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Gray LE, Buchanan RW, Keshavan MS, Torous J. Potential Role of Smartphone Technology in Advancing Work on Neurological Soft Signs with a Focus on Schizophrenia. Harv Rev Psychiatry 2023; 31:226-233. [PMID: 37699066 DOI: 10.1097/hrp.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
LEARNING OBJECTIVE AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO • Outline and Identify potential benefits of using neurological soft signs (NSS) as biomarkers of schizophrenia. ABSTRACT Since the late 1960s, NSS have been a focus of study across psychiatric illnesses, including depression, bipolar disorder, and schizophrenia in particular. Utilizing these subtle neurological impairments as biomarkers of illness has numerous benefits; NSS offer a direct connection between clinical presentation and neurological functioning, and assessments are cost-effective. However, incongruent measurement scales, confounding variables, and rating system subjectivity have hindered the advancement and scalability of NSS research and clinical implementation. This article provides a brief overview of the literature on NSS as related to schizophrenia, and proposes utilizing smartphone sensing technology to create standardized NSS assessments with objective scoring. Incorporating digital phenotyping into NSS assessment offers the potential to make measurement more scalable, accessible, and directly comparable across locations, cultures, and demographics. We conducted a narrative search in PubMed and APA PsycInfo using the following keywords: neurological soft signs, schizophrenia spectrum disorders, and psychotic illnesses. No date limitations were used. There is no other direct work on NSS and new smartphone methods like digital phenotyping; though, there is related work in neurology. Harnessing advances in smartphone technology could provide greater insight into and further our understanding of specific aspects of the NSS field. For instance, it could help us distinguish trait vs. state markers and better understand how distinct groups of signs may reflect different aspects of psychiatric illness and neurological impairment. In addition, such technology can help advance research on the capabilities of NSS as an effective diagnostic tool.
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Affiliation(s)
- Lucy E Gray
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Ms. Gray, and Drs. Keshavan and Torous); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD (Dr. Buchanan); Massachusetts Mental Health Center, Boston, MA (Drs. Keshavan and Torous)
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Schülke R, Liepach K, Brömstrup AL, Folsche T, Deest M, Bleich S, Neyazi A, Frieling H, Maier HB. Neurological soft signs are increased in major depressive disorder irrespective of treatment. J Neural Transm (Vienna) 2023; 130:575-583. [PMID: 36801977 PMCID: PMC10050027 DOI: 10.1007/s00702-023-02602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/11/2023] [Indexed: 02/23/2023]
Abstract
The significance of neurological soft signs (NSS) in major depressive disorder (MDD) remains unclear and the stability of NSS in relation to antidepressant treatment has never been investigated. We hypothesized that NSS are relatively stable trait markers of MDD. We thus predicted that patients show more NSS than healthy controls, irrespective of illness duration and antidepressant treatment. To test this hypothesis, NSS were assessed in chronically depressed, medicated MDD patients before (n = 23) and after (n = 18) a series of electroconvulsive therapy (ECT). In addition, NSS were assessed once in acutely depressed, unmedicated MDD patients (n = 16) and healthy controls (n = 20). We found that both chronically depressed, medicated MDD patients and acutely depressed, unmedicated MDD patients showed more NSS than healthy controls. The degree of NSS in both patient groups did not differ. Importantly, we found no change in NSS after on average eleven sessions of ECT. Thus, the manifestation of NSS in MDD seems to be independent of illness duration and pharmacological and electroconvulsive antidepressant treatment. From a clinical perspective, our findings corroborate the neurological safety of ECT.
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Affiliation(s)
- Rasmus Schülke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Kyra Liepach
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Anna Lena Brömstrup
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thorsten Folsche
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maximilian Deest
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Alexandra Neyazi
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Department of Psychiatry and Psychotherapy, Otto Von Guericke University, Magdeburg, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Valerio MP, Lomastro J, Igoa A, Martino DJ. Correlates of neurological soft signs in bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01558-1. [PMID: 36662294 DOI: 10.1007/s00406-023-01558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Godoy Cruz 2290 (C1425FQB), Buenos Aires, Argentina.,Psychiatric Emergencies Hospital Torcuato de Alvear, Warnes 2630 (C1427DPS), Buenos Aires, Argentina
| | - Julieta Lomastro
- Psychiatric Emergencies Hospital Torcuato de Alvear, Warnes 2630 (C1427DPS), Buenos Aires, Argentina
| | - Ana Igoa
- Psychiatric Emergencies Hospital Torcuato de Alvear, Warnes 2630 (C1427DPS), Buenos Aires, Argentina
| | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET), Godoy Cruz 2290 (C1425FQB), Buenos Aires, Argentina. .,Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1854 (C1126AAB), Buenos Aires, Argentina. .,, Charcas 4189, 1°''C'' (C1425BNG), Buenos Aires, Argentina.
