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Pattern Recognition in Mental Disorders and the Organic Integrity Tests (OIT)
Pattern Recognition in Mental Disorders and the Organic Integrity Tests (OIT) H. C.
TIE~,
• The concept of mental illness itself as disease has now heen challengeu. Discussion of the causes of mental disoruers often leads to controversies. Organic anu psychological theories are ahundant, hut consistent, objective, and quantifiable data are constantly neeued to understand mental illnesses as such. The author' has, therefore, designed the Organic Integrity Test (OIT) as a quick and efficient diagnostic aid to assess central nervous system deficit, as a loss of pattern recognition due to any brain disease. Astrom~ and Engelsmann & Drdkova" confirmed the validity and reliahility of the OIT as a useful diagnostic test of organicity in Sweden and Czechoslovakia, respectively. The OIT has heen successfully applied as a routine neuropsychiatric screening test in industry at General Motors:"'~ And the OIT proved to be equally valid and reliable in testing children.'" The OIT is based on the principle of mostsimilarity. The author l " I " has further developed this concept into a general mathematical model of pattern recognition: the theory of pattern recognition by identity, or the PRI theory. Mathematically,
If PRI(f,g)-I, then f-g. This is the principle of most-similarity, which simply means that the brain as a pattern recognition system identifies the incoming signal of an unknown pattern f hy cross-correlation pattern comparison with the mostsimilar pattern g, stored in the memory. Clearly, to achieve pattern recognition, the brain must have both an intact system fllnction and sufficient stored information.
M.S.E.E., M.D.
Indeed, the PHI theory separates all mental disorders conceptually into two basic categories: (1) system function disorders and (2) information disorders. System function disorders include organic hrain syndrome, mental deficiency, organic psychoses and schizophrenias. On the other hand, information disorders include personality disorders, psychoneuroses, and psychophysiological reactions. System function is hereby defined to mean the input-output relationship, dependcnt upon the integrity of the neural elements and their interconnections, hence the organic integrity of the pattern recognition systt·m. Here, information is the measure of the cross-correlation of input patterns and memory patterns to determine output and behavior, and not in the sense of Shannon. 7 Obviously, feedhack loops exist hetween information and system function processes, thus complicating diagnostic analysis in our clinical work, especially in schizophrenias, where the possible system function disorder I may cause information disorder, and vice versa, in vicious looping. However, if a test can be constructed to hold the information variable constant, the system function can he measured objectively and quantitatively for comparative studies in mental disorders. The OIT was constructed for this purpose: i.e., hold information constant in order to measure the integrity of system function of the brain. The author' postulated that the basic function of the brain is pattern recognition, and the loss of pattern recognition due to any brain disorder may be disclosed as chromaphilia on the 01T. ORGAl"IC I:"TEGRITY TESTO
The OIT Instrument. The OIT was deData mllcction was done with the help of the nursing staff at the Neuro-psychiatric unit of 51. Lawrence Hospital, and data processing at the Computer Center, \Ikhigan State University, East Lansing, Michigan. January-February 1969
o The OIT Test cards and manllal art' now available from Psychodiagnostic Test Company, Box 528, East Lansing, \Ikhigan 48823.
29
PSYCHOSmlATICS
WHICH TWO PICTURES ARE MOST ALIKE?
To be matched with one of two pictures at right.
Responses by:
~
Normal: Matches blue sweater with red shirt. (Form response) Organic: Matches blue sweater with blue suitcase. (Chromaphilic response) Schizophrenic: Matches blue sweater with blue suitcase. (Chromaphilic response) Figure 1. Organic Integrity Test (OlT)'
signed' to measure statistically the reduction of pattern recognition capacity in patients with frank brain damage and patients with chronic deteriorated schizophrenias, after it was observed that while testing mental patients with ink-blots, organic and schizophrenic patients could not perceive patterns onto the ink-blots, bllt merely named the colors. A similar observation was first noted by Hermann Rorschach.'; The author, therefore, reasoned that if simple pictures were used to hold "information" constant, then any system dysfunction could be detected statistically as reduced pattern recognition capacity on the OIT. The OIT instrument of 10 sets of color-form picture cards can be correctly described as a binary decision device of lOG bits. Each set of three pictures, two of which are similar in form and two in color, constitutes a bit. For example, a blue sweater used as a standard pattern to be cross-matched either with a blue suitcase or a red shirt. (See Figure 1.) It was found' that the average normal adult, when asked, "Which two pictures are most alike'?" responded by matching su:eater with shirt. With reduced capacity for pattern recognition, the patient more likely matched by color, i.e., blue sweater with blue suitcase. Patients with brain damage or dysfunction showed almost compulsive affinity to match by color, a phenomenon which is termed chromaphilia. lI The OIT is scored from 0 to 100, and normal adults score an average OIT value about 80, and about 98 30
