Neurological soft signs in bipolar I disorder patients

Prevalence and characteristics of unipolar mania in a low-income country setting: population-based data from the Butajira cohort, rural Ethiopia

PURPOSE

Previous research suggests unipolar mania, i.e., bipolar disorder without depression, to be more common in low-income countries. However, longitudinal population-based studies on unipolar mania from low-income countries are lacking. This study therefore examined unipolar mania, in Butajira, Ethiopia, and associations with possible determinants.

METHODS

Key informants and 68,378 screenings with the Composite International Diagnostic Interviews (CIDI 2.1) identified suspected cases of bipolar disorder. Diagnosis was confirmed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) (n = 2,285). 315 participants with bipolar disorder were recruited and followed up for an average of 2.5 years. Unipolar mania was defined when illness episodes consisted of at least two manic relapses. 240 cases had sufficient data to ascertain course of disorder.

RESULTS

41.7% (100 of 240 cases) of participants had unipolar mania. Unipolar mania was associated with less suicidal ideation (0% vs. 26.4%, p < 0.001), less suicidal thoughts (occasionally/often: 1%/3% vs. 19.6%/21%, p < 0.001), and less history of suicide attempt (2% vs. 11.6%, p = 0.01). The participants with unipolar mania tended to have better social functioning (OR = 2.05, p = 0.07) and less alcohol use (20.8% vs. 31.4%, p = 0.07). The study was partly based on retrospective data liable to recall bias. Some cases defined as unipolar mania in our study may later develop depression.

CONCLUSION

Previous cross-sectional studies finding high proportions of unipolar mania in low-income countries appear supported. Unipolar mania trended towards better social functioning and was associated with lower suicidality. Future unipolar mania specifications could inform treatment and prognostic estimates of bipolar disorder.

Neurological and cerebellar soft signs in bipolar disorder: The role of staging, type and history of psychotic symptoms

AIM

Bipolar disorder (BD) patients show neurological abnormalities in form of neurological and cerebellar soft signs (NSS and CSS). NSS represents heterogeneous group of symptoms representing i.a. deficits of motor coordination, sequencing of complex motor acts and sensory integration. CSS were introduced as group of the neurological deficits of posture, gait, kinetic functions, eye movements and speech, associated more specifically to cerebellar abnormalities than NSS. Studies show significant effect size variability of those symptoms in BD group suggesting the existence of differing subpopulations. The aim of our study was to evaluate the effect of BD type, stage and the history of psychotic symptoms (HoPS) on the severity of CSS and NSS as none of the previous studies had verified the role of those categories.

METHODS

This study involved 181 participants: 116 euthymic BD patients (66 BD I, 50 BD II) and 65 healthy controls (HC). CSS was assessed with the International Cooperative Ataxia Rating Scale and NSS with Neurological Evaluation Scale. Patients were divided into early and late stage of the disorder according to Kapczinski's criteria. Rater was blind to patients' stage, type and HoPS.

RESULTS

Staging was related to vast majority of CSS and NSS scores. HoPS was related to oculomotor deficits. The effect of BD type was the least significant. Late stage BD showed more severe CSS and NSS than HC in every measure. There were no differences between early stage BD and HC, apart of posture and gait disturbances. Except of sensory integration scores, late stage BD showed higher CSS and NSS rates than early stage patients.

CONCLUSION

In this hitherto the largest study of neurological abnormalities in BD we have shown significant role of staging in CSS and NSS severity. Progression criteria based on inter-episode psychosocial functioning may stand as unrecognised factor responsible for variability observed in previous studies evaluating neurological abnormalities in BD. Our study suggests that in clinical practice NSS and CSS may be potentially used as easy-to-assess biological marker of BD staging. Observed severity of neurological impairments of BD patients may more likely correspond to the disease progression than to BD type and HoPS.

Correlates of neurological soft signs in bipolar disorder

Recent research has focused on neurological soft signs (NSS) in bipolar disorder (BD), but there is still scarce evidence on their correlates with other relevant variables. The aim of this study was to explore the association between NSS and clinical demographic, neurocognitive, and functional variables. Eighty-eight euthymic BD patients were included in whom NSS were assessed using the Neurological Evaluation Scale. All subjects performed an extensive neurocognitive battery selected to assess premorbid IQ, attention, language, verbal memory, and executive functions. Psychosocial outcomes were assessed by means of the Functioning Assessment Short Test. Among the demographical variables, NSS tended to be negatively associated with years of education and increased with age. Likewise, NSS were higher in BD type I than in BD type II, but independent of age at illness onset and number of previous affective episodes. There was a negative correlation between NSS and premorbid IQ, as well as with performance in attention, language, and executive functions. Results tended to be unchanged when controlled for potential confounders. Although NSS were associated with poor psychosocial functioning in the bivariate analysis, when added to a multiple regression model including neurocognition, these neurological features did not significantly contribute to the variance of the functional outcome. Our findings contribute to a better characterization of NSS in BD; their potential clinical and theoretical implications are discussed in the manuscript.

Paternal age and specific neurological soft signs as reliable and valid neurobiological markers for the diagnosis of patients with schizophrenia

Advanced parental age at delivery and neurological soft signs (NSS) constitute risk factors for schizophrenia. The aim of the current study was to develop a neurobiological diagnostic index by combining them, and without the contribution of clinical symptomatology. The study sample included 133 patients suffering from schizophrenia according to DSM-IV-TR (77 males and 56 females; aged 33.55 ± 11.22 years old) and 122 normal controls (66 males and 56 females; aged 32.89 ± 9.91 years old). The assessment included the Neurological Evaluation Scale (NES), and a number of scales assessing the clinical symptoms and adverse effects. The statistical analysis included exploratory t-test, Pearson Correlation coefficient (R) and Discriminant Function Analysis (DFA). Exploratory t-tests and Pearson's R suggested that sex, parental age and NSS constitute independent components. On the basis of DFA results, the Psychotic Neurological Index was developed. At the cut-off PNI score of 8.5, sensitivity was equal to 94.74 and specificity to 93.44. The current is probably the first study to report on an easily obtainable diagnostic neurobiological marker with identifiable properties which is absolutely independent from the clinical manifestations and could serve in distinguishing between patients with schizophrenia and healthy controls with high efficacy.

Neurological soft signs for discrimination between euthymic patients with bipolar I disorder and healthy controls

Background

Neurological soft signs in remitted state of bipolar disorder may represent trait deficits and the aim of this study was to examine the extent of neurological soft signs in euthymic patients with bipolar I disorder as compared to healthy controls. We conducted this study in Zagazig University Hospital upon 60 subjects divided into two groups: euthymic patients with bipolar I disorder group (30 patients) and control group (30 healthy individuals). Assessment of neurological soft signs was performed through Neurological Evaluation Scale and the euthymic state was determined by Young Mania Rating Scale and Hamilton Depression Rating Scale.

Results

The euthymic patient group exhibited a significantly worse performance in the total Neurological Evaluation Scale and the whole four subtest scores than healthy control subjects. There was a statistically significant association between total neurological soft sign score and mood stabilizer therapy in the studied patients. The age of onset of the disorder was correlated to the total score of Neurological Evaluation Scale which is statistically significant. The best cutoff points of the total neurological soft signs score in the discrimination between the euthymic patient group and control group was 3.5 according to the receiver operating characteristic curve.

Conclusion

This study may emphasize the role of neurological soft signs as a sign of organic brain disorder; however, further studies may be able to extend our findings to explore the etiology and pathogenesis of bipolar I disorder.

