Handedness and schizophrenic symptoms.

Studies of the handedness of schizophrenics have produced conflicting results. One possible explanation for this is that, as schizophrenia presents in many different forms, certain symptoms of the illness may relate better than the diagnosis to laterality patterns. Some previous work supports this view. The symptoms of 232 schizophrenics were examined in relation to their handedness. Among males only the handedness patterns of those who showed expressive (formal) thought disorder differed from those of their non-thought-disordered peers, but proved to be very similar to those of normal controls. The distribution of handedness did not otherwise vary significantly with type of symptom. Thus it appears to be the schizophrenic syndrome, and not any individual symptom, that best correlates with the deviation from normal handedness patterns seen among schizophrenics.

Differences between two studies of hand preference in psychiatric patients.

Significant differences in handedness patterns between groups of psychiatric patients and normal controls were identified in two recent British studies, with substantial disagreement in some important findings. Most of the discrepancies were attributable to the different application of a simple classification of handedness data, and the remainder to differences in sample size. Diagnosis, sex and age were then found to have a similar effect on handedness in both studies. Neurotic patients were similar to controls regardless of classification, whereas mixed handedness in personality disorder depended on it. There was no overall excess of left-handedness among schizophrenics, but trends towards excess sinistrality in men and fully dextrality in women approached significance.

The lateralization of symptoms in schizophrenia.

An awareness of symptoms being lateralized was established in almost half of a series of 60 acutely ll schizophrenics and is reported in a further series of 16 patients with this disorder. Case illustrations are given. The symptoms most commonly showing this phenomenon were hypochondriacal delusions and hallucinations, usually of an auditory kind. Possible mechanisms underlying the phenomenon are discussed. Some evidence was found for a difference between the sexes in the direction of lateralization symptoms.

ECT for schizophrenia.

Electroconvulsive therapy (ECT) in the treatment of schizophrenia was evaluated in a double-blind trial; the clinical change after ECT was compared with that after a treatment procedure identical to it but for two exceptions--no electricity was used and no convulsion was induced. All patients had paranoid schizophrenia according to Present State Examination criteria and all received standard doses of neuroleptics for at least 2 weeks before random assignment to the two groups. 20 patients completed the trial: 10 had ECT and 10 were in the control group. Treatment was given three times a week, with a minimum of eight treatments and a maximum of twelve. Clinical change was assessed by the Comprehensive Psychiatric Rating Scale. Both groups improved but the improvement of patients receiving ECT was significantly greater than that of controls both after six treatments (p=0.02) and at the end of treatment (p=0.004). Thus the group receiving ECT gained a clear and early advantage compared with the control group, although by 16 weeks there was little difference between the two groups. Possible reasons for this are discussed.

Lateral response to suggestion in relation to handedness and the side of psychogenic symptoms.

A left-sided preponderance of psychogenic symptoms has often been reported. A Suggestion Test for the study of the laterality of psychogenic symptoms is described. Psychiatric patients and nurses received, on tape, the suggestion of a sensation in the hand to which they could give either right, left or bilateral responses. In both groups there was a majority of left-sided responses. Also, a history was obtained of previous psychogenic symptoms. These had occurred more on the left than on the right side of the body, and an association was found between left-sided symptoms and left-sided response to the test in individual patients. Left-sided symptoms were more prevalent among patients who were not strongly right-handed. These findings are considered in relation to ideas about the differential involvement of the cerebral hemispheres in the production of psychogenic symptoms.

Handedness in schizophrenia.

Handedness was assessed in 272 schizophrenics and compared with findings in normal controls. The schizophrenics differed significantly from the normal controls in their handedness patterns, having a higher proportion of fully right-handed subjects. Findings in brain-damaged and elderly schizophrenic patients are also reported. The lack of consistency of reporting of handedness in a schizophrenic populations in previous studies is discussed. While it is probable that differences in the methods of study of handedness account for some of the variance, differences in the type of schizophrenic illness seem likely to be of greater importance.

Lateral response to suggestion in relation to handedness.

