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Tsapakis EM, Mitkani CA, Fountoulakis KN. Neurological soft signs and schizophrenia. CNS Spectr 2023; 28:657-661. [PMID: 36924179 DOI: 10.1017/s1092852923001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Neurological soft signs (NSS) are likely to represent abnormal neurodevelopment and aberration in neural maturation and connectivity. They may not be unique to schizophrenia, but they appear to be a trait characteristic in psychosis and therefore could serve as an objective measure for the assessment of serious psychiatric disorder in the prodromal phase, at onset, and along the course of the disease. Evidence so far proposes that NSS are independent of antipsychotic treatment and therefore constitute a trait symptom, independent of the illness stage and medication. Somatomotor and somatosensory regions, spatial orientation, and visual processing areas, cerebellum, and basal ganglia are implicated as possible structural substrates of NSS. Several studies have examined the relationship between NSS and schizophrenia positive, negative symptoms and deficit syndrome; however, results have been so far ambiguous. Neurocognitive symptoms have been moderately related to NSS suggesting that neurocognitive deficits may contribute to the construct of NSS. Regardless of the fact that NSS are not unique to schizophrenia but extend across to the schizotypy continuum, they may help identify individuals at risk of developing schizophrenia later in life.
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Affiliation(s)
- Eva-Maria Tsapakis
- Agios Charalampos Mental Health Clinic, Heraklion, Greece
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Calypso A Mitkani
- Department of Neurology, Agios Pavlos General Hospital of Thessaloniki, Kalamaria, Greece
| | - Konstantinos N Fountoulakis
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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2
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Lui SSY, Yip SSL, Wang Y, Hung KSY, Ho KKY, Tsang KCM, Yeung HKH, Cheung EFC, Chan RCK. Different trajectories of neurological soft signs progression between treatment-responsive and treatment-resistant schizophrenia patients. J Psychiatr Res 2021; 138:607-614. [PMID: 34004397 DOI: 10.1016/j.jpsychires.2021.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/30/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
Schizophrenia patients exhibit subtle and non-localizing neurological abnormalities, known as neurological soft signs (NSS). Life-span evidence suggests that NSS vary along the course of schizophrenia. An association between NSS and treatment response has been proposed, suggesting that NSS reflect the underlying neuropathology development in schizophrenia. However, few studies have investigated the relationship between NSS and treatment resistance in first-episode schizophrenia patients. We conducted a longitudinal study on 52 first-episode schizophrenia patients, who were assessed at baseline, the sixth month, and the fifth year using the abridged version of the Cambridge Neurological Inventory. The trajectories of NSS between 29 treatment-responsive patients (with full symptomatic remission) and 23 treatment-resistant patients (who received clozapine) were compared using mixed model ANOVA. We also controlled for the effect of age and estimated IQ, using a mixed ANCOVA model. Although the two schizophrenia groups had comparable NSS at the baseline, their trajectories of NSS differed significantly. Compared with their treatment-responsive counterparts, treatment-resistant schizophrenia patients had worsening of NSS over time. Our findings support the potential utility of NSS in identifying treatment resistance in first-episode schizophrenia. Progressive worsening of NSS in treatment-resistant schizophrenia patients may reflect the development of underlying neuropathology. Further studies using large samples of treatment-resistant schizophrenia patients are needed.