Resting state networks activity in euthymic bipolar disorder

OBJECTIVES

Bipolar disorder (BD) is a psychiatric condition causing shifts in mood, energy and activity levels severely altering the quality of life of the patients even in the euthymic phase. Although widely accepted, the neurobiological bases of the disorder in the euthymic phase remain elusive. This study aims at characterizing resting state functional activity of the BD euthymic phase in order to better understand the pathogenesis of the disease and build future neurobiological models.

METHODS

Fifteen euthymic BD patients (10 females; mean age 40.2; standard deviation 13.5; range 20-61) and 27 healthy controls (HC) (21 females; mean age 37; standard deviation 10.6; range 22-60) underwent a 3T functional MRI scan at rest. Resting state activity was extracted through independent component analysis (ICA) run with automatic dimensionality estimation.

RESULTS

ICA identified 22 resting state networks (RSNs). Within-network analysis revealed decreased connectivity in the visual, temporal, motor and cerebellar RSNs of BD patients vs HC. Between-network analysis showed increased connectivity between motor area and the default mode network (DMN) partially overlapping with the fronto-parietal network (FPN) in BD patients.

CONCLUSION

Within-network analysis confirmed existing evidence of altered cerebellar, temporal, motor and visual networks in BD. Increased connectivity between the DMN and the motor area network suggests the presence of alterations of the fronto-parietal regions, precuneus and cingulate cortex in the euthymic condition. These findings indicate that specific connectivity alterations might persist even in the euthymic state suggesting the importance of examining both within and between-network connectivity to achieve a global understanding of the BD euthymic condition.

12-Month stability of neurological soft signs in stabilized patients with schizophrenia

Objective: Neurological soft signs (NSS) are a group of minor non-localizable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was to investigate their temporal stability and relationship to the overall outcome over a 12-month period. Material and methods: The study sample included 133 stabilized patients suffering from schizophrenia (77 males and 56 females; aged 33.55 ± 11.22 years old). The assessment included the application at baseline and after 12 months of the Neurological Evaluation Scale (NES), and a number of scales assessing the clinical symptoms and adverse effects. The statistical analysis included ANOVA, exploratory t-test and Pearson correlation coefficients with Bonferroni correction. Results: In stabilized patients, NSS are stable over a 12-month period with only the subscale of NES-sensory integration manifesting a significant worsening, while, in contrast, most of the clinical variables improved significantly. There was no relationship of NES scores with the magnitude of improvement. The only significant negative correlation was between NES-motor coordination and Positive and Negative Syndrome Scale-GP change at 1 year. Discussion: The results of the current study suggest that after stabilization of patients with schizophrenia, there are probably two separate components, a 'trait' which is stable over a 12-month period, and a 'degenerative' component with a tendency to worsen probably in parallel with the progression of the illness and in correlation with the worsening of negative symptoms. However, the statistical support of the 'degenerative' component is weak. Significant outcomes Neurological softs signs are stable over a 12-month period, with the exception of 'sensory integration' which manifests significant improvement irrespective of treatment response. They do not respond to treatment with antipsychotics. They do not constitute a prognostic factor to predict improvement over a period of 1 year. Neurological soft signs constitute a trait symptom of schizophrenia which is stable though time. Limitations All the subjects have been previously hospitalized which may represent a more severe form of schizophrenia. Also, all patients were under antipsychotic and some also under benzodiazepine medications. Patients with comorbid somatic disorders were excluded which may decrease generalizability of results.

Handwriting movements for assessment of motor symptoms in schizophrenia spectrum disorders and bipolar disorder

The main aim of the present study was to explore the value of several measures of handwriting in the study of motor abnormalities in patients with bipolar or psychotic disorders. 54 adult participants with a schizophrenia spectrum disorder or bipolar disorder and 44 matched healthy controls, participated in the study. Participants were asked to copy a handwriting pattern consisting of four loops, with an inking pen on a digitizing tablet. We collected a number of classical, non-linear and geometrical measures of handwriting. The handwriting of patients was characterized by a significant decrease in velocity and acceleration and an increase in the length, disfluency and pressure with respect to controls. Concerning non-linear measures, we found significant differences between patients and controls in the Sample Entropy of velocity and pressure, Lempel-Ziv of velocity and pressure, and Higuchi Fractal Dimension of pressure. Finally, Lacunarity, a measure of geometrical heterogeneity, was significantly greater in handwriting patterns from patients than from controls. We did not find differences in any handwriting measure on function of the specific diagnosis or the antipsychotic dose. Results indicate that participants with a schizophrenia spectrum disorder or bipolar disorder exhibit significant motor impairments and that these impairments can be readily quantified using measures of handwriting movements. Besides, they suggest that motor abnormalities are a core feature of several mental disorders and they seem to be unrelated to the pharmacological treatment.

Neurological soft signs in familial and sporadic schizophrenia

OBJECTIVE

Neurological soft signs (NSS) are a group of minor non-localizable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was investigate whether there is any difference in their manifestation in familial vs. sporadic schizophrenia.

MATERIAL AND METHODS

The study sample included 120 patients suffering from schizophrenia according to DSM-5 (71 males and 49 females; aged 32.79 ± 11.11 years old) and 110 normal controls (57 males and 53 females; aged 33.38 ± 10.14 years old). The assessment included the Neurological Evaluation Scale (NES) and the detailed investigation family history. The statistical analysis included exploratory Analysis of Covariance.

RESULTS

The results of the current study suggest that NSS are more frequent in familial cases of schizophrenia and are even more pronounced in cases with family history of psychosis in either first or second degree relatives.

DISCUSSION

Overall the results suggest the presence of a spectrum of increasing severity from healthy controls to sporadic cases, to cases with non-psychotic family history and eventually to cases with psychotic family history, rather than a categorical distribution.

Neurological soft signs in bipolar disorder in comparison to healthy controls and schizophrenia: A meta-analysis

Neurological soft signs (NSS) are subtle deficits in motor coordination, sensory integration, and sequencing of complex motor acts. Increased NSS is a well-established feature of patients with schizophrenia but a relatively smaller number of studies have investigated NSS in bipolar disorder (BD). Some authors but not others suggested that NSS can distinguish schizophrenia from BD. We conducted a meta-analysis of 18 studies to quantitatively review NSS in BD in comparison to schizophrenia and healthy controls. The current meta-analysis compared NSS scores of 725 BD patients and 634 healthy controls, and 391 BD and 471 schizophrenia patients. Patients with BD had significantly higher NSS scores (d = 1.14, CI = 0.89-1.44) than healthy controls and increased scores in BD was evident in all aspects of NSS (d = 0.88-0.99). BD was associated with a less severe increase in NSS compared to schizophrenia, however, between-group difference was modest (d = 0.42, CI = 0.18-0.65). The results of this meta-analysis demonstrated that BD is characterized by a robust increase in NSS which is only moderately less severe than schizophrenia. Increased NSS is a common feature of both disorders.

Motor dysfunction as an intermediate phenotype across schizophrenia and other psychotic disorders: Progress and perspectives

Primary motor abnormalities (PMA), as found in patients with schizophrenia, are quantitatively and qualitatively distinct markers of motor system abnormalities. PMA have been often referred to phenomena that are present across schizophrenia-spectrum disorders. A dysfunction of frontoparietal and subcortical networks has been proposed as core pathophysiological mechanism underlying the expression of PMA. However, it is unclear at present if such mechanisms are a common within schizophrenia and other psychotic disorders. To address this question, we review recent neuroimaging studies investigating the neural substrates of PMA in schizophrenia and so-called "nonschizophrenic nonaffective psychoses" (NSNAP) such as schizophreniform, schizoaffective, brief psychotic, and other unspecified psychotic disorders. Although the extant data in patients with schizophrenia suggests that further investigation is warranted, MRI findings in NSNAP are less persuasive. It is unclear so far which PMA, if any, are characteristic features of NSNAP or, possibly even specific for these disorders. Preliminary data suggest a relationship between relapsing-remitting PMA in hyper-/hypokinetic cycloid syndromes and neurodegenerative disorders of the basal ganglia, likely reflecting the transnosological relevance of subcortical abnormalities. Despite this evidence, neural substrates and mechanisms underlying PMA that are common in schizophrenia and NSNAP cannot be clearly delineated at this stage of research. PMA and their underlying brain circuits could be promising intermediate phenotype candidates for psychotic disorders, but future multimodal neuroimaging studies in schizophrenia and NSNAP patients and their unaffected first-degree relatives are needed to answer fundamental transnosologic questions.