percent of normal adults score an OIT value above 50. An OIT score of 50 or less is statistically defined as chromaphilic, indicating a reduced capacity for pattern recognition. The OIT was originally' standardized on 10 bits. However, the OIT instrument is not a single OIT test, but represents 10 basic OIT tests of 10 bits. Clearly, by using the single card A of the A set as the reference card to cross-match not only with A-lor A-2, but consecutively with the other nine united double cards of B-1 or B-2, C-l or C-2, ... and J-l or J-2, a new OIT test is formed, which the author would name henceforth the OIT-A Test to distinguish from the original OIT test." By such shiftings and combinations, the author has produced with the same OIT instrument a new series of OIT tests, OIT-A, OIT-B, OIT-C, . . . and OIT-J. The OIT instrument, therefore, may be viewed as a reliable yet flexible test battery of a good supply of (II~) individual OIT tests of 10 bits, awaiting clinical investigation and research. The author has completed the standardization for the basic 10 OIT tests on 1,000 normal subjects, and the results will be published in a separate paper, since this present study used only the original OIT test.' METHOD
The current study is based on 667 patients, representing all the admissions over a period of one year, from May 1965 to May 1966, to Volume X
PATTERN RECOGNITION-TIEN TABLE I. A O:"E.YEAR OIT SlToy OF ALL Ao~f1SSIONS TO THE PSYCHIATRIC WARD OF A GENERAL HOSPITAL -----
--
--
_.~
Percentage of
IOlal admissions
AP.-\
Diagnnsis
<':odl'
0-09 Acute brain disorder ----10·19 Chronic brain
disord('r
20
Involulional psychosis
21
~fanic.depr(,5sive
_ _ _ _ psychoSIS
--~-
Days in Hospilal N M.... n S.D.
:"
Adrni..ion OIl' M.... n S.D.
Dischar'le OIT N M.... n S.D.
17
55
29
16
73
20
3.8%
"
~Iean
25
44
14
25
13
10.3%
69
62
16
69
20
18
48
29
20
48
3/
18
2.2%
15
50
14
15
22
16
12
45
25
9
48
32
3.3%
22
42
14
22
31
18
18
43
27
17
59
18
S.D.
22
Schizophrenia
34.8%
232
36
13
232
24
20
177
45
'l.i
167
6f)
2j
3U·39
I»l'ychosomatic disordt'f l)sychonrurnsis
0.6%
4
33
17
4
14
13
2
84
12
2
84
8
34.6%
231
36
12
231
15
13
167
7/
19
113
72
22
5.5%
37
32
14
37
II
II
22
73
24
II
.rIO
9
2 10
2
34
6
2
30
44
2
34
6
5
8
12
3
40
(all l)'pe5)
50·54 Personality -------- disorder 61 ~I.nlal deli,ienc)' 100 ~{ix.d
0.3'7.
2
20
dial{nosis
0.8%
5
32
Children (nol analyzed)
3.8%
25
100% ----
667
~o
TOlal -
-
3.1 46 I 46 0 ------------
RESULTS the neuropsychiatric ward of a general city hospital. At first inspection of Tahle I, we can see The data were collected from the above pa- that the chronic brain syndrome patients are tients as follows: Upon admission all the pa- much older, usually in their 60's, and the tients were given the OIT within 24 to 72 schizophrenic patients are usually in their 30's, hours. Insofar as possible, each patient was with the average age 36. Curiously enough, 36 given the OIT periodically, and sometimes is also the average age of all the psychodaily, throughout the patient's hospital stay. A neurotic patients. Fortuitously, we have an discharge OIT is usually obtained a few days extra variable under <''Dntrol when comparing before the patient's discharge. The OIT scores pattern recognition capacities of the schizoof each patient were plotted by the psychiatric phrenic group and the psychoneurotic group. nurses much like traditional temperature- The mean admission OIT value of the schizocharting to follow the course of a medical pa- phrenic patients is 45, significantly lower than tient during treatment. Even though the OIT 71, the mean admission OIT value of the psyis a short and quick test and can be ad- choneurotic patients (p
January-February 1969
31
PSYCHOSO~IATICS
~ase
OIT 100 7S
'S7
OX: anxiety neurosis
l·.. . . .-_-"",-----...--
OIT 100
so -----------------------------
S
2S
2S
0'-_-'--_---'-_ _--'-_ _-'-
7
14
21
28 Days
Case '421
-----------------------------
0'---'-----'----'----'14 21 28 Days 7
'4
Case #27 DX:
m~nic-depressive
OX: depressive neurosis
psychosis
(unimproved)
OIT
OIT
100
100
7S
7S
Case OX: chronic brain syndrome arteriosclerosis
O~_-'-_ _I-_---''--_~
7
14
7
Case #63 DX: paranoid schizophrenia (1C1proved)
14
21
28 Days
Case 1123 OX: hebephrenic schizophrenia (lmproved) OIT 100
OIT 100 7S
SO 2S O ' - - - - ' - - -.........---'---~ 7 14 21 28 Days
7
Case #412 QX: chronic schizophrenia (unimproved)
14
21
Case 170 DX: senile brain disease (unimproved)
OIT
OIT
100
100 -
1S
so -----------------------------
so
2S
2S
O'---7----:'":----::'':---f: 14
Figure 2. The
21
28 Days
7
14
21
28 Days
on time graphs as diagnostic guide and therapeutic index.
