Schizophrenia ...............................................................................1 1.1.1 Historical Perspectives ....................................................................................... 1 1.1.2 Dementia Praecox (E. Kraepelin) ..................................................................... 2 1.1.3 Dementia Praecox or the Group of Schizophrenias (E. Bleuler) .....................4 1.1.4 First Rank Symptoms (K. Schneider) ............................................................... 7 1.1.5 The Concept of Schizophrenia: Current Perspectives ......................................9 1.2 Syndromes of Schizophrenia...................................................................................12 1.2.1 Classical Subtypes of Schizophrenia (E. Kraepelin & E. Bleuler) ................ 12 1.2.2 Positive vs. Negative Symptoms ......................................................................15 1.2.3. Factorial Models of Schizophrenic Symptoms ............................................ 16 1.3 Gestalt Perception in Schizophrenia Spectrum Disorders................................ 27 1.3.1 Gestalt Perception: Cognition and Neurophysiology .....................................28 1.3.2 Findings of Experimental Psychopathology in Schizophrenia ......................32 1.3.3 Findings of Experimental Psychopathology in Schizophrenia Spectrum Disorders ........................................................................................................... 41 1.4 Theories of Cognitive Dysfunctions in Schizophrenia Spectrum Disorders.................................................................................................................. 44 1.4.1 Models of Attentional Dysfunctions in Schizophrenia Spectrum Disorders ........................................................................................................... 44 1.4.2 Models of Context-Processing in Schizophrenia Spectrum Disorders ...........................................................................................................47 1.4.2.1 ‘Weakening of the Influence of Stored Memories or Regularities Previous Input on Current Perception’ (Hemsely & Gray) ..................................................................................47 1.4.2.2 ‘Dysfunction in the Representation and Maintenance of Context’ (Cohen & Servan-Schreiber) ................................................................. 49 1.4.2.3 ‘Dysfunctional Cognitive Coordination’ (Phillips & Silverstein) 51 1.4.3 Cognitive Dysfunction and Abnormal Lateralization in Schizophrenia Spectrum Disorders ......................................................................................... 53 1.5 Critical Issues in Research on Gestalt Perception and Theories of Cognitive Dysfunction in Schizophrenia Spectrum Disorders........................................... 57 1.5.1 General Performance Deficiencies in Schizophrenia Spectrum Disorders...57 1.5.2 Heterogeneity in Schizophrenia Spectrum Disorders .................................... 60 1.5.3 Construct Validity of Experimental Tasks ......................................................61 2. METHOD ,63 2.1 Overview of Studies .................................................................................................. 63 2.2 Ethical Considerations..............................................................................................63 2.3 Participants................................................................................................................63 2.4 Assessment of Psychopathology............................................................................. 66 2.4.1 Psychotic Disorders ...........................................................................................67 2.4.2 Schizotypy ......................................................................................................... 68 2.5 Measures.................................................................................................................... 69 2.5.1 Verbal Intelligence ............................................................................................69
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