Motor dysfunction as research domain across bipolar, obsessive-compulsive and neurodevelopmental disorders

Although genuine motor abnormalities (GMA) are frequently found in schizophrenia, they are also considered as an intrinsic feature of bipolar, obsessive-compulsive, and neurodevelopmental disorders with early onset such as autism, ADHD, and Tourette syndrome. Such transnosological observations strongly suggest a common neural pathophysiology. This systematic review highlights the evidence on GMA and their neuroanatomical substrates in bipolar, obsessive-compulsive, and neurodevelopmental disorders. The data lends support for a common pattern contributing to GMA expression in these diseases that seems to be related to cerebello-thalamo-cortical, fronto-parietal, and cortico-subcortical motor circuit dysfunction. The identified studies provide first evidence for a motor network dysfunction as a correlate of early neurodevelopmental deviance prior to clinical symptom expression. There are also first hints for a developmental risk factor model of these mental disorders. An in-depth analysis of motor networks and related patho-(physiological) mechanisms will not only help promoting Research Domain Criteria (RDoC) Motor System construct, but also facilitate the development of novel psychopharmacological models, as well as the identification of neurobiologically plausible target sites for non-invasive brain stimulation.

Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BACKGROUND

Adjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.

AIMS

To evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.

METHOD

A systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.

RESULTS

A total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive-behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.

CONCLUSIONS

Adjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.

DECLARATION OF INTEREST

None.

Neurological soft signs significantly differentiate schizophrenia patients from healthy controls

OBJECTIVE

Neurological soft signs (NSS) are a group of minor non-localisable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was to test for the effect of gender, age, parental age, age at onset and clinical symptomatology on NSS.Material and methodsThe study sample included 133 patients suffering from schizophrenia according to DSM-IV-TR (77 males and 56 females; aged 33.55±11.22 years old) and 122 normal controls (66 males and 56 females; aged 32.89±9.91 years old). The assessment included the Neurological Evaluation Scale (NES), and a number of scales assessing the clinical symptoms and adverse effects especially extrapyramidal. The statistical analysis included exploratory t-test, simple linear regression analysis, analysis of covariance and the calculation of correlation coefficients.

RESULTS

The results of the current study confirm that NSS are more frequent in patients with schizophrenia in comparison with normal controls (Wilks=0.622, p<0.0001), but do not support an effect of gender, age, age at onset, paternal or maternal age, education, medication status or clinical subtype of schizophrenia on NES scores.DiscussionOverall these results suggest that NSS constitute an independent (from the rest of symptoms), core (present in the vast majority of patients) and trait (unrelated to age and probably to the stage of schizophrenia) symptom of schizophrenia which could be of value in the clinical assessment and research of schizophrenia. Overall these results are not in full accord with the literature, but they could serve to fill in gaps and inconsistencies observed so far.

Neurological soft signs in bipolar and unipolar disorder: A case-control study

Neuropsychiatric disorders are associated with neurological soft signs (NSS), including motor, sensory, and inhibitory dysfunction. The present study aims at determining the prevalence of NSS and explore the association of sociodemographic characteristics with the occurrence of NSS in patients with bipolar disorder and unipolar depression compared to healthy controls. A case-control study included a sample of 50 bipolar and unipolar patients and 50 healthy controls. NSS subscales of the Neurological Evaluation Scale (NES) were administered to each participant. Significant differences were found in the total NES score, motor coordination, sensory integration, sequence of complex motor act and other subscales among the three groups. Compared with healthy controls, patients with bipolar disorder showed significantly more total NSS signs, motor coordination signs and sensory-integration signs. When compared with patients with unipolar disorder, patients with bipolar disorder showed significantly more sensory integration signs and a trend of difference in the sequencing of complex motor acts and other subscales. Our findings suggest that NSS may be specifically associated with bipolar disorder but not unipolar depression. The specificity of NSS expression has the potential to help the discrimination of bipolar disorder from disorders less likely to have a neurodevelopmental component such as major depression.

Motor Abnormalities: From Neurodevelopmental to Neurodegenerative Through "Functional" (Neuro)Psychiatric Disorders

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.

Aberrant cerebellar connectivity in bipolar disorder with psychosis

BACKGROUND

The cerebellum, which modulates affect and cognition in addition to motor functions, may contribute substantially to the pathophysiology of mood and psychotic disorders, such as bipolar disorder. A growing literature points to cerebellar abnormalities in bipolar disorder. However, no studies have investigated the topographic representations of resting state cerebellar networks in bipolar disorder, specifically their functional connectivity to cerebral cortical networks.

METHODS

Using a well-defined cerebral cortical parcellation scheme as functional connectivity seeds, we compared ten cerebellar resting state networks in 49 patients with bipolar disorder and a lifetime history of psychotic features and 55 healthy control participants matched for age, sex, and image signal-to-noise ratio.

RESULTS

Patients with psychotic bipolar disorder showed reduced cerebro-cerebellar functional connectivity in somatomotor A, ventral attention, salience, and frontoparietal control A and B networks relative to healthy control participants. These findings were not significantly correlated with current symptoms.

CONCLUSIONS

Patients with psychotic bipolar disorder showed evidence of cerebro-cerebellar dysconnectivity in selective networks. These disease-related changes were substantial and not explained by medication exposure or substance use. Therefore, they may be mechanistically relevant to the underlying susceptibility to mood dysregulation and psychosis. Cerebellar mechanisms deserve further exploration in psychiatric conditions, and this study's findings may have value in guiding future studies on pathophysiology and treatment of mood and psychotic disorders, in particular.

Voxel-based morphometry meta-analysis of gray and white matter finds significant areas of differences in bipolar patients from healthy controls

OBJECTIVE

We present a retrospective meta-analysis of voxel-based morphometry (VBM) of gray (GM) and white matter (WM) differences between patients with bipolar disorder (BD) and behaviorally healthy controls.

METHODS

We used the activation likelihood estimation and Sleuth software for our meta-analysis, considering P-value maps at the cluster level inference of .05 with uncorrected P<.001. Results were visualized with the software MANGO.

RESULTS

We included twenty-five articles in the analysis, and separated the comparisons where BD patients had lower GM or WM concentrations than controls (573 subjects, 21 experiments, and 117 locations/180 subjects, five experiments, and 15 locations, respectively) and the comparisons where BD patients had greater GM concentrations than controls (217 subjects, nine experiments, and 49 locations). Higher WM concentrations in BD patients were not detected. We observed for BD reduced GM concentrations in the left medial frontal gyrus and right inferior/precentral gyri encompassing the insular cortex, and greater GM concentrations in the left putamen. Further, lower WM concentrations were detected in the left inferior longitudinal fasciculus, left superior corona radiata, and left posterior cingulum.

CONCLUSIONS

This meta-analysis confirms deterioration of frontal and insular regions as already found in previous meta-analysis. GM reductions in these regions could be related to emotional processing and decision making, which are typically impaired in BD. Moreover, we found abnormalities in precentral frontal areas and putamen that have been linked to more basic functions, which could point to sensory and specific cognitive deficits. Finally, WM reductions involved circuitry that may contribute to emotional dysregulation in BD.