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Affiliation(s)
- Simon S Y Lui
- Castle Peak Hospital, Hong Kong, China; Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | | | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | | | | | | | | | | | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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3
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Cai XL, Wang YM, Wang Y, Zhou HY, Huang J, Wang Y, Lui SSY, Møller A, Hung KSY, Mak HKF, Sham PC, Cheung EFC, Chan RCK. Neurological Soft Signs Are Associated With Altered Cerebellar-Cerebral Functional Connectivity in Schizophrenia. Schizophr Bull 2021; 47:1452-1462. [PMID: 33479738 PMCID: PMC8379549 DOI: 10.1093/schbul/sbaa200] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cerebellar dysfunction is associated with neurological soft signs (NSS), which is a promising endophenotype for schizophrenia spectrum disorders. However, the relationship between cerebellar-cerebral resting-state functional connectivity (rsFC) and NSS is largely unexplored. Moreover, both NSS and cerebellar-cerebral rsFC have been found to be correlated with negative symptoms of schizophrenia. Here, we investigated the correlations between NSS and cerebellar-cerebral rsFC, explored their relationship with negative symptoms in a main dataset, and validated the significant findings in a replication dataset. Both datasets comprised schizophrenia patients and healthy controls. In schizophrenia patients, we found positive correlations between NSS and rsFC of the cerebellum with the inferior frontal gyrus and the precuneus, and negative correlations between NSS and rsFC of the cerebellum with the inferior temporal gyrus. In healthy controls, NSS scores were positively correlated with rsFC of the cerebellum with the superior frontal gyrus and negatively correlated with rsFC between the cerebellum and the middle occipital gyrus. Cerebellar-prefrontal rsFC was also positively correlated with negative symptoms in schizophrenia patients. These findings were validated in the replication dataset. Our results suggest that the uncoupling of rsFC between the cerebellum and the cerebral cortex may underlie the expression of NSS in schizophrenia. NSS-related cerebellar-prefrontal rsFC may be a potential neural pathway for possible neural modulation to alleviate negative symptoms.
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Affiliation(s)
- Xin-Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
| | - Yong-Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Han-Yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jia Huang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Simon S Y Lui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Arne Møller
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Henry K F Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pak C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Center for PanorOmic Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
- To whom correspondence should be addressed; 16 Lincui Road, Beijing 100101, China; tel: +86(0)10-64836274, fax: 86(0)10-64836274, e-mail:
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Cogo-Moreira H, Krance SH, Black SE, Herrmann N, Lanctôt KL, MacIntosh BJ, Eid M, Swardfager W. Questioning the Meaning of a Change on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog): Noncomparable Scores and Item-Specific Effects Over Time. Assessment 2020; 28:1708-1722. [PMID: 32406251 PMCID: PMC8392777 DOI: 10.1177/1073191120915273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Longitudinal invariance indicates that a construct is measured over time in the same way, and this fundamental scale property is a sine qua non to track change over time using ordinary mean comparisons. The Alzheimer’s Disease Assessment Scale–cognitive (ADAS-Cog) and its subscale scores are often used to monitor the progression of Alzheimer’s disease, but longitudinal invariance has not been formally evaluated. A configural invariance model was used to evaluate ADAS-Cog data as a three correlated factors structure for two visits over 6 months, and four visits over 2 years (baseline, 6, 12, and 24 months) among 341 participants with Alzheimer’s disease. We also attempted to model ADAS-Cog subscales individually, and furthermore added item-specific latent variables. Neither the three-correlated factors ADAS-Cog model, nor its subscales viewed unidimensionally, achieved longitudinal configural invariance under a traditional modeling approach. No subscale achieved scalar invariance when considered unidimensional across 6 months or 2 years of assessment. In models accounting for item-specific effects, configural and metric invariance were achieved for language and memory subscales. Although some of the ADAS-Cog individual items were reliable, comparisons of summed ADAS-Cog scores and subscale scores over time may not be meaningful due to a lack of longitudinal invariance.