these patients were able to score normal OIT values within 24 to 48 hours, at which time some admission OIT scores were obtained. Interestingly, the schizophrenic group, the manic-depressive group and the involutional group, statistically showed similar pattern recognition deficit, with mean admission OIT values of 45, 43. and 45, respectively. These OIT values are all chromaphilic, indicative of impaired system function. These three groups 32
O,--_-'-_ _-'-_ _-'-_ _~
are classified together by the APA Manual as psychotic disorders. It is important to note that the psychoneurotic group and the personality disorder group show mean OIT scores of 71 and 73, respectively, indicating no evidence of reduced capacity for pattern recognition on admission. The last column (Table I) displays mean and standard deviations of the discharge OIT scores of all the diagnostic groups. Using the psychoneurotic group as a Volume X
PATTERN RECOGNITION-TIEN
--------_..
TABI.E II. OtT SlTDY OF CLI:'\ICAI. IMPRO"BIE:,\T
. - - _ ..
-----_._---_. 'mpron·d
Cla5!<.ification
APA Cod.
Dia~nosi5
01·09
A{'ute hair, disordrr
10-19
Chronic brain disordrr
Admission OIl' :'\ Mean S_I>.
Grou~ _ _ _ _
_ _----':'\:..:.'o:..:.t-..:clm=I''..o..ed Group Admi..ion OtT Discharge OIl'
Dis
:'\
Mean S.D.
:'\
Mean S.D.
-------
13
47
28
13
74
21
2
29
28
18
29
.15
19
15
:'\
Mean S.D.
29
24
16
25
18
._------~----
22
Schizophrrnia
82
42
26
flO
lifl
26
14
34
22.3
Paranoid
II
1i3
18
12
76
12
6
36
21 26
12 6
45 .19
17 30
schizop:!,renia
40.0
P5ychonrurosis, anxirty typr
4i
68
23
25
-? I.
26
10
77
16
4
81
12
40.5
Psychont>urosis. depression t,·pe
i3
72
Ii
60
71
22
8
75
II
4
7f1
14
---
----------------
point of reference, the mean admission OIT value for the group is 71, and the mean discharge OIT value is 72, over an average stay of 13 days. The group as a whole showed only one point mean difference over this period. However, the acute brain disorder group showed dramatic and significant improvement on pattern recognition, as evidenced by the OIT (P
The current schizophrenic group (N = 232) scored a mean admission OIT value of 45, which is unmistakably chromaphilic. The schizophrenic group scored significantly lower than the normal mean OIT value (p
----------
by a typical patient's OIT time-graph over a period of 28 days, during which he received chemotherapy, electroshock therapy and supportive psychotherapy. This time-graph plots consistently and reliably the low capacity for pattern recognition with the OIT during the first week of the patient's admission. (See Figure 2.) Subsequently, his OIT curve rises to show improvement and then maintains a high OIT level towards the last week of the time-graph. This is a typical recovery curve, which can he contrasted with the OIT timegraphs in other mental disorders, such as chronic brain syndrome, psychoneurosis, and other typical examples as shown in Figure 2. The OIT can thus serve as a daily therapeutic index." TilE
orr
AS A TIIEHAI'ElJTIC INDEX
The concept of improvem('nt is not a unified one. Patients suffering from organic hrain syndrome, schizophrenia or psychoneurosis, do not improve in the same manner as assessed by clinicians. However, the OIT measures pattern recognition capacity, which is theorized by the author to be reduced in both organic brain disorders due to brain damage (dying or dead neurons), and in schizophrenia as due to brain dysfunction (i.e. malfunctioning neurons). In psychoneurosis, on the other hand, pattern recognition is hy and large normal, as the neurons are intact but are only programmed with inconsistent information. The OIT, therefore, is not useful in measuring improvement in psychoneurosis, although it can serve as an effective tlwrapeutic index for acute brain disorder, chronic brain disorder and schizophrenia. (See Table II.) Without knowing the patients' OIT scores, 33
PSYCHOSOMATICS
the psyehialrists separated the patients into two clinical groups upon discharge from the hospital as (I) the improved group and (2) the not-improved group as shown in Table II. Looking at this table, the improvement of pattern recognition is most dramatic in the acute brain disorder group. This group serves as a model in understanding how the OIT is being used as a therapeutic index. The admission OIT mean for the improved group of the acute brain disorder is 47, and the corresponding diseharge OIT mean is 74, which difference is very significant (P <0.001, t-test). The not-improved group of acute brain disorder is too small (1\ = 2) to consider statistically. The mixed schizophrenic group had an admission OIT of 42 and discharge OIT of 60 for the improved category, and an admission OIT of only 34 and a discharge OIT of 45 for the unimproved category. These figures again show the clinical correlation that the OIT moved from the chromaphilic range to the nonnal pattern recognition range, whereas those patients clinically assessed by the psychiatrists as unimproved stay below 50, Le. OIT = 45, which is definitely chromaphilic. Interestingly, hut requiring further research explanation, the improved group of paranoid schizophrenic patients had a higher OIT on admission with a value of 63 and also a higher discharge OIT of 76. This seems to imply that these patients have less impairment in pattern recognition from the beginning. However, the unimproved group of paranoid schizophrenic patients showed very poor pattern recognition capacity with an admission OIT of 35 and a discharge OIT of 39, a mean value change of only four points over a period of an average stay of three weeks in the hospital. This wide discrepancy may either mean that perceptual pattern recognition does not deteriorate in the improved paranoid schizophrenic group until in the later stages of this disorder, or that this represents a different type of paranoid schizophrenia. Furthennore, the OIT measures largely perceptual pattern recognition capacity, whereas only the conceptual or ideological pattern recognition capacity may be impaired in some types or in the early stages of the paranoid schizophrenic illness. However, as a periodic check, the OIT may serve as a llsC'ful therapeutic index in the proper diagnostic categories. a4
