Antisaccade and prosaccade eye movements in individuals clinically at risk for psychosis: comparison with first-episode schizophrenia and prediction of conversion

  • Luca Kleineidam
  • Ingo Frommann
  • Stephan Ruhrmann
  • Joachim Klosterkötter
  • Anke Brockhaus-Dumke
  • Wolfgang Wölwer
  • Wolfgang Gaebel
  • Wolfgang Maier
  • Michael Wagner
  • Ulrich Ettinger
Original Paper


Saccadic eye movements are well-described markers of cerebral function and have been widely studied in schizophrenia spectrum populations. However, less is known about saccades in individuals clinically at risk for schizophrenia. Therefore, we studied individuals in an at-risk mental state (ARMS) (N = 160), patients in their first episode of schizophrenia (N = 32) and healthy controls (N = 75). N = 88 ARMS participants showed an early at-risk mental state (E-ARMS), defined by cognitive-perceptive basic symptoms (COPER) or a combination of risk and loss of function, whereas N = 72 were in a late at-risk mental state (L-ARMS), defined by attenuated psychotic symptoms or brief limited intermittent psychotic symptoms. We examined prosaccades, reflecting overt attentional shifts, and antisaccades, measuring inhibitory control, as well as their relationship as an indicator of the interplay of bottom–up and top–down influences. L-ARMS but not E-ARMS participants had increased antisaccade latencies compared to controls. First-episode patients had higher antisaccade error rates compared to E-ARMS participants and controls, and increased latencies compared to all other groups. Prosaccade latencies did not differ between groups. We observed the expected negative correlation between prosaccade latency and antisaccade error rate, indicating that individuals with shorter prosaccade latencies made more antisaccade errors. The magnitude of the association did not differ between groups. No saccadic measure predicted conversion to psychosis within 2 years. These findings confirm the existence of antisaccade impairments in patients with schizophrenia and provide evidence that volitional response generation in the antisaccade task may be affected even before onset of clinically overt psychosis.


Antisaccade Prosaccade Clinical high risk Prognostic biomarkers 



This work was supported by the German Federal Ministry for Education and Research (BMBF) (Grant numbers BMBF 01GI 9934, 01GI 0234, 01GI9932, 01GI0232, 01GI0532). The funding source had no further role in the study design; the collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the paper for publication.

Author contributions

MW, WW, WM, SR and JK conceived the study and obtained funding. MW designed the study and wrote the protocol. IF, WW, and ADB were responsible for data recording and management. LK and UE performed the analysis and wrote the first draft of the manuscript. All authors have contributed to data acquisition and to revising the manuscript and have approved the final manuscript. Luca Kleineidam (LK), Ingo Frommann (IF), Stephan Ruhrmann (SR), Joachim Klosterkötter (JK), Anke Brockhaus-Dumke (ABD) Wolfgang Wölwer (WW), Wolfgang Gaebel (WG), Wolfgang Maier (WM), Michael Wagner (MW), Ulrich Ettinger (UE).

Compliance with ethical standards

Conflict of interest

All authors report no biomedical financial interests or potential conflicts of interest.

Supplementary material

406_2018_973_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Luca Kleineidam
    • 1
    • 2
  • Ingo Frommann
    • 1
    • 2
  • Stephan Ruhrmann
    • 3
  • Joachim Klosterkötter
    • 3
  • Anke Brockhaus-Dumke
    • 4
  • Wolfgang Wölwer
    • 5
  • Wolfgang Gaebel
    • 5
  • Wolfgang Maier
    • 1
    • 2
  • Michael Wagner
    • 1
    • 2
  • Ulrich Ettinger
    • 6
  1. 1.Department of Psychiatry and PsychotherapyUniversity of BonnBonnGermany
  2. 2.Department for Neurodegenerative Diseases and Geriatric PsychiatryUniversity of BonnBonnGermany
  3. 3.Department of Psychiatry and PsychotherapyUniversity of CologneCologneGermany
  4. 4.Department of Psychiatry, Psychotherapy and Psychosomatic MedicineRheinhessen-Fachklinik AlzeyAlzeyGermany
  5. 5.Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich-Heine-UniversityDüsseldorfGermany
  6. 6.Department of PsychologyUniversity of BonnBonnGermany

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