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Affiliation(s)
- Hugo Cogo-Moreira
- Freie Universität Berlin, Berlin, Germany.,Universidade Federal de São Paulo, São Paulo, Brazil
| | - Saffire H Krance
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Walter Swardfager
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Herold CJ, Duval CZ, Lässer MM, Schröder J. Neurological soft signs (NSS) and cognitive impairment in chronic schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 16:17-24. [PMID: 30671351 PMCID: PMC6305804 DOI: 10.1016/j.scog.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/16/2023]
Abstract
Recent studies indicate that neurological soft signs (NSS) in schizophrenia are associated with generalized cognitive impairments rather than changes in specific neuropsychological domains. However, the majority of studies solely included first-episode patients or patients with a remitting course and did not consider age, course, education or severity of global cognitive deficits as potential confounding variables. Therefore, we examined NSS with respect to cognitive deficits in chronic schizophrenia, i.e. patients who are particularly vulnerable to both, NSS and cognitive impairments. Eighty patients with chronic schizophrenia (43.36 ± 15a) and 60 healthy controls (47.52 ± 14.8a) matched for age, sex and years of education were examined on the Heidelberg NSS scale and a broad neuropsychological battery including short term, working, logical and autobiographic memory (AM), theory of mind (ToM), psychomotor speed and cognitive flexibility. When contrasted with the controls, patients showed significantly higher NSS scores and impairments in all neuropsychological domains but short-term memory. NSS were significantly associated with all neuropsychological domains considered but short-term memory and semantic AM. Except for episodic AM (which was significantly correlated with NSS in patients only) these correlations applied to both groups and were confirmed when age, years of education and severity of global cognitive deficits (Mini Mental State Examination) were controlled for. Results demonstrate that NSS reflect a rather wide range of cognitive impairments in schizophrenia, which also involves episodic AM and ToM. These associations were not accounted for by age, education or severity of global cognitive deficits and facilitate the clinical usage of NSS as a screening instrument.
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Affiliation(s)
- Christina J Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Céline Z Duval
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc M Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
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Pedroso VSP, Teixeira AL, Salgado JV. Characterization of neurological soft signs in a Brazilian sample of stable patients with schizophrenia. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:244-247. [PMID: 30234886 DOI: 10.1590/2237-6089-2017-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/25/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Neurological soft signs (NSS) have been considered one of the target features and a potential endophenotype for schizophrenia. The present study aimed to characterize NSS in a sample of patients with chronic schizophrenia and to compare them with healthy control individuals. METHODS In this study, we evaluated the presence of NSS in a sample of stable patients (n = 24) diagnosed with schizophrenia according to DSM-IV criteria, recruited at the Schizophrenia Outpatient Clinic of Instituto Raul Soares, Belo Horizonte, state of Minas Gerais, southeastern Brazil. Assessment was made with the Brief Motor Scale (BMS), and extrapyramidal symptoms (EPS) were evaluated with the Simpson-Angus Scale (SAS) and the Abnormal Involuntary Movement Scale (AIMS). A control group (n = 21) was also submitted to the same battery of tests. RESULTS We observed a significant difference in relation to BMS and SAS scores (p < 0.0001), revealing that individuals with schizophrenia present more NSS and EPS than healthy ones. BMS total scores correlated positively with SAS scores (r = 0.495, p = 0.014), but not with AIMS scores, indicating that NSS could be influenced by the intensity of EPS. Nevertheless, we observed that this relationship remained only for motor coordination tasks (r = 0.550, p = 0.005), while motor sequencing tasks were not influenced by EPS (r = 0.313, p = 0.136). CONCLUSION The results suggest that NSS are more frequent in patients with schizophrenia and that motor sequencing tasks could be more specific to the syndrome.