CONCLUSION
The current OIT study was carried out to study the pattern recognition capacity of 667 patients, representing all neuropsychiatric admissions to a general city hospital over a one-year period. Approximately one-third (N = 232) had a final diagnosis of schizophrenia, another one-third (N =231) had a diagnosis of psychoneurosis, and the remaining one-third was distributed amongst organic brain syndrome and others. This study is empirical in comparative analysis of pattern recognition capacities of the brain in the mental disorders. The OIT merely serves as a measuring device, by holding information constant, Le., simple, so that the brain's system function as a pattern recognition system can be measured independently of infonnation. The OIT is a relatively new instrument. Though heuristic, its validity and reliability are yet open to larger scale study and confinnation. However, the following tentative conclusions may be drawn from this one-year observation with the OIT about pattern recognition in mental disorders: 1. There is no appreciable reduction in pattern recognition capacity in psychoneurosis and personality disorder. 2. There is significant reduction in pattern recognition capacity in the acute brain syndrome; but with clinical recovery, the OIT returns to nonnal. 3. Predictably, the pattern recognition capacity in chronic brain syndrome is severely reduced as permanent chromaphilia (Le., color-bound perception and decision-making on the OIT), and this is repeatedly demonstrable with testing-retesting over a period of one month. 4. Pattern recognition capacity is reduced in involutional psychosis and manic-depressive psychosis to the same extent as in schizophrenia, but less than in chronic brain syndrome. 5. The OIT data confinn the reduced pattern recognition capacity in schizophrenia, even though we do not yet know the specific etiologic agents of this type of system dysfunction. 6. The OIT may be useful as a diagnostic screening test or as a periodic therapeutic index in the various mental disorders, but it cannot determine the cause of the disorders or Volume X
PAITERN RECOCNITION-TIEN
the agents of brain system dysfunction. For example, some clinicians· who suhscrihe to the psychogenic theories of schizophrenia, may well ask at this point, may sOllle abnormal infornuttion he the cause of system dysfunction? l\onctheless, the OIT results have demonstrated significantly that the schizophrenic patients showed a poor pattern recognition capacity as a group, scoring a mean OIT value of 45. The mean OIT value for the normal population is 78." And as these schizophrenic patients responded to drugs, electroshock therapy and psychotherapy, their pattern recognition capacity improved on the OIT. The OIT can, therefore, be used effectively as a therapeutic index, especially in the timegraph study. The OIT time-graphs plotted unmistakably the frank brain damage of the organic brain syndrome and clearly the subtle organic brain dysfunction of schizophrenia as one of reduced capacity for pattern recognition. reversible. transient or otherwise. Cogently. the reality of this mental disorder as disease is brought home by an objective test of the hrain's system function. SU:\fMARY
The Organic Integrity Test (OIT) was designed by the author' to measure pattern recognition capacity of the human brain, hased on the principle of l/Iost-.simiwrity. The OIT is a simple three-minute color-form binary device for detecting organicity. The OIT has been confirmed in Europe and America as a valid and reliable instrument. This one-year study compares the pattern recognition capacities of the common mental disorders. The OIT was, therefore, given almost daily to aU (;\; =667) patients, admitted to the Neuropsychiatric ward of a general city hospital. The OIT results disclosed significant difference (P
sonality disorders showed normal OIT scores. However, the daily time-graph study revealed ullmistakably that a reduced capacity for pattern recognition can he a subtle index of schizophrenic brain dysfunction. And the OIT has thus proven itself as a useful diagnostic and therapeutic index hy monitoring pattern recognition capacity daily in all and varied mental patients on the neuropsychiatric ward of a general City Hospital. REFERENCES
1. Aricti, Silvano: InteryJretation af Sclli;:;o"lrrenia. New York: Robert Brunner, 1955. 2. Astrom, J.: Organic integrity test in clinical use. Nord. Psykiat. T., 2: 160-169, 1963. 3. Engelsmann, F., and Drdkova, S.: Organic Integrity Test, CzecJwslol'ak Journal
215 Medical Center West 701 N. Logan Street Lansing, Michigan 48915
I respect faith but doubt is what gets you an education.-WILsoN
January-February 1969
~hZ"'ER
(1876-1933).