Neurological soft signs and cognitive functions: Amongst euthymic bipolar I disorder cases, non-affected first degree relatives and healthy controls

Both neurological soft signs (NSS) and cognitive deficits are present among euthymic bipolar patients. NSS could be related to neurocognitive performance, but this is not explored thoroughly. Healthy relatives of patients may also suffer from similar deficits. This study compared NSS and cognitive functions in euthymic Bipolar I Disorder (BPI) cases to their non-affected first degree relatives and healthy controls. We also investigated the association between NSS and cognitive functions in these three groups. NSS were assessed in three groups using Neurological Evaluation Scale-revised (NES-r). Eight cognitive domains were assessed in 31 euthymic BPI cases, their 30 non-affected first degree relatives and 30 healthy controls using Computerized Neurocognitive Battery (CNB). Euthymic BPI patients had significantly more NSS than non-affected first degree relatives on 5/7 tests (p-value ranges from 0.042 to p=0.0001) and healthy controls on all tests (p-value from 0.042 to <0.0001). Non-affected first degree relatives and controls did not have any significant difference. BPI participants performed worse than their non-affected first degree relatives on one neurocognitive domain of CNB (spatial memory accuracy, p=0.03) and healthy controls on four domains (spatial memory accuracy (p=0.04), abstraction and mental flexibility efficiency (p=0.04), spatial memory efficiency (p=0.04), and emotion efficiency (p=0.04). Non-affected relatives and healthy controls were similar on neurocognitive domains. Accuracy and efficiency indices of some specific cognitive domains were negatively associated with AV rating and tap copying NSS ratings.

Neuropsychological, electrophysiological and neurological impairments in patients with obsessive compulsive disorder, their healthy siblings and healthy controls: Identifying potential endophenotype(s)

The etiology of obsessive-compulsive disorder (OCD) has not been clarified. This study aimed to investigate the cognitive, neurological, electrophysiological functions which are reflected in executive functions, memory, visuospatial integration; neurological examination and auditory event related potentials (AERP) (N100, N200, P200 and P300) in patients with OCD, their siblings, and control subjects and to determine potential endophenotypic markers. Thirty-three patients with OCD, 18 siblings and 21 controls; matched for age, gender and years of education were included. Yale Brown Obsessive Compulsive Symptoms Checklist Scale, Hamilton Depression-Rating Scale, an exhaustive neuropscyhological test battery and Neurological Evaluation Scale were administered. Their AERP recordings were obtained. Executive functions and visuospatial integration were highly impaired in patients and slightly in their siblings compared to controls. P200 amplitude was sorted as siblings>patients>controls. P300 amplitude was sorted as patients<siblings<controls. Neurological Evaluation Scale scores were lower in patients compared to siblings and controls. The logistic regression analysis showed that, higher P300 amplitude, better performance on block design test and faster completion of Stroop test would predict being in the control group, whereas higher P200 amplitude would predict being in the case (patient and sibling) groups. We suggest that these seem to be the potential endophenotypes of OCD.

Neurological soft signs in euthymic bipolar I patients: A comparative study with healthy siblings and controls

Neurological Soft Signs (NSS) are endophenotypic markers widely studied in schizophrenia and remain poorly evaluated in bipolar disorder. The aims of this paper were to determine the prevalence and scores of NSS in bipolar I patients, compared to healthy siblings and controls and to explore correlations with socio-demographic and clinical features of patients. This was a case-control study comparing 92 euthymic bipolar I patients, 44 of their healthy siblings and 60 control subjects. The neurological assessment was performed through the NSS scale validated by Krebs et al. (2000). Bipolar I patients were also assessed with the Bech-Rafaelsen Mania Scale (MAS), the Hamilton Depression Rating Scale (HDRS) and the Global Assessment of Functioning (GAF). The raters were not blinded to groups. The prevalence and the total score of NSS were significantly higher in bipolar I patients compared to their healthy siblings and controls. The sibling group had significantly higher NSS prevalence and total score than controls. No correlation was found between NSS total score and socio-demographic and clinical features of patients, except a negative correlation with the school level and the GAF score. In conclusion, bipolar I patients have motor and sensory signs, which are unrelated to their clinical features.

Socioeconomic disadvantage and neural development from infancy through early childhood

BACKGROUND

Early social experiences are believed to shape neurodevelopment, with potentially lifelong consequences. Yet minimal evidence exists regarding the role of the social environment on children's neural functioning, a core domain of neurodevelopment.

METHODS

We analysed data from 36 443 participants in the United States Collaborative Perinatal Project, a socioeconomically diverse pregnancy cohort conducted between 1959 and 1974. Study outcomes included: physician (neurologist or paediatrician)-rated neurological abnormality neonatally and thereafter at 4 months and 1 and 7 years; indicators of neurological hard signs and soft signs; and indicators of autonomic nervous system function.

RESULTS

Children born to socioeconomically disadvantaged parents were more likely to exhibit neurological abnormalities at 4 months [odds ratio (OR) = 1.20; 95% confidence interval (CI) = 1.06, 1.37], 1 year (OR = 1.35; CI = 1.17, 1.56), and 7 years (OR = 1.67; CI = 1.48, 1.89), and more likely to exhibit neurological hard signs (OR = 1.39; CI = 1.10, 1.76), soft signs (OR = 1.26; CI = 1.09, 1.45) and autonomic nervous system dysfunctions at 7 years. Pregnancy and delivery complications, themselves associated with socioeconomic disadvantage, did not account for the higher risks of neurological abnormalities among disadvantaged children.

CONCLUSIONS

Parental socioeconomic disadvantage was, independently from pregnancy and delivery complications, associated with abnormal child neural development during the first 7 years of life. These findings reinforce the importance of the early environment for neurodevelopment generally, and expand knowledge regarding the domains of neurodevelopment affected by environmental conditions. Further work is needed to determine the mechanisms linking socioeconomic disadvantage with children's neural functioning, the timing of such mechanisms and their potential reversibility.

Motor dysfunction within the schizophrenia-spectrum: A dimensional step towards an underappreciated domain

At the beginning of the 20th century, genuine motor abnormalities (GMA) were considered to be intricately linked to schizophrenia. Subsequently, however, GMA have been increasingly regarded as unspecific transdiagnostic phenomena or related to side effects of antipsychotic treatment. Despite possible medication confounds, within the schizophrenia spectrum GMA have been categorized into three broad categories, i.e. neurological soft signs, abnormal involuntary movements and catatonia. Schizophrenia patients show a substantial overlap across a broad range of distinct motor signs and symptoms suggesting a prominent involvement of the motor system in disease pathophysiology. There have been several attempts to increase reliability and validity in diagnosing schizophrenia based on behavior and neurobiology, yet relatively little attention has been paid to the motor domain in the past. Nevertheless, accumulating neuroscientific evidence suggests the possibility of a motor endophenotype in schizophrenia, and that GMA could represent a specific dimension within the schizophrenia-spectrum. Here, we review current neuroimaging research on GMA in schizophrenia with an emphasis on distinct and common mechanisms of brain dysfunction. Based on a dimensional approach we show that multimodal neuroimaging combined with fine-grained clinical examination can result in a comprehensive characterization of structural and functional brain changes that are presumed to underlie core GMA in schizophrenia. We discuss the possibility of a distinct motor domain, together with its implications for future research. Investigating GMA by means of multimodal neuroimaging can essentially contribute at identifying novel and biologically reliable phenotypes in psychiatry.

