Neuropsychiatry
Συγγραφέας Ορέστης Γιωτάκος Γράφτηκε στις ,
Crossed Hand-Eye Dominance In Male Psychiatric Patients
Key words: Crossed-dominance, Laterality, schizophrenia, mental disorders
Introduction. Many authors have pointed out abnormal motor asymmetry in neurological and psychiatric diseases. The research revealed increase in mixed-handedness (Cannon, Byrne, Cassidy, Larkin, Horgan, Sheppard & O’Callaghan, 1995, Hayden, Kern, Burdick & Green, 1997), and lack of agreement between hand, eye, and foot preferences (Piran, Bigler & Cohen, 1988) among schizophrenics. The functional significance of hand-eye crossed dominance causes is not well understood. Some studies have shown that crossed dominance may be indicative of a poorly established hemispheric specialization (Bryden, 1982) and of developmental brain impairment in various neuropsychiatric diseases (Corbalis, 1983). An excess of crossed hand-eye dominance has been reported in schizophrenics (Oddy & Lobstein, 1972, Krynicki & Nahas, 1979, Shan-Ming, Deyi, Zhen, Jingsu, Taylor, 1985). Merrin (1984) has reported that left-eyedness, particularly in right-handed paranoid schizophrenics, is associated with later age of first hospitalization and more benign course, whereas Gureje (1988) found that it is more prevalent in non-paranoid patient with younger age of onset and earlier age of first hospitalization. Recently, Tabaris, Sanjuan, Gomez-Beneyto & Leal (1999), found that the crossed hand-eye dominant group of schizophrenics had a significant earlier clinical onset and smaller brain size, global and frontal area, than the consistent hand-eye dominance group. Little is known about the factors involved in eye preference. Evidence for an effect of parental pattern on offspring eye dominance is controversial (Brackenridge, 1982, Coren & Porac, 1980), but it is generally accepted that eye dominance is associated with handedness. According to the meta-analysis of Bourassa, McManus & Bryden (1996), in a population with 9.25% left-handedness and 36.53% left-eyedness, 34.43% of right-handers and 57.14% of left-handers are left-eyed. Piran, Bigler & Cohen (1982), suggested that the excess of left-eye dominance they found in schizophrenics could be considered as left-hemispheric dysfunction of this disorder. The aim of this study is to investigate whether psychiatric patients of different diagnostic categories show increased incidence of left-eye dominance, as well as crossed hand-eye dominance, as compared with controls.
Methods. All patients (n=252) were male conscripts, drawn from the psychiatric department of the Tripolis Army Hospital, and admitted consecutively during the first eight months of the year 2000.They had all signed informed consent and were interviewed with the Structured Clinical Interview (SCID) for the DSM-III-R, Axis I and II (Spitzer, Williams, Gibbon & First, 1990). The investigation included, 68 patients with schizophrenia (mean age: 22.4, SD:3.3), 62 patients with panic disorder (mean age: 23.7, SD:4), 35 patients with borderline personality disorder (mean age: 23.5, SD:3), 54 patients with heroin addiction (mean age: 21, SD:1.5) and 33 patients with mental retardation (mean age:19.8, SD:1.0) on whom full handedness and eyedness data were available. All schizophrenic patients were under antipsychotic therapy, 13 (21%) and 18 (29%) of the patients with panic disorder had a comorbidity with depression or agoraphobia respectively, and 41 (76%) of the patients with heroin addiction also had multiple drug use. Mental retardation patients had an IQ range from 51 to 65, according to their psychiatric reports and histories, none of which being a case of known chromosomal anomaly, like Down syndrome. Nine hundred forty-four individuals consented to participate as a control group. They were male recruits and they were screened for mental and somatic diseases and anyone of them with symptoms were excluded before any survey began. Both patients and controls were matched for age and socio-economic status. All patients and controls were administered the Annett Hand Preference Questionnaire (Annett, 1985), which assesses hand preference according to the stated and demonstrated preference for 12 discrete actions: six primary actions (writing, throwing a ball, hammering a nail, teeth brushing, striking a match, holding a racquet) and six secondary actions (sweeping, shoveling, unscrewing a jar lid, dealing cards, threading a needle, holding scissors). Subjects stated and demonstrated “right”, “left”, or “either” to each action. Based on his response pattern, the subject was assigned to one of eight classes (Annett, 1970, 1985). In order to extract results with a maximum clarity, only pure right- and pure left-handers (i.e. all actions with right or left hand respectively – 1st and 8th classes), were used in this study. Eye preference was assessed by sighting through a telescope. Results were analyzed with Mantel-Haenszel odds ratio and 2X2 chi-squared analysis using Fisher’s two-tailed probability tests, using the Statistical Package for the Social Science (SPSS) for Windows.
