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Green et al present a useful extension and refinement of our study. They showed that a subgroup of patients with schizophrenia could benefit from instruction and maintain improvment on the Wisconsin Card Sorting Test through the use of reward. We noted in our own study that "If teaching were more intensive, included more significant rewards, and was very frequent, it is possible that some patients could eventually master the task." The findings of Green et al support this view. It is interesting to note that despite the instruction and reward, half of the patients still could not improve their performance!While we recognize that the study by Green et al is in a preliminary stage, it might gain more power if a number of issues were addressed. First, it appears to us that the initial performance of the group that benefited from reinforcement was considerably better than that
Goldberg T, Berman K, Weinberger D. Teaching the Wisconsin Card Sorting Test to Schizophrenic Patients-Reply. Arch Gen Psychiatry. 1990;47(1):92. doi:10.1001/archpsyc.1990.01810130094017
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