Brain area-related neurological soft signs in depressive patients with different types of childhood maltreatment

INTRODUCTION

This study aims to investigate the effects of childhood maltreatment on neurological soft signs (NSS) associated with certain brain area in depressive patients.

METHODS

One hundred three depressive patients were enrolled into this study, and evaluated by Childhood Trauma Questionnaire (CTQ), brain area-related neurological examination scale, 24-item Hamilton Rating scale (HAMD24), the scale for suicidal ideation (SSI) and Beck Hopelessness Scale (BHS).

RESULTS

Patients undergoing childhood maltreatment exhibited higher frontal area-related NSS scores than patients without childhood maltreatment experience. Patients experiencing childhood emotional or physical neglect displayed more frontal area-related NSS compared to their respective non-maltreatment group. Moreover, physical neglect maltreatment caused more temporal area-related NSS. Patients suffering from childhood sexual abuse had more frontal, temporal and occipital area-related NSS than patients lacking experience of childhood sexual abuse. Further correlation analysis revealed that the total score of maltreatment positively correlated with frontal and temporal area-related NSS score. There was a positive correlation between emotional abuse, emotional neglect or physical abuse and frontal area-related NSS. Physical neglect and sexual abuse were positively associated with the temporal area-related NSS score. HAMD24 score was positively correlated with all brain area-related NSS score; The SSI score correlated with three area (excluded occipital area)-related NSS score. The BHS score only positively correlated with frontal area score of NSS. Finally, no significant association was found between suicidal frequencies and brain area-related NSS score.

DISCUSSION

Childhood maltreatment adversely affects the brain of depressive patients; the different maltreatment may impair different brain areas, especially frontal and temporal areas.

The impact of cognitive impairment, neurological soft signs and subdepressive symptoms on functional outcome in bipolar disorder

BACKGROUND

Cognitive impairments and subsyndromal depressive symptoms are present during euthymic periods of bipolar disorder (BD). Most studies have determined that cognitive impairments and residual depressive symptoms have major impacts on psychosocial functioning. The aim of the present study was to identify the major factor responsible for low psychosocial functioning in a subgroup of patients with BD despite clinical recovery.

METHODS

Sixty patients with bipolar I disorder and 41 healthy subjects were enrolled in this study. Cognitive performance, neurological soft signs (NSSs), psychosocial functioning, residual mood symptoms and illness characteristics were assessed. Using the median value of the Functioning Assessment Short Test (FAST) as the cut-off point, the patients were divided into two groups, high- (n=29) or low-functioning (n=31), and they were compared based on total NSS, residual depressive symptoms, cognitive performance and clinical variables.

RESULTS

Performances on the verbal memory tests and social functioning were significantly worse in the euthymic patients with BD. Increased rates of NSS were identified in the patients compared with the normal controls. The low-functioning patients performed significantly worse on verbal memory, and their NSS and residual depressive symptoms were significantly higher compared to high-functioning patients. In the regression analysis, subsyndromal depressive symptoms and verbal learning measures were identified as the best predictors of psychosocial functioning.

LIMITATIONS

The patients were artificially separated into two groups based on a FAST score cut-off.

CONCLUSIONS

In this study, residual depressive symptoms and verbal memory impairments were the most prominent factors associated with the level of functioning.

Effect of cognitive intervention on children with ADHD

Although not considered a diagnostic criterion in DSM-IV, motor difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD) are commonly reported. Prevalence of co-morbidity of ADHD and Developmental Coordination Disorder is as high as 50%. Cognitive Orientation to daily Occupational Performance (CO-OP) is a problem-solving approach originally developed for children with Developmental Coordination Disorder. In this approach, therapists support children to use cognitive strategies in a process of guided discovery to solve occupational performance problems. A single case experimental design (multiple baselines) was used to examine the influence of a 12-week intervention using CO-OP with six children with ADHD. Outcome measures included the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling and the Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP). The results of this study demonstrated improvements in both goals and motor performance in the participants due to the intervention. These results provide some support for the use of CO-OP with children with ADHD. Further research into the application of CO-OP with children with ADHD is warranted based on these preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties.

Neurological soft signs and prepulse inhibition of the startle reflex in psychosis: A pilot study

OBJECTIVE

Prepulse inhibition (PPI) of the startle reflex deficit and neurological soft signs (NSS) are two markers of vulnerability to psychosis. This study investigated the possibility of a PPI-NSS relation due to a putative common biological substrate, hypothesizing that patients with higher NSS scores also show higher PPI deficits. Moreover, we examined the possibility of an association of PPI deficits and NSS with negative symptoms.

METHODS

Fifteen subjects with psychosis and fifteen healthy controls underwent PPI and NSS evaluations.

RESULTS

Patients did not exhibit higher PPI deficits but only higher NSS rates (p < 0.01), as compared with healthy controls. Higher NSS rates were not associated with PPI deficits, and NSS sensory integration signs correlated positively with negative symptoms (p < 0.01).

CONCLUSION

Our study supported the hypothesis that NSS are trait markers whereas PPI deficits state markers and that their putative common biological substrate is not sufficient to determinate an association between them. The study hypothesis, however, needs further investigation.

Neurological soft signs are not "soft" in brain structure and functional networks: evidence from ALE meta-analysis

BACKGROUND

Neurological soft signs (NSS) are associated with schizophrenia and related psychotic disorders. NSS have been conventionally considered as clinical neurological signs without localized brain regions. However, recent brain imaging studies suggest that NSS are partly localizable and may be associated with deficits in specific brain areas.

METHOD

We conducted an activation likelihood estimation meta-analysis to quantitatively review structural and functional imaging studies that evaluated the brain correlates of NSS in patients with schizophrenia and other psychotic disorders. Six structural magnetic resonance imaging (sMRI) and 15 functional magnetic resonance imaging (fMRI) studies were included.

RESULTS

The results from meta-analysis of the sMRI studies indicated that NSS were associated with atrophy of the precentral gyrus, the cerebellum, the inferior frontal gyrus, and the thalamus. The results from meta-analysis of the fMRI studies demonstrated that the NSS-related task was significantly associated with altered brain activation in the inferior frontal gyrus, bilateral putamen, the cerebellum, and the superior temporal gyrus.

CONCLUSIONS

Our findings from both sMRI and fMRI meta-analyses further support the conceptualization of NSS as a manifestation of the "cerebello-thalamo-prefrontal" brain network model of schizophrenia and related psychotic disorders.

Are neurological soft signs pre-existing markers in individuals with an at-risk mental state for psychosis?

Neurological soft signs (NSS) are more common in schizophrenic psychoses and in genetically high-risk individuals than in healthy controls. But nothing is known so far regarding individuals with a clinical at-risk mental state (ARMS). The goals of our study therefore were (a) to compare the NSS frequency in ARMS individuals to that of first-episode psychosis (FEP) patients and (b) to test whether NSS could predict the transition to psychosis. Neurological soft signs were assessed using a shortened version of the Neurological Evaluation Scale (NES). Fifty-three ARMS individuals (16 with later transition to psychosis=ARMS-T, and 37 without transition=ARMS-NT) and 27 FEP patients were recruited through the Basel Early Detection Clinic FePsy. Of the FEP patients 37% showed NSS. We found no significant differences between FEP and ARMS-T patients or between ARMS-NT and ARMS-T. Our findings of NSS being present already before transition to psychosis to the same extent as after transition provide further support to the neurodevelopmental hypothesis of schizophrenic psychoses. Furthermore, our findings might indicate that ARMS-NT individuals also suffer from some sort of neurodevelopmental abnormalities.

