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Sambataro F, Fritze S, Rashidi M, Topor CE, Kubera KM, Wolf RC, Hirjak D. Moving forward: distinct sensorimotor abnormalities predict clinical outcome after 6 months in patients with schizophrenia. Eur Neuropsychopharmacol 2020; 36:72-82. [PMID: 32522386 DOI: 10.1016/j.euroneuro.2020.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 01/24/2023]
Abstract
Despite substantial efforts in the last decades, objective measures that can predict clinical outcome in patients with schizophrenia (SZ) after an acute psychotic episode are still lacking. Here, we introduced a comprehensive assessment of sensorimotor function to predict mid-term clinical outcome following an acute psychotic episode. This naturalistic follow-up of 43 patients with DSM-IV-TR diagnosis of SZ examined sensorimotor abnormalities (i.e. Neurological Soft Signs (NSS), parkinsonism, akathisia, catatonia and acute dyskinesia), psychopathology, cognition and psychosocial functioning using well-established instruments. A collection of statistical methods was used to examine the relationship between sensorimotor domain, psychopathology, cognition and psychosocial functioning. We also tested the clinical feasibility of this relationship when predicting clinical outcome after an acute psychotic episode. Longitudinal data were collected on 43 individuals after a follow-up period of >6 months. At follow-up, patients showed significantly reduced general symptom severity, as well as decreased levels of NSS, parkinsonism and catatonia. Further, NSS scores at baseline predicted PANSS negative scores and cognitive functioning at baseline. Finally, NSS scores at baseline predicted symptom change (reduction of PANSS positive and negative scores) at follow-up. In conclusion, our results suggest that NSS are significant predictors of poor clinical outcome in SZ at baseline and >6 months after an acute psychotic episode. These findings propose sensorimotor domain as state biomarker of SZ and support its predictive power with respect to treatment outcome.
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Affiliation(s)
- Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, D-68159, Germany
| | - Mahmoud Rashidi
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, D-68159, Germany; Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Cristina E Topor
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, D-68159, Germany
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, D-68159, Germany.
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Feng Y, Wang Z, Lin G, Qian H, Gao Z, Wang X, Li M, Hu X, Li Y. Neurological soft signs and neurocognitive deficits in remitted patients with schizophrenia, their first-degree unaffected relatives, and healthy controls. Eur Arch Psychiatry Clin Neurosci 2020; 270:383-391. [PMID: 31123823 DOI: 10.1007/s00406-019-01024-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 05/15/2019] [Indexed: 01/10/2023]
Abstract
Neurological soft signs (NSS) and neurocognitive deficits (ND) are highly prevalent in schizophrenia, and have been separately proposed as candidate endophenotypes of schizophrenia. However, few relevant studies focus on remitted patients with schizophrenia (RP) and integrate NSS and ND as a composite endophenotype. This study aimed to explore the NSS and ND and examine the comparative relationship between them in RP, their first-degree unaffected relatives (FDR), and healthy controls, furthermore, to seek potential endophenotypes subitems of NSS and ND and create a composite endophenotype. 86 RP, 86 FDR, and 86 healthy controls were included. NSS and ND were independently assessed with Cambridge Neurological Inventory and MATRICSTM Consensus Cognitive Battery. RP had more NSS and ND than FDR in all subitems except disinhibition, information processing speed, working memory, and visual memory. Similarly, FDR presented poorer performance than controls in all subscales except disinhibition, sensory integration, working memory, and visual memory. Six subitems of NSS and ND met the criteria of endophenotype and the three groups were most accurately classified (71.2%) with these subitems working as a composite endophenotype. Moreover, information processing speed, attention, and social cognition were associated with sensory integration in RP and FDR. These findings add evidences that certain subitems of NSS and ND might be the endophenotypes of schizophrenia and integrating these endophenotypes may prove useful in identifying schizophrenia and high-risk individuals. Furthermore, sensory integration and specific cognitive domains covary, hence suggesting an overlap of compromised underlying neural systems.