35
TIE~,
• The concept of mental illness itself as disease has now heen challengeu. Discussion of the causes of mental disoruers often leads to controversies. Organic anu psychological theories are ahundant, hut consistent, objective, and quantifiable data are constantly neeued to understand mental illnesses as such. The author' has, therefore, designed the Organic Integrity Test (OIT) as a quick and efficient diagnostic aid to assess central nervous system deficit, as a loss of pattern recognition due to any brain disease. Astrom~ and Engelsmann & Drdkova" confirmed the validity and reliahility of the OIT as a useful diagnostic test of organicity in Sweden and Czechoslovakia, respectively. The OIT has heen successfully applied as a routine neuropsychiatric screening test in industry at General Motors:"'~ And the OIT proved to be equally valid and reliable in testing children.'" The OIT is based on the principle of mostsimilarity. The author l " I " has further developed this concept into a general mathematical model of pattern recognition: the theory of pattern recognition by identity, or the PRI theory. Mathematically,
If PRI(f,g)-I, then f-g. This is the principle of most-similarity, which simply means that the brain as a pattern recognition system identifies the incoming signal of an unknown pattern f hy cross-correlation pattern comparison with the mostsimilar pattern g, stored in the memory. Clearly, to achieve pattern recognition, the brain must have both an intact system fllnction and sufficient stored information.
M.S.E.E., M.D.
Indeed, the PHI theory separates all mental disorders conceptually into two basic categories: (1) system function disorders and (2) information disorders. System function disorders include organic hrain syndrome, mental deficiency, organic psychoses and schizophrenias. On the other hand, information disorders include personality disorders, psychoneuroses, and psychophysiological reactions. System function is hereby defined to mean the input-output relationship, dependcnt upon the integrity of the neural elements and their interconnections, hence the organic integrity of the pattern recognition systt·m. Here, information is the measure of the cross-correlation of input patterns and memory patterns to determine output and behavior, and not in the sense of Shannon. 7 Obviously, feedhack loops exist hetween information and system function processes, thus complicating diagnostic analysis in our clinical work, especially in schizophrenias, where the possible system function disorder I may cause information disorder, and vice versa, in vicious looping. However, if a test can be constructed to hold the information variable constant, the system function can he measured objectively and quantitatively for comparative studies in mental disorders. The OIT was constructed for this purpose: i.e., hold information constant in order to measure the integrity of system function of the brain. The author' postulated that the basic function of the brain is pattern recognition, and the loss of pattern recognition due to any brain disorder may be disclosed as chromaphilia on the 01T. ORGAl"IC I:"TEGRITY TESTO
The OIT Instrument. The OIT was deData mllcction was done with the help of the nursing staff at the Neuro-psychiatric unit of 51. Lawrence Hospital, and data processing at the Computer Center, \Ikhigan State University, East Lansing, Michigan. January-February 1969
o The OIT Test cards and manllal art' now available from Psychodiagnostic Test Company, Box 528, East Lansing, \Ikhigan 48823.
29
PSYCHOSmlATICS
WHICH TWO PICTURES ARE MOST ALIKE?
To be matched with one of two pictures at right.
Responses by:
~
Normal: Matches blue sweater with red shirt. (Form response) Organic: Matches blue sweater with blue suitcase. (Chromaphilic response) Schizophrenic: Matches blue sweater with blue suitcase. (Chromaphilic response) Figure 1. Organic Integrity Test (OlT)'
signed' to measure statistically the reduction of pattern recognition capacity in patients with frank brain damage and patients with chronic deteriorated schizophrenias, after it was observed that while testing mental patients with ink-blots, organic and schizophrenic patients could not perceive patterns onto the ink-blots, bllt merely named the colors. A similar observation was first noted by Hermann Rorschach.'; The author, therefore, reasoned that if simple pictures were used to hold "information" constant, then any system dysfunction could be detected statistically as reduced pattern recognition capacity on the OIT. The OIT instrument of 10 sets of color-form picture cards can be correctly described as a binary decision device of lOG bits. Each set of three pictures, two of which are similar in form and two in color, constitutes a bit. For example, a blue sweater used as a standard pattern to be cross-matched either with a blue suitcase or a red shirt. (See Figure 1.) It was found' that the average normal adult, when asked, "Which two pictures are most alike'?" responded by matching su:eater with shirt. With reduced capacity for pattern recognition, the patient more likely matched by color, i.e., blue sweater with blue suitcase. Patients with brain damage or dysfunction showed almost compulsive affinity to match by color, a phenomenon which is termed chromaphilia. lI The OIT is scored from 0 to 100, and normal adults score an average OIT value about 80, and about 98 30
percent of normal adults score an OIT value above 50. An OIT score of 50 or less is statistically defined as chromaphilic, indicating a reduced capacity for pattern recognition. The OIT was originally' standardized on 10 bits. However, the OIT instrument is not a single OIT test, but represents 10 basic OIT tests of 10 bits. Clearly, by using the single card A of the A set as the reference card to cross-match not only with A-lor A-2, but consecutively with the other nine united double cards of B-1 or B-2, C-l or C-2, ... and J-l or J-2, a new OIT test is formed, which the author would name henceforth the OIT-A Test to distinguish from the original OIT test." By such shiftings and combinations, the author has produced with the same OIT instrument a new series of OIT tests, OIT-A, OIT-B, OIT-C, . . . and OIT-J. The OIT instrument, therefore, may be viewed as a reliable yet flexible test battery of a good supply of (II~) individual OIT tests of 10 bits, awaiting clinical investigation and research. The author has completed the standardization for the basic 10 OIT tests on 1,000 normal subjects, and the results will be published in a separate paper, since this present study used only the original OIT test.' METHOD
The current study is based on 667 patients, representing all the admissions over a period of one year, from May 1965 to May 1966, to Volume X
PATTERN RECOGNITION-TIEN TABLE I. A O:"E.YEAR OIT SlToy OF ALL Ao~f1SSIONS TO THE PSYCHIATRIC WARD OF A GENERAL HOSPITAL -----
--
--
_.~
Percentage of
IOlal admissions
AP.-\
Diagnnsis
<':odl'
0-09 Acute brain disorder ----10·19 Chronic brain
disord('r
20
Involulional psychosis
21
~fanic.depr(,5sive
_ _ _ _ psychoSIS
--~-
Days in Hospilal N M.... n S.D.