Sensory and motor secondary symptoms as indicators of brain vulnerability

In addition to the primary symptoms that distinguish one disorder from the next, clinicians have identified, yet largely overlooked, another set of symptoms that appear across many disorders, termed secondary symptoms. In the emerging era of systems neuroscience, which highlights that many disorders share common deficits in global network features, the nonspecific nature of secondary symptoms should attract attention. Herein we provide a scholarly review of the literature on a subset of secondary symptoms––sensory and motor. We demonstrate that their pattern of appearance––across a wide range of psychopathologies, much before the full-blown disorder appears, and in healthy individuals who display a variety of negative symptoms––resembles the pattern of appearance of network abnormalities. We propose that sensory and motor secondary symptoms can be important indicators of underlying network aberrations and thus of vulnerable brain states putting individuals at risk for psychopathology following extreme circumstances.

Is the non-verbal behavioural emotion-processing profile of bipolar disorder impaired? A critical review

OBJECTIVE

Growing evidence suggests that patients with bipolar disorder (BD) are impaired in their ability to process non-verbal emotion, although few comprehensive reviews of the behavioural literature exist, and there has been little consideration of methodological issues that may account for discrepant empirical findings. This review examines the behavioural facial, prosodic and multimodal processing literature in BD and discusses methodological issues in the context of this evidence.

METHOD

Major computer databases including Google Scholar and PsychINFO were consulted to conduct a comprehensive review of quantitative behavioural differences in the emotion-processing literature in BD. Articles were accepted only if the target population sample met criteria for a DSM-III, DSM-IV or ICD-10 diagnosis, and they contained a healthy control group.

RESULTS

The current literature suggests that facial emotion processing is impaired, and there is preliminary evidence for some behavioural impairment in the processing of emotional prosody.

CONCLUSION

The specificity or generalisability of impairments in facial emotion processing and the effects of mood state are unclear. Similarly, the lack of clarity around the impact of auditory processes on emotional prosody processing warrants a comprehensive examination of the auditory profile in BD.

A kinematic analysis of manual aiming control on euthymic bipolar disorder

Motor deficits in tasks that require force steadiness or scaling of movement velocity have been found in bipolar disorder (BD). A potential explanation for these results is the abnormal functioning of the frontostriatal circuitry. We designed this study to investigate the possible impairments in a manual aiming task. Participants comprised 15 euthymic BD patients and 15 healthy controls, who performed 100 trials of a goal-directed manual movement with a non-inking pen on a digitizing tablet. Four different conditions of execution were required. The control condition appeared on the computer screen in 70% of the trials, and the other three conditions, (a) distractor, (b) inhibition of response and (c) higher index of difficulty, each appeared in 10% of the trials. Compared to the controls, the BD patients were less fluent in their movements, relied more heavily on visual feedback to control their manual movements and presented a lower spatial accuracy. We found that motor deficits in euthymic BD were observed in the kinematic analysis of manual aiming. Our findings are consistent with the hypothesis of abnormal functioning of the frontostriatal circuitry in euthymic BD.

Neurological soft signs discriminate schizophrenia from major depression but not bipolar disorder

BACKGROUND

Neurological soft signs (NSS) are minor neurological abnormalities, including motor, sensory, and inhibitory dysfunction. Schizophrenia and other neuropsychiatric disorders are associated with a higher prevalence of NSS. However, the relationships between NSS and schizophrenia, bipolar disorder, and major depression are unclear. The present study aimed to examine the specificity of NSS among these three clinical groups.

METHOD

A total of 120 demographically matched participants (30 each in schizophrenia, bipolar disorder, major depression, and healthy controls) were recruited for the study. NSS subscales of the Cambridge Neurological Inventory (CNI) were administered to each participant.

RESULTS

Significant differences were found in the total score of NSS (p<0.01), and the subscale scores for motor coordination (p<0.01), sensory integration (p=0.01) and disinhibition (p<0.01). Both patients with schizophrenia and bipolar disorder showed more total NSS signs than healthy controls (p<0.01). Patients with schizophrenia also showed more total NSS signs than patients with major depression (p=0.02). Both patients with schizophrenia and patients with bipolar disorder showed more motor coordination signs than healthy controls and patients with major depression (p<0.05). Moreover, compared with healthy controls, patients with schizophrenia showed more disinhibition signs (p<0.01), while patients with bipolar disorder showed more sensory integration signs (p<0.01). Discriminant analysis showed 77.5% of correct classification of patients with schizophrenia and bipolar disorder from patients with major depression and healthy controls.

CONCLUSIONS

NSS are not unique to schizophrenia, but are also found in bipolar disorder, while patients with major depression are comparable to normal controls. Our results suggest that NSS, especially motor-coordination signs, can differentiate schizophrenia from major depression but not bipolar disorder. Our results may provide further evidence to support the similarity between schizophrenia and bipolar disorder from the dimension of behavioral expression.

Neurological soft signs in obsessive-compulsive disorder: two empirical studies and meta-analysis

BACKGROUND

Neurological soft signs (NSS) have been inconsistently reported in obsessive-compulsive disorder (OCD) but may make an impact on treatment response. Method The current study examined the presence of NSS in two independent European samples of OCD patients (combined 85 patients and 88 matched healthy controls) using a standardized instrument and conducted a meta-analysis of all published studies identified in the literature with the aim to provide a more definitive answer to the question of whether OCD patients are characterized by increased NSS.

RESULTS

Both empirical studies found elevated NSS scores in patients compared with matched controls. The results of the meta-analysis, which included 15 studies (combined 498 patients and 520 controls) showed large effect sizes (Hedges' g=1.27, 95% confidence interval 0.80-1.75), indicating that OCD patients have significantly higher rates of NSS than matched controls on both sides of the body and in multiple domains (motor coordination, sensory integration and primitive reflexes). The results were robust and remained largely unchanged in our reliability analyses, which controlled for possible outliers. Meta-regression was employed to examine the role of potential variables of interest including sociodemographic variables, symptom severity, medication effects and the use of different instruments, but none of these variables was clearly associated with NSS.

CONCLUSIONS

As a group, OCD patients are characterized by increased rates of NSS, compared with healthy controls. However, their origins and potential clinical importance remain to be clarified. Future directions for research are discussed.

Neurological soft signs in individuals with pathological gambling

Increased neurological soft signs (NSSs) have been found in a number of neuropsychiatric syndromes, including chemical addiction. The present study examined NSSs related to perceptual-motor and visuospatial processing in a behavioral addiction viz., pathological gambling (PG). As compared to mentally healthy individuals, pathological gamblers displayed significantly poorer ability to copy two- and three-dimensional figures, to recognize objects against a background noise, and to orient in space on a road-map test. Results indicated that PG is associated with subtle cerebral cortical abnormalities. Further prospective clinical research is needed to address the NSSs' origin and chronology (e.g., predate or follow the development of PG) as well as their response to therapeutic interventions and/or their ability to predict such a response.

Finding behavioral and network indicators of brain vulnerability

Resilience research has usually focused on identifying protective factors associated with specific stress conditions (e.g., war, trauma) or psychopathologies (e.g., post-traumatic stress disorder [PTSD]). Implicit in this research is the concept that resilience is a global construct, invariant to the unfavorable circumstances or the psychopathologies that may develop (i.e., the mechanisms underlying the resilience of an individual in all cases are expected to be similar). Here we contribute to the understanding of resilience—and its counterpart, vulnerability—by employing an approach that makes use of this invariant quality. We outline two main characteristics that we would expect from indicators of a vulnerable state: that they should appear across disorders regardless of specific circumstances, and that they should appear much before the disorder is evident. Next, we identify two sets of factors that exhibit this pattern of association with psychopathological states. The first was a set of “low-level” sensory, motor and regulatory irregularities that have been reported across the clinical literature; we suggest that these can serve as behavioral indicators of a vulnerable state. The second was the set of aberrations in network metrics that have been reported in the field of systems neuroscience; we suggest that these can serve as network indicators of a vulnerable state. Finally, we explore how behavioral indicators may be related to network indicators and discuss the clinical and research-related implications of our work.