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Affiliation(s)
- Yingying Feng
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Zongqin Wang
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Guorong Lin
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Hong Qian
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Zuohui Gao
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xiaoli Wang
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Mingcao Li
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xiaohua Hu
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China.
| | - Yi Li
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
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Fritze S, Sambataro F, Kubera KM, Bertolino AL, Topor CE, Wolf RC, Hirjak D. Neurological soft signs in schizophrenia spectrum disorders are not confounded by current antipsychotic dosage. Eur Neuropsychopharmacol 2020; 31:47-57. [PMID: 31780303 DOI: 10.1016/j.euroneuro.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022]
Abstract
Neurological soft signs (NSS) have garnered increasing attention in psychiatric research on motor abnormalities in schizophrenia spectrum disorders (SSD). However, it remains unclear whether the assessment of NSS severity could have been confounded by current antipsychotic dosage. In this study, we recruited 105 patients with SSD that underwent a comprehensive motor assessment evaluating NSS and extrapyramidal motor symptoms (EPMS) by means of standardized instruments. Current antipsychotic dosage equivalence estimates were determined by the classical mean dose method (doses equivalent to 1 mg/d olanzapine). We used multiple regression analyses to describe the relationship between NSS, EPMS and antipsychotic medication. In line with our expectations, current antipsychotic dosage had no significant effects on NSS total score (p = 0.27), abnormal involuntary movements (p = 0.17), akathisia (p = 0.32) and parkinsonism (p = 0.26). Further, NSS total score had a significant effect on akathisia (p = 0.003) and parkinsonism (p = 0.0001, Bonferroni corr.), but only marginal effect on abnormal involuntary movements (p = 0.08). Our results support the notion that NSS are not significantly modulated by current antipsychotic dosage in SSD. The associations between NSS, akathisia and parkinsonism, as revealed by this study, support the genuine rather than medication-dependent origin of particular motor abnormalities in SSD.
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Affiliation(s)
- Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Alina L Bertolino
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Cristina E Topor
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Cuesta MJ, Peralta V. Modeling neuromotor pathology in schizophrenia: A window to brain mechanisms and clinical insight into the syndrome. Schizophr Res 2018; 200:1-4. [PMID: 29884551 DOI: 10.1016/j.schres.2018.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 01/09/2023]
Affiliation(s)
- M J Cuesta
- Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.
| | - V Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
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Emsley R, Chiliza B, Asmal L, Kilian S, Riaan Olivier M, Phahladira L, Ojagbemi A, Scheffler F, Carr J, Kidd M, Dazzan P. Neurological soft signs in first-episode schizophrenia: State- and trait-related relationships to psychopathology, cognition and antipsychotic medication effects. Schizophr Res 2017; 188:144-150. [PMID: 28130002 DOI: 10.1016/j.schres.2017.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neurological soft signs (NSS) are proposed to represent both state- and trait-related features of schizophrenia. METHOD We assessed the course of NSS with the Neurological Evaluation Scale (NES) over 12months of standardised treatment in 126 patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder, and evaluated their state- and trait-related associations with psychopathology, functionality, cognition and antipsychotic treatment. We considered change scores from baseline to be state-related and endpoint scores to be trait-related. RESULTS Significant effects for time were recorded for all NSS domains. For state-related change-scores greater improvements in sensory integration were predicted by more improvement in working memory (p=0.01); greater improvements in motor sequencing scores were predicted by more improvement in working memory (p=0.005) and functionality (p=0.005); and greater improvements in NES Total score were predicted by more improvement in disorganised symptoms (p=0.02). There were more substantial associations between trait-related endpoint scores than for state-related change scores. For endpoint scores lower composite cognitive score predicted poorer sensory integration (p=0.001); higher Parkinsonism score predicted poorer motor co-ordination (p=0.0001); lower composite cognitive score (p=0.001) and higher Parkinsonism score (p=0.005) predicted poorer motor sequencing; higher Parkinsonism score (p=0.0001) and disorganised symptoms (p=0.04), and lower composite cognitive score (p=0.0007) predicted higher NES total score. CONCLUSIONS NSS improved with treatment, but were weakly associated with improvements in psychopathology. Studies investigating NSS as trait-markers should ensure that patients have been optimally treated at the time of testing, and should take possible effects of extrapyramidal symptoms into account.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