:"
Adrni..ion OIl' M.... n S.D.
Dischar'le OIT N M.... n S.D.
17
55
29
16
73
20
3.8%
"
~Iean
25
44
14
25
13
10.3%
69
62
16
69
20
18
48
29
20
48
3/
18
2.2%
15
50
14
15
22
16
12
45
25
9
48
32
3.3%
22
42
14
22
31
18
18
43
27
17
59
18
S.D.
22
Schizophrenia
34.8%
232
36
13
232
24
20
177
45
'l.i
167
6f)
2j
3U·39
I»l'ychosomatic disordt'f l)sychonrurnsis
0.6%
4
33
17
4
14
13
2
84
12
2
84
8
34.6%
231
36
12
231
15
13
167
7/
19
113
72
22
5.5%
37
32
14
37
II
II
22
73
24
II
.rIO
9
2 10
2
34
6
2
30
44
2
34
6
5
8
12
3
40
(all l)'pe5)
50·54 Personality -------- disorder 61 ~I.nlal deli,ienc)' 100 ~{ix.d
0.3'7.
2
20
dial{nosis
0.8%
5
32
Children (nol analyzed)
3.8%
25
100% ----
667
~o
TOlal -
-
3.1 46 I 46 0 ------------
RESULTS the neuropsychiatric ward of a general city hospital. At first inspection of Tahle I, we can see The data were collected from the above pa- that the chronic brain syndrome patients are tients as follows: Upon admission all the pa- much older, usually in their 60's, and the tients were given the OIT within 24 to 72 schizophrenic patients are usually in their 30's, hours. Insofar as possible, each patient was with the average age 36. Curiously enough, 36 given the OIT periodically, and sometimes is also the average age of all the psychodaily, throughout the patient's hospital stay. A neurotic patients. Fortuitously, we have an discharge OIT is usually obtained a few days extra variable under <''Dntrol when comparing before the patient's discharge. The OIT scores pattern recognition capacities of the schizoof each patient were plotted by the psychiatric phrenic group and the psychoneurotic group. nurses much like traditional temperature- The mean admission OIT value of the schizocharting to follow the course of a medical pa- phrenic patients is 45, significantly lower than tient during treatment. Even though the OIT 71, the mean admission OIT value of the psyis a short and quick test and can be ad- choneurotic patients (p
January-February 1969
31
PSYCHOSO~IATICS
~ase
OIT 100 7S
'S7
OX: anxiety neurosis
l·.. . . .-_-"",-----...--
OIT 100
so -----------------------------
S
2S
2S
0'-_-'--_---'-_ _--'-_ _-'-
7
14
21
28 Days
Case '421
-----------------------------
0'---'-----'----'----'14 21 28 Days 7
'4
Case #27 DX:
m~nic-depressive
OX: depressive neurosis
psychosis
(unimproved)
OIT
OIT
100
100
7S
7S
Case OX: chronic brain syndrome arteriosclerosis
O~_-'-_ _I-_---''--_~
7
14
7
Case #63 DX: paranoid schizophrenia (1C1proved)
14
21
28 Days
Case 1123 OX: hebephrenic schizophrenia (lmproved) OIT 100
OIT 100 7S
SO 2S O ' - - - - ' - - -.........---'---~ 7 14 21 28 Days
7
Case #412 QX: chronic schizophrenia (unimproved)
14
21
Case 170 DX: senile brain disease (unimproved)
OIT
OIT
100
100 -
1S
so -----------------------------
so
2S
2S
O'---7----:'":----::'':---f: 14
Figure 2. The
21
28 Days
7
14
21
28 Days
on time graphs as diagnostic guide and therapeutic index.