Poor fine-motor and visuospatial skills predict persistence of pediatric-onset obsessive-compulsive disorder into adulthood

BACKGROUND

Half of pediatric-onset OCD cases remit by adulthood. Studies have demonstrated that initial response to pharmacotherapy, age of onset, prominent hoarding symptoms, and the presence of comorbid tic disorders are associated with long-term outcome. Our goal was to examine the association between childhood performance on neuropsychological testing and persistence of OCD into adulthood.

METHODS

Twenty-four children with OCD were followed for an average of 7.5 years into early adulthood. Neuropsychological performance in childhood (<16 years) was measured. The battery included the Wechsler Intelligence Scale for Children (WISC-III), the Purdue pegboard test, the Rey-Osterreith Complex Figure Task (RCFT) and the Beery-Buktenica test of Visual Motor Integration (VMI). We hypothesized that deficits in fine-motor skills, visuospatial skills, and nonverbal memory as well as overall intelligence would be associated with adulthood outcome. We used a Cox proportional hazard model of survival analysis in which time to remission of OCD symptoms was the main outcome variable.

RESULTS

Poor childhood performance on the Purdue pegboard task and the block design subscale of WISC-III was associated with persistence of OCD symptoms into adulthood. IQ, VMI, and nonverbal memory performance did not predict significantly the persistence of OCD.

CONCLUSIONS

These results suggest that visuospatial and fine-motor skill deficits are predictive of poor long-term outcome in pediatric-onset OCD. Future longitudinal studies are needed to chart the course of these deficits relative to the course of symptoms in OCD and to determine whether the association of these neuropsychiatric deficits with long-term outcome is specific to pediatric-onset OCD or generalizes to other psychiatric disorders.

Progressive neurostructural changes in adolescent and adult patients with bipolar disorder

OBJECTIVES

Several lines of evidence suggest that bipolar disorder is associated with progressive changes in gray matter volume (GMV), particularly in brain structures involved in emotional regulation and expression. The majority of these studies however, have been cross-sectional in nature. In this study we compared baseline and follow-up scans in groups of bipolar disorder and healthy subjects. We hypothesized bipolar disorder subjects would demonstrate significant GMV changes over time.

METHODS

A total of 58 bipolar disorder and 48 healthy subjects participated in structural magnetic resonance imaging (MRI). Subjects were rescanned 3-34 months after their baseline MRI. MRI images were segmented, normalized to standard stereotactic space, and compared voxel-by-voxel using statistical parametrical mapping software (SPM2). A model was developed to investigate differences in GMV at baseline, and associated with time and episodes, as well as in comparison to healthy subjects.

RESULTS

We observed increases in GMV in bipolar disorder subjects across several brain regions at baseline and over time, including portions of the prefrontal cortex as well as limbic and subcortical structures. Time-related changes differed to some degree between adolescent and adult bipolar disorder subjects. The interval between scans positively correlated with GMV increases in bipolar disorder subjects in portions of the prefrontal cortex, and both illness duration and number of depressive episodes were associated with increased GMV in subcortical and limbic structures.

CONCLUSIONS

Our findings support suggestions that widely observed progressive neurofunctional changes in bipolar disorder patients may be related to structural brain abnormalities in anterior limbic structures. Abnormalities largely involve regions previously noted to be integral to emotional expression and regulation, and appear to vary by age.

Postural control in bipolar disorder: increased sway area and decreased dynamical complexity

Structural, neurochemical, and functional abnormalities have been identified in the brains of individuals with bipolar disorder, including in key brain structures implicated in postural control, i.e. the cerebellum, brainstem, and basal ganglia. Given these findings, we tested the hypothesis that postural control deficits are present in individuals with bipolar disorder. Sixteen participants with bipolar disorder (BD) and 16 age-matched non-psychiatric healthy controls were asked to stand as still as possible on a force platform for 2 minutes under 4 conditions: (1) eyes open-open base; (2) eyes closed-open base; (3) eyes open-closed base; and (4) eyes closed-closed base. Postural sway data were submitted to conventional quantitative analyses of the magnitude of sway area using the center of pressure measurement. In addition, data were submitted to detrended fluctuation analysis, a nonlinear dynamical systems analytic technique that measures complexity of a time-series, on both the anterior-posterior and medio-lateral directions. The bipolar disorder group had increased sway area, indicative of reduced postural control. Decreased complexity in the medio-lateral direction was also observed for the bipolar disorder group, suggesting both a reduction in dynamic range available to them for postural control, and that their postural corrections were primarily dominated by longer time-scales. On both of these measures, significant interactions between diagnostic group and visual condition were also observed, suggesting that the BD participants were impaired in their ability to make corrections to their sway pattern when no visual information was available. Greater sway magnitude and reduced complexity suggest that individuals with bipolar disorder have deficits in sensorimotor integration and a reduced range of timescales available on which to make postural corrections.

Strategies for the study of neuropsychiatric disorders using endophenotypes in developing countries: a potential databank from china

Endophenotypic research can be considered to be one of the most promising strategies to bridge the gap between genomic complexity and the phenotypic heterogeneity observed in neuropsychiatric disorders. However, despite the promising and systematic work initiated by our western counterparts, this research strategy is still not well known in developing countries. Thus, the purpose of this paper is to argue the merits and promise of a potentially useful database on phenotypes and endophenotypes for developing countries.

Neurological signs and late-life depressive symptoms in a community population: the ESPRIT study

OBJECTIVE

Depression in the elderly is common and often resistant to treatment. It has been suggested that late-life depression may be related to underlying neurobiological changes. However, these observations are derived from diverse clinical samples and as yet have not been confirmed in a more representative population study. Our aim was to investigate associations between neurological signs as markers of underlying brain dysfunction and caseness for depression in an elderly community sample, controlling for physical health and comorbid/past neurological disorders.

METHOD

A cross-sectional analysis of 2102 older people without dementia from the ESPRIT project. Depressive symptomatology was ascertained using the CES-D and abnormal neurological signs/comorbidity from a full neurological examination according to ICD-10 criteria.

RESULTS

Pyramidal, extrapyramidal, cranial nerve and sensory deficit signs were significantly associated with case-level depressive symptoms. However, all odds ratios were close to null values in participants who did not have previous neurological disorder.

CONCLUSIONS

We confirmed previous findings of an association between neurological signs and case-level depressive symptoms in late life. However, this association may simply reflect the impact of more severe comorbid neurological disorder.

Genetics and intermediate phenotypes of the schizophrenia--bipolar disorder boundary

Categorization of psychotic illnesses into schizophrenic and affective psychoses remains an ongoing controversy. Although Kraepelinian subtyping of psychosis was historically beneficial, modern genetic and neurophysiological studies do not support dichotomous conceptualization of psychosis. Evidence suggests that schizophrenia and bipolar disorder rather present a clinical continuum with partially overlapping symptom dimensions, neurophysiology, genetics and treatment responses. Recent large scale genetic studies have produced inconsistent findings and exposed an urgent need for re-thinking phenomenology-based approach in psychiatric research. Epidemiological, linkage and molecular genetic studies, as well as studies in intermediate phenotypes (neurocognitive, neurophysiological and anatomical imaging) in schizophrenia and bipolar disorders are reviewed in order to support a dimensional conceptualization of psychosis. Overlapping and unique genetic and intermediate phenotypic signatures of the two psychoses are comprehensively recapitulated. Alternative strategies which may be implicated into genetic research are discussed.