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The Impact of Antipsychotic Treatment on Neurological Soft Signs in Patients with Predominantly Negative Symptoms of Schizophrenia. Biomedicines 2022; 10:biomedicines10112939. [PMID: 36428507 PMCID: PMC9687986 DOI: 10.3390/biomedicines10112939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia is a complex and incompletely elucidated pathology that affects sensorimotor function and also produces numerous therapeutic challenges. The aims of this cross-sectional study were to identify the profile of neurological soft signs (NSS) in patients with predominantly negative symptoms of schizophrenia (PNS) compared with patients with schizophrenia who do not present a predominance of negative symptoms (NPNS) and also to objectify the impact of treatment on the neurological function of these patients. Ninety-nine (n = 99; 56 females and 43 males) patients diagnosed with schizophrenia according to DSM-V were included; these patients were undergoing antipsychotic (4 typical antipsychotics, 86 atypical antipsychotics, and 9 combinations of two atypical antipsychotics) or anticholinergic treatment (24 out of 99) at the time of evaluation, and the PANSS was used to identify the patients with predominantly negative symptoms (n = 39), the Neurological Evaluation Scale (NES) was used for the evaluation of neurological soft signs (NSS), and the SAS was used for the objectification of the extrapyramidal side effects induced by the neuroleptic treatment, which was converted to chlorpromazine equivalents (CPZE). The study's main finding was that, although the daily dose of CPZE did not represent a statistically significant variable, in terms of neurological soft signs, patients with PNS had higher rates of NSS.
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Fountoulakis KN, Panagiotidis P, Tegos T, Kimiskidis V, Nimatoudis I. Paternal age and specific neurological soft signs as reliable and valid neurobiological markers for the diagnosis of patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:1087-1096. [PMID: 34842982 DOI: 10.1007/s00406-021-01357-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Panagiotis Panagiotidis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Kimiskidis
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Nimatoudis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Martin L, Stein K, Kubera K, Troje NF, Fuchs T. Movement markers of schizophrenia: a detailed analysis of patients' gait patterns. Eur Arch Psychiatry Clin Neurosci 2022; 272:1347-1364. [PMID: 35362775 PMCID: PMC9508056 DOI: 10.1007/s00406-022-01402-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
Motor abnormalities occur in the majority of persons with schizophrenia but are generally neglected in clinical care. Psychiatric diagnostics fail to include quantifiable motor variables and few assessment tools examine full-body movement. We assessed full-body movement during gait of 20 patients and 20 controls with motion capture technology, symptom load (PANSS, BPRS) and Neurological Soft Signs (NSS). In a data-driven analysis, participants' motion patterns were quantified and compared between groups. Resulting movement markers (MM) were correlated with the clinical assessment. We identified 16 quantifiable MM of schizophrenia. While walking, patients and controls display significant differences in movement patterns related to posture, velocity, regularity of gait as well as sway, flexibility and integration of body parts. Specifically, the adjustment of body sides, limbs and movement direction were affected. The MM remain significant when controlling for medication load. They are systematically related to NSS. Results add assessment tools, analysis methods as well as theory-independent MM to the growing body of research on motor abnormalities in schizophrenia.
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Affiliation(s)
- Lily Martin
- Department of Psychology, Faculty of Behavioural and Cultural Studies, Heidelberg University, Heidelberg, Germany.
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany.
| | - Kevin Stein
- Optimization, Robotics and Biomechanics, ZITI-Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Katharina Kubera
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany
| | - Nikolaus F Troje
- BioMotionLab, Department of Biology, Centre for Vision Research, York University, Toronto, Canada
| | - Thomas Fuchs
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany
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Bachmann S, Beck M, Tsai DH, Haupt F. Neurological Soft Signs (NSS) in Census-Based, Decade-Adjusted Healthy Adults, 20 to >70 Years of Age. Front Psychiatry 2021; 12:670539. [PMID: 34248707 PMCID: PMC8264425 DOI: 10.3389/fpsyt.2021.670539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Neurological soft signs (NSS) represent minor neurological features and have been widely studied in psychiatric disease. The assessment is easily performed. Quantity and quality may provide useful information concerning the disease course. Mostly, NSS scores differ significantly between patients and controls. However, literature does not give reference values. In this pilot study, we recruited 120 healthy women and men to build a cross-sectional, census-based sample of healthy individuals, aged 20 to >70 years, subdivided in 10-year blocks for a close approach to the human lifeline. Testing for NSS and neurocognitive functioning was performed following the exclusion of mental and severe physical illness. NSS scores increased significantly between ages 50+ and 60+, which was primarily accountable to motor signs. Gender and cognitive functioning were not related to changes of scores. Although the number of individuals is small, study results may lay a foundation for further validation of NSS in healthy individuals.
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Affiliation(s)
- Silke Bachmann
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University Hospitals and Martin-Luther University, Halle, Germany
| | - Michaela Beck
- Geriatriezentrum Zwenkau, Sana Kliniken AG, Zwenkau, Germany
| | - Dai-Hua Tsai
- Swiss Centre for Occupational and Environmental Health (SCOEH), Winterthur, Switzerland
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El Safy ER, El Masry NM, El Shabrawy A, Ellatif ARRA. Neurological soft signs for discrimination between euthymic patients with bipolar I disorder and healthy controls. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-019-0012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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Boks MPM, Selten JP, Leask S, Van den Bosch RJ. The 2-year stability of neurological soft signs after a first episode of non-affective psychosis. Eur Psychiatry 2020; 21:288-90. [PMID: 16380235 DOI: 10.1016/j.eurpsy.2005.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Accepted: 09/13/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractWe examined the 2-year stability of neurological soft signs (NSS) in 29 patients after a first episode of psychosis. The numbers of NSS at inclusion and at 2 years follow-up were similar, but there was a significant increase in the numbers of NSS in the sub-group of patients whose dosage of antipsychotic medication had increased over time.