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Affiliation(s)
- Vinicius Sousa Pietra Pedroso
- Grupo de Pesquisa em Psiquiatria e Cognição, Instituto Raul Soares, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, MG, Brazil.,Departamento de Medicina, Pontifícia Universidade Católica de Minas Gerais, Betim, MG, Brazil
| | - Antônio Lúcio Teixeira
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - João Vinícius Salgado
- Grupo de Pesquisa em Psiquiatria e Cognição, Instituto Raul Soares, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, MG, Brazil.,Programa de Pós-Graduação em Neurociências, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Morfologia, Instituto de Ciências Biológicas, UFMG, Belo Horizonte, MG, Brazil
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de Bartolomeis A, Prinzivalli E, Callovini G, D'Ambrosio L, Altavilla B, Avagliano C, Iasevoli F. Treatment resistant schizophrenia and neurological soft signs may converge on the same pathology: Evidence from explanatory analysis on clinical, psychopathological, and cognitive variables. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:356-366. [PMID: 28887181 DOI: 10.1016/j.pnpbp.2017.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/17/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022]
Abstract
Here, we investigated neurological soft signs (NSSs) in treatment resistant schizophrenia (TRS) vs treatment responder schizophrenia (SZ) patients. TRS is a severe condition, affecting approximately one-third of schizophrenia patients and representing a relevant clinical challenge. NSSs are neurological abnormalities reportedly described in schizophrenia patients and linked to dysregulated network connections. We explored the possibility that NSSs may be: i) more severe in TRS patients; ii) differentially associated to clinical/cognitive variables in TRS vs SZ; iii) predictive of having TRS. In addition, we evaluated whether diagnosis may mediate NSSs associations with the above-mentioned variables. Consecutive patients with schizophrenia diagnosis underwent stringent assessment for TRS diagnosis. Demographics and clinical variables were recorded. Psychopathology (by Positive and Negative Syndrome Scale, PANSS), cognitive performances, and NSSs (by Neurological Evaluation Scale, NES) were tested. TRS had higher scores than SZ patients in total NES score and in almost all NES subscales, even after correction for duration of illness and antipsychotic dose (ANCOVA, p<0.05). NSSs significantly correlated with multiple clinical, psychopathological, and cognitive variables (above all: duration of disease and negative symptoms) in TRS but not in SZ patients. Two-way ANOVA showed NSS-x-diagnosis interaction in determining outcomes on multiple cognitive performances, but not in other clinical variables. However, simple main effect analysis detected a significant relationship between high severity NSSs and TRS diagnosis on multiple clinical and cognitive outcomes. Hierarchical regression analysis showed that diagnosis was among a discrete number of predictors yielding significant increases in variance explained on NES total, Sensory Integration and Other Signs subscales' scores. NSSs, together with antipsychotic dose and disease severity, were found to be significantly predictive of TRS diagnosis in a binary logistic regression model. These results suggest a stringent association between NSSs and TRS diagnosis, and may imply that NSSs association with clinical, psychopathological, and cognitive variables may be in part mediated by TRS diagnosis.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
| | - Emiliano Prinzivalli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Gemma Callovini
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Luigi D'Ambrosio
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Benedetta Altavilla
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Camilla Avagliano
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Felice Iasevoli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
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Neurological soft signs precede the onset of schizophrenia: a study of individuals with schizotypy, ultra-high-risk individuals, and first-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci 2018; 268:49-56. [PMID: 28761988 DOI: 10.1007/s00406-017-0828-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
Neurological soft signs (NSS) are one of the biomarkers for schizophrenia spectrum disorders. However, a few studies have examined the prevalence of NSS across the schizophrenia spectrum. The present study adopted a quasi-longitudinal study design and examined the prevalence of NSS and their associations with clinical and behavioural manifestations in participants in different stages of the illness. The abridged version of the Cambridge Neurological Inventory was administered to 39 patients with the first-episode schizophrenia, 39 individuals with ultra-high risk (UHR) for psychosis, 39 individuals with schizotypy, and 39 healthy controls. Patients with the first-episode schizophrenia had a higher prevalence of NSS in motor coordination than healthy controls as well as individuals with UHR and schizotypy. Individuals with UHR exhibited a higher prevalence of sensory integration items than individuals with schizotypy and healthy controls. Discriminant analysis classified the membership of the individuals correctly across the spectrum with an accuracy of up to 60.9%. In particular, NSS could discriminate individuals with UHR from healthy controls at up to 85.9% accuracy. These findings suggest that NSS are robust biomarkers to detect and discriminate individuals in different stages of the schizophrenia spectrum from healthy controls.