Motor function may differentiate attention deficit hyperactivity disorder from early onset bipolar disorder

BACKGROUND

Differentiating between bipolar spectrum disorder (BD) and attention deficit hyperactivity disorder (ADHD) in childhood and adolescence is difficult because the clinical presentation is influenced by ongoing neural development, causing considerable symptom overlap. Motor problems and neurological soft signs have been associated with ADHD for decades. Little is known about motor skills in BD. Here we assess the diagnostic accuracy of neuromotor deviations in differentiating ADHD from BD in clinical practice. We also investigate if these deviations exist in concurrent ADHD and BD, thus indicating true comorbidity

METHODS

64 patients 6-18 years (31 girls, 33 boys) fulfilling the diagnostic criteria of BD, ADHD combined subtype (ADHD-C) or comorbid BD and ADHD-C, were compared using an age-standardized neuromotor test; NUBU. Categorical variables were analyzed using cross table with two-tailed chi square test or Fisher's exact test when appropriate. Continuous variables were analyzed by Kruskal-Wallis test and, if significant, Mann-Whitney U test and ROC plots.

RESULTS

The ADHD-C group and the comorbid ADHD-C and BD group both showed significantly more neurological soft signs (p less than 0.01) and lower mean static coordination percentile (p less than 0.01) than the BD group. The positive predictive value of NUBU in the diagnosis of ADHD-C with or without concurrent BD was 89% (80-95) for total soft signs and 87% (79-95) for static coordination below the 7.5 percentile.

CONCLUSION

An age-standardized neuromotor test battery may promote diagnostic accuracy in differentiating ADHD from BD in clinical practice, and help evaluating whether symptoms of ADHD in children who have BD reflect symptom overlap or real comorbidity. This may have important implications for everyday diagnostic work.

Brain morphology and neurological soft signs in adolescents with first-episode psychosis

BACKGROUND

Adolescents with first-episode psychosis have increased severity of neurological soft signs when compared with controls, but it is unclear whether increased severity of neurological soft signs is an expression of specific structural brain deficits.

AIMS

To examine whether increased severity of neurological soft signs was associated with decreased brain volumes in adolescents with first-episode psychosis.

METHOD

Brain scans were obtained for 70 adolescents (less than 18 years of age) with first-episode psychosis (duration of positive symptoms less than 6 months). Volumes were assessed using voxel-based morphometry and through segmentation of anatomical structures.

RESULTS

Increased severity of sensory integration neurological soft signs correlated with smaller right and left thalamus volume, whereas increased severity of sequencing of complex motor acts neurological soft signs correlated with smaller right caudate volume.

CONCLUSIONS

Neurological soft signs may be an easy-to-assess marker of region-specific structural brain deficits in adolescents with first-episode psychosis.

Neurological signs and involuntary movements in schizophrenia: intrinsic to and informative on systems pathobiology

While it has long been considered whether the pathobiology of schizophrenia extends beyond its defining symptoms to involve diverse domains of abnormality, in the manner of a systemic disease, studies of neuromotor dysfunction have been confounded by treatment with antipsychotic drugs. This challenge has been illuminated by a new generation of studies on first-episode schizophrenia before initiation of antipsychotic treatment and by opportunities in developing countries to study chronically ill patients who have remained antipsychotic naive due to limitations in provision of psychiatric care. Building from studies in antipsychotic-naive patients, this article reviews 2 domains of neuromotor dysfunction in schizophrenia: neurological signs and involuntary movements. The presence and characteristics of neurological signs in untreated vis-à-vis treated psychosis indicate a vulnerability marker for schizophrenia and implicate disruption to neuronal circuits linking the basal ganglia, cerebral cortex, and cerebellum. The presence and characteristics of involuntary movements in untreated vis-à-vis treated psychosis indicate an intrinsic feature of the disease process and implicate dysfunction in cortical-basal ganglia-cortical circuitry. These neuromotor disorders of schizophrenia join other markers of subtle but pervasive cerebral and extracerebral, systemic dysfunction, and complement current concepts of schizophrenia as a disorder of developmentally determined cortical-basal ganglia-thalamo-cortical/cerebellar network disconnectivity.

Expanding the schizophrenia phenotype: a composite evaluation of neurodevelopmental markers

Minor physical anomalies (MPAs) and neurologic soft signs (NSSs) have been consistently reported to be more frequent in schizophrenia subjects and their first-degree relatives. We aimed at coassessing both these neurodevelopmental markers in neuroleptic-naive recent-onset schizophrenia (NRS) subjects in comparison to healthy control (HC) subjects to explore the predictive validity of this composite endophenotype. We administered the Modified Waldrop Scale (MWS) and the Neurological Evaluation Scale (NES) to evaluate MPAs and NSSs, respectively, in 40 NRS and 30 matched HC subjects. Schizophrenia subjects had significantly higher frequencies of MPAs and NSSs than HC. Minor physical anomaly total scores were correlated with greater severity of illness, whereas NES scores did not show any relationship with clinical variables. Schizophrenia and HC subjects were most accurately classified (82.9%) when MPAs and NSSs were considered as a composite phenotype rather than independently. Minor physical anomalies and NSSs constitute independent neurodevelopmental markers of schizophrenia and would afford greater predictive validity when used as a composite endophenotype in genetic association studies.

Soft neurological signs do not increase with age in euthymic bipolar subjects

BACKGROUND

Soft neurological signs (SNS) are found to be in excess in bipolar disorder (BD). This paper explores changes in SNS with ageing to ascertain whether BD is associated with a progressive neurological decline or a relatively fixed, persistent deficit.

METHODS

53 euthymic BD subjects and controls, aged 15-55 years, were for examined for the presence of SNS which were rated using a modified Kolakowska battery.

RESULTS

In controls, SNS scores increased slowly and significantly with age whereas in BD subjects high scores occurred throughout the age range and were not age dependent. This confirms and extends an earlier, smaller, study which is reanalysed.

LIMITATIONS

The study design was cross-sectional whereas a longitudinal study would better reveal changes in soft signs with ageing.

CONCLUSIONS

The studies suggest strongly that BD is accompanied by a significant neurobiological deficit which may progress only minimally with increasing age.

Aberrant functional organization and maturation in early-onset psychosis: evidence from magnetoencephalography

Studies of the location of somatosensory and auditory cortical responses have shown anomalous hemispheric asymmetries in a variety of neurodevelopmental disorders. To date, abnormal asymmetries in the somatosensory region have shown greater specificity, being reported only in psychotic adults. This study examines the functional organization of the somatosensory cortices using magnetoencephalography in adolescents with childhood-onset psychotic disorders. Eighteen young outpatients with history of psychotic illness and 15 healthy adolescents participated. Both groups underwent stimulation of the index finger as magnetoencephalography was acquired from the contralateral hemisphere. Neural generators of the M50 somatosensory response were modeled using an equivalent current dipole for each hemisphere, and later investigated for systematic variation with diagnosis. Consistent with adult psychosis data, adolescent patients showed hemispheric symmetry in the anterior-posterior dimension. In controls, a reversed pattern of hemispheric asymmetry was observed relative to previous findings in normal adults [Reite, M., Teale, P., Rojas, D.C., Benkers, T.L., Carlson, J., 2003. Anomalous somatosensory cortical localization in schizophrenia. American Journal of Psychiatry 160, 2148-2153], but trend-level correlations suggested source location became more adult-like during the transition from adolescence to adulthood. Source parameters also exhibited robust inter-hemispheric correlations only in adolescent controls. In sum, source locations, patterns of cerebral lateralization, and inter-hemispheric correlations all distinguish patients from their normally developing cohort. These findings suggest aberrant maturation underlies the reduction in cerebral laterality associated with psychosis.