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Affiliation(s)
- Marco P M Boks
- Department of Psychiatry, University Hospital Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands.
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Ojagbemi A, Chiliza B, Bello T, Esan O, Asmal L, Emsley R, Gureje O. Spontaneous and emergent extrapyramidal syndromes in Black Africans with first-episode schizophrenia and first exposure to antipsychotics. J Ment Health 2020; 30:240-245. [PMID: 32169007 DOI: 10.1080/09638237.2020.1739242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Persons of African ancestry are thought to carry a higher risk for extrapyramidal syndromes (EPS) in schizophrenia. AIM We investigated the phenomenon of spontaneous and treatment-emergent EPS in a sample comprising Xhosa (South Africa) and Yoruba (Nigeria) Africans with first-episode schizophrenia and first exposure to antipsychotics. METHODS The Extrapyramidal Symptom Rating Scale (ESRS) and a variety of validated tools were used for the assessment of participants before, and two-weekly after treatment with low dose flupenthixol decanoate. Participants were followed up for 12 months. Association of EPS with clinical characteristics was investigated using Pearson's correlation and linear regression analyses. RESULTS Of 88 participants at baseline, 16 (18.1%) had at least one definite EPS prior to antipsychotic exposure and 34 (38.6%) had treatment-emergent EPS. While spontaneous Parkinsonism was associated with negative symptoms (r = 0.2, p = 0.043; β = 0.6, p = 0.043), treatment-emergent EPS demonstrated non-significant correlations with clinical characteristics. Apart from dyskinesia, the frequency of treatment-emergent EPS decreased over 12 months observation. CONCLUSION These findings support the hypothesis suggesting that spontaneously occurring Parkinsonism in schizophrenia may be the motor spectrum of negative symptomatology. Future studies of this relationship may lead to early identification of patients who may be more sensitive to EPS.
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Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neurosciences, and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Bonginkosi Chiliza
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Toyin Bello
- Department of Psychiatry, World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neurosciences, and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Oluyomi Esan
- Department of Psychiatry, World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neurosciences, and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Oye Gureje
- Department of Psychiatry, World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neurosciences, and Substance Abuse, University of Ibadan, Ibadan, Nigeria
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Fountoulakis KN, Panagiotidis P, Kimiskidis V, Nimatoudis I. 12-Month stability of neurological soft signs in stabilized patients with schizophrenia. Nord J Psychiatry 2019; 73:451-461. [PMID: 31393751 DOI: 10.1080/08039488.2019.1649724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Panagiotis Panagiotidis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Ioannis Nimatoudis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Fountoulakis KN, Panagiotidis P, Kimiskidis V, Nimatoudis I, Gonda X. Neurological soft signs in familial and sporadic schizophrenia. Psychiatry Res 2019; 272:222-229. [PMID: 30590276 DOI: 10.1016/j.psychres.2018.12.105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Professor of Psychiatry, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos str (1st Parodos Ampelonon str.), Pylaia, Thessaloniki 55535, Greece.
| | - Panagiotis Panagiotidis
- Research associate, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, School of Medicine, Aristotle University of Thessaloniki Greece.
| | - Ioannis Nimatoudis
- Professor of Psychiatry, Chair, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group of the Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary; NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary.
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Janssens S, Moens H, Coppens V, Vandendriessche F, Hulstijn W, Sabbe B, Morrens M. Psychomotor assessment as a tool to differentiate schizophrenia from other psychotic disorders. Schizophr Res 2018; 200:92-96. [PMID: 28673755 DOI: 10.1016/j.schres.2017.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/20/2017] [Accepted: 06/23/2017] [Indexed: 12/29/2022]
Abstract
GOAL The aim of this study is to assess to what extent psychomotor assessment can aid the clinician in differentiating between schizophrenia and other psychotic disorders. METHODS Enrolled subjects were recent in remission patients (n=304), who all met DSM-IV (APA, 2013) criteria for either schizophrenia (Sz; n=117), schizoaffective disorder (SaD; n=36), psychotic disorder not otherwise specified (P-NOS) (n=86), substance/medication-induced psychotic disorder (SIPD; n=33) or major depressive disorder with psychotic features (MDD-p; n=32). The patients were submitted to a psychomotor test battery. RESULTS Patients with schizophrenia generally perform worse on most tests. Using cluster analysis a combination of three tests, namely the sensory integration subscale of the Neurological Evaluation Scale (NES), a Figure Copying Task (FCT) and the finger tapping test (FTT), came out to be useful to clinically differentiate between schizophrenia and substance-induced psychotic disorder (SIPD) or psychosis not otherwise specified (P-NOS). When comparing schizophrenia only to a group of patients with SIPD, the differentiation potential becomes even greater with a 76.1% chance to correctly diagnose patients with schizophrenia and 75% chance for patients with SIPD. CONCLUSION A combination of NES, FCT and FTT shows promising results as a clinical tool in daily practice to differentiate schizophrenia from other psychotic disorders. Future prospective studies to confirm these results are necessary.
