Prefrontal Structural and Functional Deficits in Schizotypal Personality Disorder

Structural prefrontal deficits have been reported in patients with schizophrenia, but it is unclear if they are also found in patients with schizophrenia spectrum personality disorders. The hypothesis that a spectrum group will be characterized by prefrontal structural deficits was tested by assessing prefrontal gray and white volumes using magnetic resonance imaging in a community sample of 16 individuals with schizotypal/paranoid personality disorder, 27 comparisons, and 26 psychiatric controls. Frontal neurocognitive functioning was also assessed using the Wisconsin Card Sorting Test and the Continuous Performance Test. The spectrum group showed reduced prefrontal gray volumes and poorer frontal functioning compared to both other groups. Structural deficits were independent of functional deficits and together correctly classified 84.2 percent of subjects. Structural but not functional deficits were abolished after a strict control for antisocial personality was made. Results support the notion that frontal deficits may be centrally involved in the etiology of schizophrenia but also suggest that comorbid antisocial behavior may be one factor accounting for differences in prefrontal structural findings across studies.