these patients were able to score normal OIT values within 24 to 48 hours, at which time some admission OIT scores were obtained. Interestingly, the schizophrenic group, the manic-depressive group and the involutional group, statistically showed similar pattern recognition deficit, with mean admission OIT values of 45, 43. and 45, respectively. These OIT values are all chromaphilic, indicative of impaired system function. These three groups 32
O,--_-'-_ _-'-_ _-'-_ _~
are classified together by the APA Manual as psychotic disorders. It is important to note that the psychoneurotic group and the personality disorder group show mean OIT scores of 71 and 73, respectively, indicating no evidence of reduced capacity for pattern recognition on admission. The last column (Table I) displays mean and standard deviations of the discharge OIT scores of all the diagnostic groups. Using the psychoneurotic group as a Volume X
PATTERN RECOGNITION-TIEN
--------_..
TABI.E II. OtT SlTDY OF CLI:'\ICAI. IMPRO"BIE:,\T
. - - _ ..
-----_._---_. 'mpron·d
Cla5!<.ification
APA Cod.
Dia~nosi5
01·09
A{'ute hair, disordrr
10-19
Chronic brain disordrr
Admission OIl' :'\ Mean S_I>.
Grou~ _ _ _ _
_ _----':'\:..:.'o:..:.t-..:clm=I''..o..ed Group Admi..ion OtT Discharge OIl'
Dis
:'\
Mean S.D.
:'\
Mean S.D.
-------
13
47
28
13
74
21
2
29
28
18
29
.15
19
15
:'\
Mean S.D.
29
24
16
25
18
._------~----
22
Schizophrrnia
82
42
26
flO
lifl
26
14
34
22.3
Paranoid
II
1i3
18
12
76
12
6
36
21 26
12 6
45 .19
17 30
schizop:!,renia
40.0
P5ychonrurosis, anxirty typr
4i
68
23
25
-? I.
26
10
77
16
4
81
12
40.5
Psychont>urosis. depression t,·pe
i3
72
Ii
60
71
22
8
75
II
4
7f1
14
---
----------------
point of reference, the mean admission OIT value for the group is 71, and the mean discharge OIT value is 72, over an average stay of 13 days. The group as a whole showed only one point mean difference over this period. However, the acute brain disorder group showed dramatic and significant improvement on pattern recognition, as evidenced by the OIT (P
The current schizophrenic group (N = 232) scored a mean admission OIT value of 45, which is unmistakably chromaphilic. The schizophrenic group scored significantly lower than the normal mean OIT value (p
----------
by a typical patient's OIT time-graph over a period of 28 days, during which he received chemotherapy, electroshock therapy and supportive psychotherapy. This time-graph plots consistently and reliably the low capacity for pattern recognition with the OIT during the first week of the patient's admission. (See Figure 2.) Subsequently, his OIT curve rises to show improvement and then maintains a high OIT level towards the last week of the time-graph. This is a typical recovery curve, which can he contrasted with the OIT timegraphs in other mental disorders, such as chronic brain syndrome, psychoneurosis, and other typical examples as shown in Figure 2. The OIT can thus serve as a daily therapeutic index." TilE
orr
AS A TIIEHAI'ElJTIC INDEX
The concept of improvem('nt is not a unified one. Patients suffering from organic hrain syndrome, schizophrenia or psychoneurosis, do not improve in the same manner as assessed by clinicians. However, the OIT measures pattern recognition capacity, which is theorized by the author to be reduced in both organic brain disorders due to brain damage (dying or dead neurons), and in schizophrenia as due to brain dysfunction (i.e. malfunctioning neurons). In psychoneurosis, on the other hand, pattern recognition is hy and large normal, as the neurons are intact but are only programmed with inconsistent information. The OIT, therefore, is not useful in measuring improvement in psychoneurosis, although it can serve as an effective tlwrapeutic index for acute brain disorder, chronic brain disorder and schizophrenia. (See Table II.) Without knowing the patients' OIT scores, 33
PSYCHOSOMATICS
the psyehialrists separated the patients into two clinical groups upon discharge from the hospital as (I) the improved group and (2) the not-improved group as shown in Table II. Looking at this table, the improvement of pattern recognition is most dramatic in the acute brain disorder group. This group serves as a model in understanding how the OIT is being used as a therapeutic index. The admission OIT mean for the improved group of the acute brain disorder is 47, and the corresponding diseharge OIT mean is 74, which difference is very significant (P <0.001, t-test). The not-improved group of acute brain disorder is too small (1\ = 2) to consider statistically. The mixed schizophrenic group had an admission OIT of 42 and discharge OIT of 60 for the improved category, and an admission OIT of only 34 and a discharge OIT of 45 for the unimproved category. These figures again show the clinical correlation that the OIT moved from the chromaphilic range to the nonnal pattern recognition range, whereas those patients clinically assessed by the psychiatrists as unimproved stay below 50, Le. OIT = 45, which is definitely chromaphilic. Interestingly, hut requiring further research explanation, the improved group of paranoid schizophrenic patients had a higher OIT on admission with a value of 63 and also a higher discharge OIT of 76. This seems to imply that these patients have less impairment in pattern recognition from the beginning. However, the unimproved group of paranoid schizophrenic patients showed very poor pattern recognition capacity with an admission OIT of 35 and a discharge OIT of 39, a mean value change of only four points over a period of an average stay of three weeks in the hospital. This wide discrepancy may either mean that perceptual pattern recognition does not deteriorate in the improved paranoid schizophrenic group until in the later stages of this disorder, or that this represents a different type of paranoid schizophrenia. Furthennore, the OIT measures largely perceptual pattern recognition capacity, whereas only the conceptual or ideological pattern recognition capacity may be impaired in some types or in the early stages of the paranoid schizophrenic illness. However, as a periodic check, the OIT may serve as a llsC'ful therapeutic index in the proper diagnostic categories. a4