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Affiliation(s)
- S Janssens
- Collaborative Antwerp Psychiatric Research Institute, Building A, Campus Drie Eiken, Universiteitsplein 1, B-2610 Antwerp, Belgium; Psychiatric University Hospital Antwerp, Campus Duffel, Stationstraat 22c, Duffel, Belgium.
| | - H Moens
- Psychiatric University Hospital Antwerp, Campus Duffel, Stationstraat 22c, Duffel, Belgium
| | - V Coppens
- Collaborative Antwerp Psychiatric Research Institute, Building A, Campus Drie Eiken, Universiteitsplein 1, B-2610 Antwerp, Belgium; Psychiatric University Hospital Antwerp, Campus Duffel, Stationstraat 22c, Duffel, Belgium
| | - F Vandendriessche
- Psychiatric University Hospital Antwerp, Campus Duffel, Stationstraat 22c, Duffel, Belgium
| | - W Hulstijn
- Collaborative Antwerp Psychiatric Research Institute, Building A, Campus Drie Eiken, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - B Sabbe
- Collaborative Antwerp Psychiatric Research Institute, Building A, Campus Drie Eiken, Universiteitsplein 1, B-2610 Antwerp, Belgium; Psychiatric University Hospital Antwerp, Campus Duffel, Stationstraat 22c, Duffel, Belgium
| | - M Morrens
- Collaborative Antwerp Psychiatric Research Institute, Building A, Campus Drie Eiken, Universiteitsplein 1, B-2610 Antwerp, Belgium; Psychiatric University Hospital Antwerp, Campus Duffel, Stationstraat 22c, Duffel, Belgium
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15
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Neurological soft signs significantly differentiate schizophrenia patients from healthy controls. Acta Neuropsychiatr 2018; 30:97-105. [PMID: 29183417 DOI: 10.1017/neu.2017.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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16
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Neurological soft signs in bipolar and unipolar disorder: A case-control study. Psychiatry Res 2018; 261:253-258. [PMID: 29329044 DOI: 10.1016/j.psychres.2017.12.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/21/2017] [Accepted: 12/30/2017] [Indexed: 11/20/2022]
Abstract
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.
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17
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Bachmann S, Schröder J. Neurological Soft Signs in Schizophrenia: An Update on the State- versus Trait-Perspective. Front Psychiatry 2018; 8:272. [PMID: 29375401 PMCID: PMC5766896 DOI: 10.3389/fpsyt.2017.00272] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neurological soft signs (NSS) represent minor neurological signs, which indicate non-specific cerebral dysfunction. In schizophrenia, their presence has been documented extensively across all stages of the disease. Until recently, NSS were considered an endophenotype or a trait phenomenon. During the past years, however, researchers report fluctuations of the NSS scores. AIMS To further clarify the question whether NSS exhibit state or trait components or both, studies that have investigated NSS longitudinally were reviewed. METHOD Studies which have assessed NSS longitudinally in adults suffering from schizophrenia, were searched for. The time frame was January 1966 to June 2017. Studies on teenagers were excluded because of interferences between brain maturation and pathology. RESULTS Twenty-nine follow-up studies were identified. They included patients during different stages of their illness and mainly used established instruments for NSS assessment. Patients with a first episode or a remitting course predominantly show a decrease of NSS over time, whereas a worsening of NSS can be found in the chronically ill. It was shown that change of NSS total scores over time is predominantly caused by motor system subscales and to a lesser extent by sensory integration scales. With respect to medication, the majority of studies agree on a relationship between medication response and improvement of NSS while the type of antipsychotic does not seem to play a major role. Moreover, where information on side-effects is given, it does not favor a strong relationship with NSS. However, NSS seem to correlate with negative and cognitive symptoms. CONCLUSION Studies manifest a conformity regarding the presence of NSS in schizophrenia patients on the one hand. On the other hand, fluctuations of NSS scores have been widely described in subgroups. Taken together results strongly support a state-trait dichotomy of NSS. Thus, the usage of NSS as an endophenotype has to be called into question.
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Affiliation(s)
- Silke Bachmann
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospitals of Halle (Saale), Halle, Germany
- Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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18
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Picchioni MM, Dazzan P. Clinical significance of neurological abnormalities in psychosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.004408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThe neurological deficits in sensory and motor function in schizophrenia have been described using a confusing variety of terms, reflecting their uncertain relevance and significance to psychosis. In this article we explore the nature of neurological abnormalities in psychosis, describe their assessment and suggest their potential relevance for clinician and patient. We propose that the assessment of neurological abnormalities and extrapyramidal side-effects should figure in the assessment of any patient with psychosis, particularly at illness onset. Furthermore, we suggest that neurological abnormalities can inform prognostic predictions and help to identify patients with more complex future care needs.