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Minichino A, Francesconi M, Carrión RE, Bevilacqua A, Parisi M, Rullo S, Ando' A, Biondi M, Delle Chiaie R, Cadenhead K. Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system. Schizophr Res 2017; 185:114-121. [PMID: 28041918 DOI: 10.1016/j.schres.2016.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 01/04/2023]
Abstract
A critical research goal is to identify modifiable risk factors leading to functional disabilities in young psychiatric patients. The authors developed a multidimensional trans-diagnostic predictive model of functional outcome in patients with the recent-onset of a psychiatric illness. Baseline clinical, psychosis-risk status, cognitive, neurological-soft-signs measures, and dopamine-related-gene polymorphisms (DRD1-rs4532, COMT-rs165599, and DRD4-rs1800955) were collected in 138 young non-psychotic outpatients. 116 individuals underwent follow-up (mean=2.2years, SD=0.9) examination. A binary logistic model was used to predict low-functioning status at follow-up as defined by a score lower than 65 in the social occupational functioning assessment scale. A total of 54% of patients experiences low functioning at follow-up. Attention, Avolition, and Motor-Coordination subscale were significant predictors of low-functioning with an accuracy of 79.7%. A non-significant trend was found for a dopamine-related-gene polymorphism (DRD1-rs4532). The model was independent of psychotic-risk status, DSM-diagnosis, and psychotic conversion. A trans-diagnostic approach taking into account specific neurocognitive, clinical, and neurological information has the potential to identify those individuals with low-functioning independent of DSM diagnosis or the level of psychosis-risk. Specific early interventions targeting modifiable risk factors and emphasize functional recovery in young psychiatric samples, independent of DSM-diagnosis and psychosis-risk, are essential.
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Affiliation(s)
- Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States.
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States
| | - Ricardo E Carrión
- Division of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | - Arturo Bevilacqua
- Research Center in Neurobiology, Daniel Bovet (CRiN), Rome, Italy; Department of Psychology, Section of Neuroscience, Sapienza University of Rome, Italy
| | | | | | - Agata Ando'
- Department of Psychology, University of Turin
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
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Minichino A, Francesconi M, Carrión RE, Delle Chiaie R, Bevilacqua A, Parisi M, Rullo S, Bersani FS, Biondi M, Cadenhead K. From neurological soft signs to functional outcome in young individuals in treatment with secondary services for non-psychotic disorders: a path analysis. Psychol Med 2017; 47:1192-1203. [PMID: 28052777 DOI: 10.1017/s0033291716003056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Functional decline among patients with mental illness is not unique to individuals with psychotic disorders. Despite this, research on early predictors of functional outcome mainly focused on individuals thought to have an 'at risk mental state' (ARMS) for psychosis. There is evidence suggesting that certain early vulnerability markers, such as neurological soft signs (NSS), may explain variability in functional outcomes independent of the level of psychosis risk and the traditional diagnostic classification. METHOD Structural equation modeling was applied to baseline data from a prospective longitudinal study of 138 young individuals in treatment with secondary services for non-psychotic disorders. We evaluated theoretically based models of pathways to functional outcome starting from NSS. The intervening variables were established according to previous evidence and drawn from two general categories: cognition (neuro- and social-) and negative symptoms (expressive and experiential). RESULTS A final trimmed model was a single path running from NSS to neurocognition to experiential negative symptoms to outcome. It could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from NSS to outcome was significant. The validity of the model was independent of the ARMS status and the psychiatric diagnosis. CONCLUSIONS Our results provide evidence for a single pathway model in which the starting and intervening variables represent modifiable trans-diagnostic therapeutic targets to improve functional trajectories in young individuals with a recent-onset psychiatric diagnosis and different levels of psychosis risk.
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Affiliation(s)
- A Minichino
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - M Francesconi
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - R E Carrión
- Division of Psychiatry,Zucker Hillside Hospital,Long Island,NY,USA
| | - R Delle Chiaie
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - A Bevilacqua
- Research Center in Neurobiology,Daniel Bovet (CRiN),Rome,Italy
| | | | - S Rullo
- Casa di Cura Villa Letizia,Rome,Italy
| | - F S Bersani
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - M Biondi
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - K Cadenhead
- Department of Psychiatry,UCSD,La Jolla,CA,USA
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