CONCLUSION
The current OIT study was carried out to study the pattern recognition capacity of 667 patients, representing all neuropsychiatric admissions to a general city hospital over a one-year period. Approximately one-third (N = 232) had a final diagnosis of schizophrenia, another one-third (N =231) had a diagnosis of psychoneurosis, and the remaining one-third was distributed amongst organic brain syndrome and others. This study is empirical in comparative analysis of pattern recognition capacities of the brain in the mental disorders. The OIT merely serves as a measuring device, by holding information constant, Le., simple, so that the brain's system function as a pattern recognition system can be measured independently of infonnation. The OIT is a relatively new instrument. Though heuristic, its validity and reliability are yet open to larger scale study and confinnation. However, the following tentative conclusions may be drawn from this one-year observation with the OIT about pattern recognition in mental disorders: 1. There is no appreciable reduction in pattern recognition capacity in psychoneurosis and personality disorder. 2. There is significant reduction in pattern recognition capacity in the acute brain syndrome; but with clinical recovery, the OIT returns to nonnal. 3. Predictably, the pattern recognition capacity in chronic brain syndrome is severely reduced as permanent chromaphilia (Le., color-bound perception and decision-making on the OIT), and this is repeatedly demonstrable with testing-retesting over a period of one month. 4. Pattern recognition capacity is reduced in involutional psychosis and manic-depressive psychosis to the same extent as in schizophrenia, but less than in chronic brain syndrome. 5. The OIT data confinn the reduced pattern recognition capacity in schizophrenia, even though we do not yet know the specific etiologic agents of this type of system dysfunction. 6. The OIT may be useful as a diagnostic screening test or as a periodic therapeutic index in the various mental disorders, but it cannot determine the cause of the disorders or Volume X
PAITERN RECOCNITION-TIEN
the agents of brain system dysfunction. For example, some clinicians· who suhscrihe to the psychogenic theories of schizophrenia, may well ask at this point, may sOllle abnormal infornuttion he the cause of system dysfunction? l\onctheless, the OIT results have demonstrated significantly that the schizophrenic patients showed a poor pattern recognition capacity as a group, scoring a mean OIT value of 45. The mean OIT value for the normal population is 78." And as these schizophrenic patients responded to drugs, electroshock therapy and psychotherapy, their pattern recognition capacity improved on the OIT. The OIT can, therefore, be used effectively as a therapeutic index, especially in the timegraph study. The OIT time-graphs plotted unmistakably the frank brain damage of the organic brain syndrome and clearly the subtle organic brain dysfunction of schizophrenia as one of reduced capacity for pattern recognition. reversible. transient or otherwise. Cogently. the reality of this mental disorder as disease is brought home by an objective test of the hrain's system function. SU:\fMARY
The Organic Integrity Test (OIT) was designed by the author' to measure pattern recognition capacity of the human brain, hased on the principle of l/Iost-.simiwrity. The OIT is a simple three-minute color-form binary device for detecting organicity. The OIT has been confirmed in Europe and America as a valid and reliable instrument. This one-year study compares the pattern recognition capacities of the common mental disorders. The OIT was, therefore, given almost daily to aU (;\; =667) patients, admitted to the Neuropsychiatric ward of a general city hospital. The OIT results disclosed significant difference (P
sonality disorders showed normal OIT scores. However, the daily time-graph study revealed ullmistakably that a reduced capacity for pattern recognition can he a subtle index of schizophrenic brain dysfunction. And the OIT has thus proven itself as a useful diagnostic and therapeutic index hy monitoring pattern recognition capacity daily in all and varied mental patients on the neuropsychiatric ward of a general City Hospital. REFERENCES
1. Aricti, Silvano: InteryJretation af Sclli;:;o"lrrenia. New York: Robert Brunner, 1955. 2. Astrom, J.: Organic integrity test in clinical use. Nord. Psykiat. T., 2: 160-169, 1963. 3. Engelsmann, F., and Drdkova, S.: Organic Integrity Test, CzecJwslol'ak Journal
215 Medical Center West 701 N. Logan Street Lansing, Michigan 48915
I respect faith but doubt is what gets you an education.-WILsoN
January-February 1969
~hZ"'ER
(1876-1933).
35