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19
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Peralta V, Cuesta MJ. Motor Abnormalities: From Neurodevelopmental to Neurodegenerative Through "Functional" (Neuro)Psychiatric Disorders. Schizophr Bull 2017; 43:956-971. [PMID: 28911050 PMCID: PMC5581892 DOI: 10.1093/schbul/sbx089] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Motor abnormalities (MAs) of severe mental disorders have been traditionally neglected both in clinical practice and research, although they are an increasing focus of attention because of their clinical and neurobiological relevance. For historical reasons, most of the literature on MAs has been focused to a great extent on schizophrenia, and as a consequence their prevalence and featural properties in other psychiatric or neuropsychiatric disorders are poorly known. In this article, we evaluated the extent to which catatonic, extrapyramidal and neurological soft signs, and their associated clinical features, are present transdiagnostically. Methods We examined motor-related features in neurodevelopmental (schizophrenia, obsessive compulsive disorder, autism spectrum disorders), "functional" (nonschizophrenic nonaffective psychoses, mood disorders) and neurodegenerative (Alzheimer's disease) disorders. Examination of the literature revealed that there have been very few comparisons of motor-related features across diagnoses and we had to rely mainly in disorder-specific studies to compare it transdiagnostically. Results One or more motor domains had a substantial prevalence in all the diagnoses examined. In "functional" disorders, MAs, and particularly catatonic signs, appear to be markers of episode severity; in chronic disorders, although with different degree of strength or evidence, all motor domains are indicators of both disorder severity and poor outcome; lastly, in Alzheimer's disease they are also indicators of disorder progression. Conclusions MAs appear to represent a true transdiagnostic domain putatively sharing neurobiological mechanisms of neurodevelopmental, functional or neurodegenerative origin.
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Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Psychiatry Service, Complejo Hospitalario de Navarra, Pamplona, Spain
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20
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Mhalla A, Ben Mohamed B, Correll CU, Amamou B, Mechri A, Gaha L. Neurological soft signs in Tunisian patients with first-episode psychosis and relation with cannabis use. Ann Gen Psychiatry 2017; 16:30. [PMID: 28717382 PMCID: PMC5508788 DOI: 10.1186/s12991-017-0153-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 07/01/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neurological soft signs (NSS) are minor non-localizing neurological abnormalities that are conceptualized as neurodevelopmental markers that mediate the biological risk for psychosis. We aimed to explore the relationship between NSS and cannabis use, an environmental risk factor of psychosis. METHODS This was a cross-sectional study in consecutively admitted patients hospitalized for first-episode psychosis. NSS were assessed by the NSS scale (23 items exploring motor coordination, motor integrative function, sensory integration, involuntary movements or posture, quality of lateralization). Presence of NSS was defined as a NSS scale total score ≥9.5. Cannabis use was ascertained with the cannabis subsection in the Composite International Diagnostic Interview. RESULTS Among 61 first-episode psychosis patients (mean age = 28.9 ± 9.4 years; male = 86.9%, antipsychotic-naïve = 75.4%), the prevalence of current cannabis use was 14.8% (heavy use = 8.2%, occasional use = 6.6%). NSS were present in 83.6% of the sample (cannabis users = 66.7% versus cannabis non-users = 85.5%, p = 0.16). The mean total NSS score was 15.3 ± 6.7, with a significant lower total NSS score in cannabis users (11.2 ± 5.6 versus 16.0 ± 6.7, p = 0.048). Differences were strongest for the "motor coordination" (p = 0.06) and "involuntary movements" (p = 0.07) sub-scores. CONCLUSIONS This study demonstrated a negative association between cannabis use and NSS, especially regarding motor discoordination. This finding supports the hypothesis that a strong environmental risk factor, such as cannabis, may contribute to the onset of psychosis even in the presence of lower biological and genetic vulnerability, as reflected indirectly by lower NSS scores. Nevertheless, additional studies are needed that explore this interaction further in larger samples and considering additional neurobiological and environmental risk factors.
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Affiliation(s)
- Ahmed Mhalla
- Psychiatry Department, Fattouma Bourguiba Hospital, 5000 Monastir, Tunisia.,Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Bochra Ben Mohamed
- Psychiatry Department, Fattouma Bourguiba Hospital, 5000 Monastir, Tunisia.,Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY USA.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY USA
| | - Badii Amamou
- Psychiatry Department, Fattouma Bourguiba Hospital, 5000 Monastir, Tunisia.,Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Anouar Mechri
- Psychiatry Department, Fattouma Bourguiba Hospital, 5000 Monastir, Tunisia.,Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Lotfi Gaha
- Psychiatry Department, Fattouma Bourguiba Hospital, 5000 Monastir, Tunisia.,Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
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21
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Sharma S, Bhatia T, Mazumdar S, Deshpande SN. Neurological soft signs and cognitive functions: Amongst euthymic bipolar I disorder cases, non-affected first degree relatives and healthy controls. Asian J Psychiatr 2016; 22:53-9. [PMID: 27520894 PMCID: PMC5061649 DOI: 10.1016/j.ajp.2016.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 02/15/2016] [Accepted: 04/16/2016] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Srikant Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
| | - Triptish Bhatia
- GRIP-NIH Project, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
| | - Sati Mazumdar
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, USA.