| | - Bonginkosi Chiliza
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | - Sanja Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | - M Riaan Olivier
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | - Lebogang Phahladira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | | | - Freda Scheffler
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | - Jonathan Carr
- Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, South Africa
| | - Paola Dazzan
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Peralta V, Cuesta MJ. Motor Abnormalities: From Neurodevelopmental to Neurodegenerative Through "Functional" (Neuro)Psychiatric Disorders. Schizophr Bull 2017; 43:956-971. [PMID: 28911050 PMCID: PMC5581892 DOI: 10.1093/schbul/sbx089] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Motor abnormalities (MAs) of severe mental disorders have been traditionally neglected both in clinical practice and research, although they are an increasing focus of attention because of their clinical and neurobiological relevance. For historical reasons, most of the literature on MAs has been focused to a great extent on schizophrenia, and as a consequence their prevalence and featural properties in other psychiatric or neuropsychiatric disorders are poorly known. In this article, we evaluated the extent to which catatonic, extrapyramidal and neurological soft signs, and their associated clinical features, are present transdiagnostically. Methods We examined motor-related features in neurodevelopmental (schizophrenia, obsessive compulsive disorder, autism spectrum disorders), "functional" (nonschizophrenic nonaffective psychoses, mood disorders) and neurodegenerative (Alzheimer's disease) disorders. Examination of the literature revealed that there have been very few comparisons of motor-related features across diagnoses and we had to rely mainly in disorder-specific studies to compare it transdiagnostically. Results One or more motor domains had a substantial prevalence in all the diagnoses examined. In "functional" disorders, MAs, and particularly catatonic signs, appear to be markers of episode severity; in chronic disorders, although with different degree of strength or evidence, all motor domains are indicators of both disorder severity and poor outcome; lastly, in Alzheimer's disease they are also indicators of disorder progression. Conclusions MAs appear to represent a true transdiagnostic domain putatively sharing neurobiological mechanisms of neurodevelopmental, functional or neurodegenerative origin.
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Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Psychiatry Service, Complejo Hospitalario de Navarra, Pamplona, Spain
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Chan RCK, Geng FL, Lui SSY, Wang Y, Ho KKY, Hung KSY, Gur RE, Gur RC, Cheung EFC. Course of neurological soft signs in first-episode schizophrenia: Relationship with negative symptoms and cognitive performances. Sci Rep 2015; 5:11053. [PMID: 26053141 PMCID: PMC4459190 DOI: 10.1038/srep11053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/15/2015] [Indexed: 11/09/2022] Open
Abstract
This prospective study examined the course of neurological soft signs (NSS) in patients with first-episode schizophrenia and its relationship with negative symptoms and cognitive functions. One hundred and forty-five patients with first-episode schizophrenia were recruited, 29 were classified as having prominent negative symptoms. NSS and neuropsychological measures were administered to all patients and 62 healthy controls at baseline. Patients were then followed-up prospectively at six-month intervals for up to a year. Patients with prominent negative symptoms exhibited significantly more motor coordination signs and total NSS than patients without prominent negative symptoms. Patients with prominent negative symptoms performed worse than patients without negative symptoms in working memory functions but not other fronto-parietal or fronto-temporal functions. Linear growth model for binary data showed that the prominent negative symptoms were stable over time. Despite general improvement in NSS and neuropsychological functions, the prominent negative symptoms group still exhibited poorer motor coordination and higher levels of NSS, as well as poorer working memory than patients without prominent negative symptoms. Two distinct subtypes of first-episode patients could be distinguished by NSS and prominent negative symptoms.