Lateralization of response to the suggestion of a sensation was recorded in 100 psychiatric patients and related to their handedness. Responses showed no over-all preponderance to right or left side. There was, however, a significant association between side of response and handedness.

Diagnosis 'uncertain': a follow-up study.

During a ten year study, 10% of patients at a general hospital in-patient unit had unsolved diagnostic problems at the time of discharge from hospital. These 132 cases were designated 'uncertain' and were followed up. Eighty-three patients were ultimately diagnosed, and 300 consecutive in-patients discharged from the same unit with a definite diagnosis were also studied. The clinical features and diagnoses of the two groups were compared. Special features associated with uncertainty were: a presenting complaint of pain; apathy without apparent mental or physical cause; hallucinosis or major paranoid symptoms without other good evidence of psychosis. Age was found to be relevant; compared with patients receiving confident diagnoses, those with uncertain diagnosis due to depressive psychosis were more often younger, while those due to neurosis or personality disorder tended to be older. Atypical psychotic depression was the condition most commonly associated with diagnostic doubt.

Handedness in psychiatric patients.

Eight hundred psychiatric patients and eight hundred controls completed a handedness preference questionnaire. There was no significant difference in handedness between the two samples, but, contrary to some previous reports, excess of sinistrality was not associated with male sex. The distribution of handedness was similar in neurotics and controls, but among psychotics in general there was a higher proportion of fully right-handed subjects. Among schizophrenics there was a significantly higher proportion of left-handed writers among males than females. There were relatively few left-handed writers of either sex among patients with affective psychosis. Female patients with personality disorders had a significantly higher proportion of mixed handedness than controls. The findings are considered in relation to suggestions that functional psychoses may be associated with asymmetrical cerebral dysfunction, and that poorly lateralized function may be related to anomalous psychological development.

Investigation of cerebral dominance in 'left-handers' and 'right-handers' using unilateral electroconvulsive therapy.

Twenty-four patients receiving unilateral electroconvulsive therapy for depression were given the first treatment with electrodes on the left or right side of the head and the second treatment with electrodes on the opposite side. They were tested with the Word Associate Learning subtest of the Wechsler Memory Scale when fully responsive after the first ECT and after the same time interval following the second ECT. Twelve were left-handed and 12 were right-handed writers. In both groups, better scores were usually obtained after right-sided treatment. Redistribution of patients into sinistral, mixed, and dextral groups showed that this difference between the effects of left and right-sided ECT was significant only in dextrals. Only two right-handed writers had scores indicating right-sided dominance for speech; both were 'shifted sinistrals'. Left hemisphere dominance was indicated in 67% of all non-dextrals. Eight of nine patients in whom testing was repeated after a second pair of treatments on alternate sides obtained scores favouring the same side in both pairs of testing. Findings indicate the need for closer inquiry into handedness than is often made before unilateral ECT is prescribed. Further development of unilateral ECT for establishing cerebral dominance in individuals is supported by the results.

Presenile dementia: the difficulties of early diagnosis.

A follow-up of 35 patients first diagnosed as having presenile dementia at York Clinic is described. In only 15 cases did progressive deterioration confirm the diagnosis. A retrospective case note study of all the patients is described comparing the clinical features and results of special investigations of those patients in whom the diagnosis was confirmed in this way and those in whom it was not. The results of this study are used to illuminate some of the special difficulties in the early diagnosis of presenile dementia.

Unilateral electroconvulsive therapy and cerebral dominance: effect of right- and left-sided electrode placement on verbal memory.

Unilateral electroconvulsive therapy was given to 32 right-handed patients for relief of depression. Sixteen patients received electrode placement on the right side for the first treatment and on the left side for the second treatment. For the other 16 patients the order of sides was reversed. The word Associate Learning subtest of the Wechsler Memory Scale was administered about 20 minutes after each treatment (Wechsler, 1945). Results supported the hypothesis that performance on this test would be better when the electrodes were applied over the right than when they were applied over the right than when they were applied over the left cerebral hemisphere. It is suggested that investigation along these lines could assist in establishing the cerebral dominance of individual patients.