| | - Smita N Deshpande
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
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22
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Chan RCK, Xie W, Geng FL, Wang Y, Lui SSY, Wang CY, Yu X, Cheung EFC, Rosenthal R. Clinical Utility and Lifespan Profiling of Neurological Soft Signs in Schizophrenia Spectrum Disorders. Schizophr Bull 2016; 42:560-70. [PMID: 26712863 PMCID: PMC4838107 DOI: 10.1093/schbul/sbv196] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neurological soft signs (NSSs) bear the promise for early detection of schizophrenia spectrum disorders. Nonetheless, the sensitivity and specificity of NSSs in the psychosis continuum remains a topic of controversy. It is also unknown how NSSs reveal neurodevelopmental abnormality in schizophrenia. We investigated the effect sizes of NSSs in differentiating individuals with schizophrenia spectrum disorders from individuals with other psychiatric conditions and from covariate-matched healthy subjects. We also investigated the partitioned age-related variations of NSSs in both schizophrenia and healthy individuals. NSSs were assessed by the abridged version of the Cambridge Neurological Inventory (CNI) in 3105 participants, consisting of healthy individuals (n=1577), unaffected first-degree relatives of schizophrenia patients (n= 155), individuals with schizotypal personality disorder (n= 256), schizophrenia patients (n= 738), and other psychiatric patients (n= 379). Exact matching and propensity score matching procedures were performed to control for covariates. Multiple regression was used to partition age-related variations. Individuals along the schizophrenia continuum showed elevated levels of NSSs, with moderate effect sizes, in contrast to other psychiatric patients who had minimal NSSs, as well as matched healthy controls. Furthermore, the age-and-NSS relationship in schizophrenia patients was represented by a flat but overall elevated pattern, in contrast to a U-shaped pattern in healthy individuals. In sum, NSSs capture a moderate portion of psychosis proneness with reasonable specificity. Lifespan profiling reveals an abnormal developmental trajectory of NSSs in schizophrenia patients, which supports the endophenotype hypothesis of NSSs by associating it with the neurodevelopmental model of schizophrenia.
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Affiliation(s)
- Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,,*To whom correspondence should be addressed; tel: 86-10-64836274, fax: 86-10-64836274, e-mail:
| | - Weizhen Xie
- Department of Psychology, University of California, Riverside, CA, USA
| | - Fu-lei Geng
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,,University of Chinese Academy of Sciences, Beijing, China
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Simon S. Y. Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,,University of Chinese Academy of Sciences, Beijing, China,,Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Chuan-yue Wang
- Beijing Key Laboratory of Mental Disorders, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, China,,Centre of Schizophrenia, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders (Capital Medical University), Ministry of Science and Technology, Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Beijing, China,,Peking University Institute of Mental Health, Beijing, China,,Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Eric F. C. Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Robert Rosenthal
- Department of Psychology, University of California, Riverside, CA, USA
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23
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Mrad A, Wassim Krir M, Ajmi I, Gaha L, Mechri A. Neurological soft signs in euthymic bipolar I patients: A comparative study with healthy siblings and controls. Psychiatry Res 2016; 236:173-178. [PMID: 26775167 DOI: 10.1016/j.psychres.2015.11.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 07/28/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Amel Mrad
- Research Laboratory "Vulnerability to Psychotic Disorders", Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
| | - Mohamed Wassim Krir
- Research Laboratory "Vulnerability to Psychotic Disorders", Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Inès Ajmi
- Research Laboratory "Vulnerability to Psychotic Disorders", Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Lotfi Gaha
- Research Laboratory "Vulnerability to Psychotic Disorders", Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Anwar Mechri
- Research Laboratory "Vulnerability to Psychotic Disorders", Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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24
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Seigneurie AS, Sauvanaud F, Limosin F. [Prevention and treatment of tardive dyskinesia caused by antipsychotic drugs]. Encephale 2016; 42:248-54. [PMID: 26922134 DOI: 10.1016/j.encep.2015.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/24/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tardive dyskinesia (TD) is a movement disorder of tongue, jawbone, trunk and/or limbs that may appear after a prolonged use of dopamine receptor blocking agents (after 3 months of treatment or after 1 month for patients over 60), and that are present during at least four consecutive weeks. TD is a frequent side effect of both classical neuroleptics and new generation antipsychotic drugs. The prevalence of iatrogenic TD is between 24 and 32 % after treatment with classical neuroleptics and about 13 % after treatment with a new generation antipsychotic. OBJECTIVE This paper presents an updated literature review of data on diagnosis, prevention and treatment of TD. METHODS We conducted a review of literature using the Medline Browser tool, screening studies from 1950 to 2013 in English or French with keywords « tardive dyskinesia », « tardive dystonia », and « abnormal movements caused by antipsychotic drugs ». RESULTS We first describe and define semeiological features of TD: dystonia, tremor, myoclonus, acathisie, chorea, ballism and athetosia. Secondarily, we resume the main differential diagnoses to exclude when confronted with this kind of movement disorders. Differential diagnoses for dyskinesia can be classified between primary (Parkinson and Huntington diseases) and secondary (Wilson disease, intoxication, metabolic abnormality, cerebrovascular accident) abnormal movements. Psychogenic TD can be evocated if previous pathologies are excluded in case