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March 1991

Impaired Wisconsin Card Sort Performance in Schizophrenia May Reflect Motivational Deficits-Reply

Arch Gen Psychiatry. 1991;48(3):283. doi:10.1001/archpsyc.1991.01810270095020

In Reply.—  Summerfelt et al found that monetary reward improved certain aspects of Wisconsin Card Sorting Test (WCST) performance in their sample of schizophrenic patients of unspecified inpatient/outpatient status. There are several conceptual and methodologic issues raised by their study that merit critical analysis. We hope that the complete database will be published so that this is possible. In the meantime, we address some of their key points.Summerfelt et al focused on the percentage of perseverative errors, a measure that indicates the frequency with which the same incorrect response is repeated. However, it is interesting that the number of categories did not improve, although thismeasure is usually positively correlated with correct responses and negatively correlated with perseverative errors. This result raises a question about what exactly was learned by their patients. On the face of it, in spite of the reinforcement, the patients did not learn the "essence" of this test,