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

Background: In the 1940s and 1950s, prefrontal lobotomy was widely used to treat aggressive, disruptive and psychotic behavior in schizophrenics. Subs equent observations have confirmed its ineffectiveness in schizophrenia. Fe w studies have addressed its long-term consequences. Methods: We conducted tests of frontal function: behavior (Frontal Behavioral Inventory). psychop athology (PANSS), neurological examinations and CT scans in 19 chronically institutionalized schizophrenic patients (mean age 74) who had undergone or bitofrontal leukotomy between 1948 and 1972 and 11 controls (mean age 74) m atched for age, length of hospitalization, education, and diagnosis. Result s: 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 seq uences, verbal fluency, imitation behavior? motor impersistence, primitive reflexes, or psychopathology. Significant differences were found on clock d rawing and on the go/no-go test, which may reflect the presence of an orbit ofrontal lesion in the leukotomized group. There was a tendency for the leu kotomized group to have fewer indices of frontal behavioral dysfunction. Bo th groups showed comparable impairment on the Stroop test and cognitive rig idity on the Odd Man Out test of category shifting. Conclusions: With few e xceptions, elderly leukotomized and nonleukotomized schizophrenic patients show varying degrees of distractibility, difficulty in set shifting, poor p lanning and organization, susceptibility to interference, primitive reflexe s and signs of global cognitive impairment. Allowing for the small sample s ize, variability in the surgical frontal lesion, and the long interval from surgery to testing, these observations likely reflect the long-term conseq uences of severe schizophrenia in both groups. (C) 2000 Elsevier Science B. V. All rights reserved.