of atypical clinical presentation. We detail the risk factors for TD. Endogenous risk factors are related to the patient's age, underlying psychiatric disease (bipolar disorder or Alzheimer dementia), addiction to alcohol or cocaine, female gender, or neurodevelopmental vulnerability. Iatrogenic risk factors are high doses of antipsychotics, long or intermittent administration, and particular pharmaceutical classes or associations of antipsychotics. As a comprehensive tool, we review the main physiopathological hypotheses to explain the occurrence of TD in some patients: hypersensitivity of D2 neuronal receptor or neurotoxicity associated with oxidative stress mechanisms. We also summarize the current guidelines for prevention and treatment of TD. Three successive curative strategies are suggested in the literature. First, the clinician can adapt the current antipsychotic treatment (switch to a new generation antipsychotic, diminution or cessation of antipsychotic drugs). If this first intervention is not pertinent or ineffective, the clinician can prescribe an antikinetic therapeutic agent, such as tetrabenazine, or an antioxidant. Review of the published studies does not show proof of efficacy of cholinergic or anticholinergic drugs, benzodiazepine or other GABAergic drugs, nor for amantadine. Non-medication therapeutics such as ECT and TMS are discussed, but the level of proof is insufficient to promote them as a curative treatment for TD. In case of high resistance and discomfort for the patient, a neurosurgical intervention should be discussed. These curative interventions are limited, emphasising the importance of TD prevention, by limiting the prescription and doses of antipsychotics, regularly evaluating their side effects and informing the patient of TD's risk. CONCLUSION We propose to practitioners a synthesised update of literature concerning a frequent iatrogenic effect of antipsychotics. Nevertheless, no solid guidelines have as yet been established, and further clinical studies are expected in order to better understand this frequent and discomforting side effect.
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Affiliation(s)
- A-S Seigneurie
- Service de psychiatrie de l'adulte et du sujet âgé, hôpital Corentin-Celton, groupe hospitalier hôpitaux universitaires Paris Ouest, Assistance publique-Hôpitaux de Paris (AP-HP), 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - F Sauvanaud
- Service de psychiatrie de l'adulte et du sujet âgé, hôpital Corentin-Celton, groupe hospitalier hôpitaux universitaires Paris Ouest, Assistance publique-Hôpitaux de Paris (AP-HP), 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - F Limosin
- Service de psychiatrie de l'adulte et du sujet âgé, hôpital Corentin-Celton, groupe hospitalier hôpitaux universitaires Paris Ouest, Assistance publique-Hôpitaux de Paris (AP-HP), 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France; Université Paris Descartes, Sorbonne Paris-Cité, 75006 Paris, France; Inserm, U894, centre de psychiatrie et neurosciences, 75014 Paris, France.
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25
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Neurological and cerebellar soft signs do not discriminate schizophrenia from bipolar disorder patients. Prog Neuropsychopharmacol Biol Psychiatry 2016; 64:96-101. [PMID: 26241859 DOI: 10.1016/j.pnpbp.2015.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 07/16/2015] [Accepted: 07/26/2015] [Indexed: 12/12/2022]
Abstract
Patients with schizophrenia (SZ) and bipolar disorder (BD) share subtle motor abnormalities called the neurological soft signs (NSS). Since in both diseases there is evidence for alterations in cerebellar functions, structure and connectivity, we expected that the cerebellar soft signs (CSS), analogue of NSS focusing strictly on cerebellar symptoms, would be also a common trait in SZ and BD. We examined 30 patients with BD, 30 patients with SZ and 28 control subjects using the Neurological Evaluation Scale (NES, for NSS) and International Cooperative Ataxia Rating Scale (ICARS, for CSS). SZ and BD did not differ in total and subscales' scores in both NES and ICARS. Subscale analysis revealed that SZ performed significantly worse than controls in all the subscales of both NES and ICARS. BD patients scored significantly worse than controls in all NES subscales and in oculomotor and kinetic subscales of the ICARS, while other ICARS subscales did not differentiate those two groups. To our knowledge this is the first study to show that CSS constitute common symptoms in BD and SZ. We recommend a special focus on those diseases in further research regarding structural and functional changes of cerebellum and their clinical outcome.
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Chin-Lun Hung G, Hahn J, Alamiri B, Buka SL, Goldstein JM, Laird N, Nelson CA, Smoller JW, Gilman SE. Socioeconomic disadvantage and neural development from infancy through early childhood. Int J Epidemiol 2015; 44:1889-99. [PMID: 26675752 DOI: 10.1093/ije/dyv303] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Galen Chin-Lun Hung
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Jill Hahn
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Bibi Alamiri
- Section of Child & Adolescent Psychiatry, Lahey Hospital & Medical Center, Burlington, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jill M Goldstein
- Departments of Psychiatry and Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nan Laird
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Charles A Nelson
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit Department of Psychiatry Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen E Gilman
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Psychiatry Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
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Morrens M, Docx L, Sabbe B. Catatonia as part of the psychomotor syndrome in schizophrenia. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Although the prevalence and severity of catatonia may have decreased over time, it is still a highly relevant, frequently occurring symptom cluster that can be observed in schizophrenia patients. Apart from this syndrome, neurological soft signs, psychomotor slowing and extrapyramidal symptoms are other psychomotor symptom clusters that are part of the clinical picture of schizophrenia. In this overview, the relevance of catatonia as a contemporary symptom cluster of the illness as well as its relationship with other psychomotor symptoms of the illness are discussed.