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Affiliation(s)
- Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Fu-Lei Geng
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Simon S Y Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Castle Peak Hospital, Hong Kong Special Administration Region, China
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Karen K Y Ho
- Castle Peak Hospital, Hong Kong Special Administration Region, China
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administration Region, China
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Philadelphia Veterans Administration Medical Center, Philadelphia, United States of America
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Philadelphia Veterans Administration Medical Center, Philadelphia, United States of America
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administration Region, China
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Bourgou Gaha S, Halayem Dhouib S, Amado I, Bouden A. [Neurological soft signs in early onset schizophrenia]. L'ENCEPHALE 2014; 41:209-14. [PMID: 24854724 DOI: 10.1016/j.encep.2014.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 01/16/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Neurological soft signs (NSS) are subtle neurological abnormalities that cannot be linked to the achievement of a specific region of the central nervous system and which are not part of a particular neurological syndrome. These signs are observed in the case of diseases supporting the neurodevelopmental model such as schizophrenia in general and its early form defined notably by an age of onset of less than 18 years. Indeed, the NSS belong to a set of clinical, cognitive, electrophysiological and neuroanatomical markers reflecting neurodevelopmental brain abnormalities in patients with schizophrenia. OBJECTIVE The objectives of our study were to determine the prevalence, the scores, and the nature of neurological soft signs (NSS) in adolescent patients suffering from early onset schizophrenia diagnosis in comparison to healthy controls, and to explore the correlations between NSS and the demographic, clinical and therapeutic features of these patients. MATERIALS AND METHODS Twelve adolescents were recruited in the Child Psychiatry Department at the Razi Hospital (Tunisia), with the diagnosis of schizophrenia according to the DSM-IV supplemented by the Kiddie SAD PL. They were matched by age and educational level with twelve healthy controls without psychiatric family or personal history. The clinical status of the patients was assessed using the Positive and Negative Syndrome Scale (PANSS). Neurological soft signs (NSS) were rated with the Neurological Soft Signs Examination (NSSE) by Krebs et al. (2000) for the two groups. This scale is composed of 23 items exploring motor coordination, motor integrative function, sensory integration, involuntary movements and quality of lateralization. RESULTS The mean age of our population was 14.7 years. The average age of onset of the disease was 12.2 years. The sex-ratio was 1.4. Educational level was 7.4 years. The PANSS mean total score was 74.3. The mean daily dose, in chlorpromazine equivalents, was 523.9 mg/day. Four patients received a strict monotherapy of antipsychotics, while the other patients were receiving an association of two neuroleptics. The prevalence of NSS was 100% (cut-off point=11) with a mean total score of 29.3±4.1. The highest score was for the motor coordination (10.1). As for the control group, the mean total score was 7±1.3. A highly significant difference was found between patients and controls for all sub-scores of NSS. Negative correlations were found in patients, between age and neurological soft signs total score (P=0.05; r=-0.57) and also with sensory integration score (P=0.04; r=-0.58). The NSS total score was also correlated with low educational level (P=0.03; r=-0.61). There was no correlation between neurological soft signs scores and PANSS scores or the daily dose of antipsychotics. CONCLUSION The prevalence and NSS scores are high among young people with early onset schizophrenia diagnosis illustrating the existence of structural abnormalities of the brain, themselves consequences of early neurodevelopmental disturbances, which would support the neurodevelopmental hypothesis concerning this pathology.
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Affiliation(s)
- S Bourgou Gaha
- Service de pédopsychiatrie, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Unité de recherche UR 02/04 : processus cognitifs en pathologie psychiatrique, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie.
| | - S Halayem Dhouib
- Service de pédopsychiatrie, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Unité de recherche UR 02/04 : processus cognitifs en pathologie psychiatrique, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, rue Jbel lakhdhar, Tunis, Tunisie
| | - I Amado
- Service hospitalo-universitaire, hôpital Saint-Anne, 1, rue Cabanis, 75014 Paris, France; UMR894, Inserm, laboratoire de physiopathologie des maladies psychiatriques, 2 ter, rue d'Alésia, 75014 Paris, France; Faculté de médecine Paris Descartes, 15, rue de l'école de médecine, 75006 Paris, France
| | - A Bouden
- Service de pédopsychiatrie, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Unité de recherche UR 02/04 : processus cognitifs en pathologie psychiatrique, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, rue Jbel lakhdhar, Tunis, Tunisie
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Hüttlova J, Kikinis Z, Kerkovsky M, Bouix S, Vu MA, Makris N, Shenton M, Kasparek T. Abnormalities in Myelination of the Superior Cerebellar Peduncle in Patients with Schizophrenia and Deficits in Movement Sequencing. THE CEREBELLUM 2014; 13:415-24. [DOI: 10.1007/s12311-014-0550-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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