Results. The whole group of psychiatric patients, showed a significant excess of left-eye dominance (69 persons, [27.3%]), in comparison to the control group (129 persons, [13.7%]) (p=0.000, Odds ratio:2.36, CI 95%: 1.7-3.3). Especially, the left-eye dominance in patients with schizophrenia was 30.4% (21 persons), with panic disorder 19.4% (12 persons), with borderline personality disorder 25.7% (9 persons), with heroin addiction 25.9% (14 persons), and with mental retardation 39.4% (13 persons). Furthermore, psychiatric patients showed a significant excess of crossed hand-eye dominance (33 persons, [13.1%]), in comparison to the control group (46 persons, [4.9%]). Particularly, they showed a non-significant excess of crossed left-hand and right eye dominance (p=0.09), but a highly significant excess of crossed right-hand and left eye dominance, in comparison to the controls (p=0.000, Odds ratio: 2.9, CI95%: 1.7-4,8). Patients with schizophrenia, heroin addiction, and mental retardation showed a significant excess (8 persons, [11.8%], 10 persons, [18.5%], and 5 persons, [15.2%], respectively) of crossed hand-eye dominance, in comparison to the controls (46 persons, [4,9%]), ([p=0.02, Odds ratio: 2.6, CI:1.2-5.7], [p=0.00, Odds ratio:4.4, CI: 2.1-9.4], and [p=0.02, Odds ratio: 3.5, CI:1.3-9.4], respectively). Patient with panic disorder showed a slightly significant excess (7 persons, [11.3%]) of crossed hand-eye dominance (p=0.04, Odds ratio: 2.5, CI: 1.0-5.7), and patients with borderline personality disorder showed a non-significant excess (3 persons, [8.6%]) of crossed hand-eye dominance in comparison to the controls (p=0.4).
Discussion. The main limitations of this study is the small sample and the lack of a female comparison group. The present findings of highly significant increase of left-eye preference in schizophrenics confirm with findings in previous studies (Piran, Bigler, & Cohen, 1982, Krynicki & Nahas, 1979). All findings have been considered as evidence of left-hemispheric dysfunction in schizophrenics. A similar dysfunction has been contributed to mentally retarded populations (Metzig, Rosenberg & Ast,1975), and in fact, the mentally retarded sample of the present study also showed a highly excess of left-eye preference. The smaller but significant increase rate of left-eye preference in patients with panic disorder, borderline personality disorder, and heroin addiction, may indicate also a left-hemispheric dysfunction in these diagnostic categories. It should be noted that, recent studies and reviews on brain asymmetry give little information about eye dominance (Dellatolas, Curt, Dargent-Pare & Agostini, 1998), and that the method of assesment of eyedness is crucial for the detection of subjects without clearly defined sighting dominance (Bourassa, McManus & Bryden, 1996). Findings with significant excess of crossed hand-eye dominance in the present sample with schizophrenics confirm with previous findings in schizophrenics with either earlier (Tabaris, Sanjuan, Gomez-Beneyto & Leal, 1999) or later clinical onset, or even with different subtypes of the disorder (Merrin, 1984, Gureje, 1981). The findings with strong significant increase of crossed hand-eye dominance in the patients with heroin addiction, and mental retardation of the present study also confirm with previous findings in patients with dyslexia, autism, mental retardation, and other neuropsychiatric diseases, which showed crossed dominance and cerebral asymmetry (Metzig, Rosenberg & Ast, 1975, McManus, Murray, Doyle, Baron-Cohen, 1992). These findings suggest that this type of abnormality do not seem to be specific or specially predispose to schizophrenia. Finally, the greater cross dominance of schizophrenic and mentally retarded patients, in relation to the other diagnostic groups of this study, may suggest a greater cerebral asymmetry of patients with psychotic and organic disorders, than with neurotic disorders. It is important that these suggestions are in accordance with previous analysis of this sample (Giotakos, in press) where it was found that the “organic” and the “psychotic” part of psychopathology spectrum tended to show an excess of mixed-handedness, whereas the “neurotic” part tended to show a normal- or non-mixed-handedness.
Summary. Increased incidence of left-eye and crossed hand-eye dominance have been considered as left hemispheric dysfunction in many neuropsychiatric disorders. The aim of this study was to investigate the incidence of left-eye and cross hand-eye dominance in patients with schizophrenia (n=68), panic disorder (n=62), borderline personality disorder (n=35), heroin addictive (n=54), and mental retardation (n=33), in comparison with controls (n=944). All psychiatric groups showed a significant excess of left-eye dominance. Furthermore, patients with schizophrenia, heroin addiction, and mental retardation showed a highly significant excess of crossed hand-eye dominance, whereas patients with personality disorder and panic disorder showed only a merely excess of hand-eye dominance. These findings confirm with previous findings in these disorders, and indicate that the “organic” and the “psychotic” part of the present psychopathology spectrum tends to show a poorer established hemishperic specialization, in relation to the “neurotic” part.
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