Leukotomy revisited: Late cognitive and behavioral effects in chronic institutionalized schizophrenics

Deborah N. Black, Emmanuel Stip, Marc André Bádard, Isabelle Paquette, Marie Josée Bigras, Michel Kabay

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

Abstract

Background: In the 1940s and 1950s, prefrontal lobotomy was widely used to treat aggressive, disruptive and psychotic behavior in schizophrenics. Subsequent observations have confirmed its ineffectiveness in schizophrenia. Few studies have addressed its long-term consequences. Methods: We conducted tests of frontal function, behavior (Frontal Behavioral Inventory), psychopathology (PANSS), neurological examinations and CT scans in 19 chronically institutionalized schizophrenic patients (mean age 74) who had undergone orbitofrontal leukotomy between 1948 and 1972 and 11 controls (mean age 74) matched for age, length of hospitalization, education, and diagnosis. Results: There were no significant differences between leukotomized patients and controls on: Folstein Mini-Mental score (leuko 22.13 ± 5.66; controls 23.55 ± 5.93), utilization behavior, Luria alternating written and motor sequences, verbal fluency, imitation behavior, motor impersistence, primitive reflexes, or psychopathology. Significant differences were found on clock drawing and on the go/no-go test, which may reflect the presence of an orbitofrontal lesion in the leukotomized group. There was a tendency for the leukotomized group to have fewer indices of frontal behavioral dysfunction. Both groups showed comparable impairment on the Stroop test and cognitive rigidity on the Odd Man Out test of category shifting. Conclusions: With few exceptions, elderly leukotomized and nonleukotomized schizo-phrenic patients show varying degrees of distractibility, difficulty in set shifting, poor planning and organization, susceptibility to interference, primitive reflexes and signs of global cognitive impairment. Allowing for the small sample size, variability in the surgical frontal lesion, and the long interval from surgery to testing, these observations likely reflect the long-term consequences of severe schizophrenia in both groups.

Original languageEnglish
Pages (from-to)57-64
Number of pages8
JournalSchizophrenia Research
Volume43
Issue number1
DOIs
Publication statusPublished - 2000
Externally publishedYes

Keywords

  • Chronic
  • Cognition
  • Dementia
  • Evolution
  • Executive functions
  • Frontal
  • Geriatric
  • Leukotomy
  • Lobotomy
  • Long-term
  • Natural history
  • Psychosurgery
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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