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Affiliation(s)
- Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Antwerp, Universiteitsplein 1 - 2610 Antwerp, Belgium
- Psychiatric Hospital Alexian Brothers, Provinciesteenweg 408 - 2530 Boechout, Belgium
| | - Lise Docx
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Antwerp, Universiteitsplein 1 - 2610 Antwerp, Belgium
- Psychiatric Hospital Alexian Brothers, Provinciesteenweg 408 - 2530 Boechout, Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Antwerp, Universiteitsplein 1 - 2610 Antwerp, Belgium
- Psychiatric Hospital St Norbertushuis, Stationstraat 22c, 2570 Duffel, Belgium
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Ilanković V, Ilanković AN, Ilanković NN. Diagnostic Assessment of Movement Disorders and Psychomotor Deficiency in Residual Schizophrenia. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Movement disorders and motor deficiency is highly represented among patients in Schizophrenia – residual type (DSM IV): 37% of patients examined in our research had psycho‑motor disturbances. Dominant disturbances are the following: disturbed tonus among 65% of patients, abnormal postural reactions among 90%, abnormal voluntary movements among 75%, disturbed speech among 85%, disturbed static and dynamic postures among 90%. Involuntary movements are present among 20% of patients.Classic neurological diagnostics offers general assessment of the motor status. Standardized clinical motor scales only register the presence and intensity of the motor disturbance. Rehabilitation treatment requires individual and up to date functional diagnostics of the motor deficiency.We would like to stress that psychiatric patients in psychotic, (prepsychotic) and postpsychotic states, besides being mentally ill, also suffer from serious movement disorders (psychomotor disturbances and deficits) which put them into the category of disabled persons, who besides requiring psychiatric (neuropsychiatric) treatment, also require systematic psychomotor and speech rehabilitation.
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Zhao Q, Li Z, Huang J, Yan C, Dazzan P, Pantelis C, Cheung EFC, Lui SSY, Chan RCK. Neurological soft signs are not "soft" in brain structure and functional networks: evidence from ALE meta-analysis. Schizophr Bull 2014; 40:626-41. [PMID: 23671197 PMCID: PMC3984512 DOI: 10.1093/schbul/sbt063] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Qing Zhao
- *To whom correspondence should be addressed; 4A Datun Road, Beijing 100101, China; tel/fax: +86(0)10 64836274, e-mail:
| | - Zhi Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China;,Key Laboratory of Mental Health, University of Chinese Academy of Sciences, Beijing, China
| | - Jia Huang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Chao Yan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China;,Key Laboratory of Mental Health, University of Chinese Academy of Sciences, Beijing, China
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Australia
| | - Eric F. C. Cheung
- General Adult Psychiatry, Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S. Y. Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China;,Key Laboratory of Mental Health, University of Chinese Academy of Sciences, Beijing, China;,General Adult Psychiatry, Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China;,*To whom correspondence should be addressed; 4A Datun Road, Beijing 100101, China; tel/fax: +86(0)10 64836274, e-mail:
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Mittal VA, Orr JM, Turner JA, Pelletier AL, Dean DJ, Lunsford-Avery J, Gupta T. Striatal abnormalities and spontaneous dyskinesias in non-clinical psychosis. Schizophr Res 2013; 151:141-7. [PMID: 24156901 PMCID: PMC3855894 DOI: 10.1016/j.schres.2013.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/25/2013] [Accepted: 10/03/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accumulating evidence suggests that individuals experiencing non-clinical psychosis (NCP) represent a critical group for improving understanding of etiological factors underlying the broader psychosis continuum. Although a wealth of evidence supports widespread neural dysfunction in formal psychosis, there has been little empirical evidence to inform our understanding of putative vulnerability markers or brain structure in NCP. In this study, we examined the neural correlates of spontaneous movement abnormalities, a biomarker previously detected in NCP that is linked to abnormalities in the striatal dopamine. METHODS We screened a total of 1285 adolescents/young adults, and those scoring in the upper 15th percentile on a NCP scale were invited to participate; 20 of those invited agreed and these individuals were matched with healthy controls. Participants were administered a structural scan, clinical interviews, and an instrumental motor assessment. RESULTS The NCP group showed elevated force variability and smaller putamen (but not caudate), and there was a significant relationship between motor dysfunction and striatal abnormalities for the sample. Elevated force variability was associated with both higher positive and negative symptoms, and there was a strong trend (p=.06) to suggest that smaller left putamen volumes were associated with elevated positive symptoms. CONCLUSIONS The results are among the first to suggest an association between neural structure and a risk marker in NCP. Findings indicate that vulnerabilities seen in schizophrenia also characterize the lower end of the psychosis spectrum.
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Affiliation(s)
- Vijay A. Mittal
- University of Colorado Boulder, Department of Psychology and Neuroscience,University of Colorado Boulder, Center for Neuroscience
| | - Joseph M. Orr
- University of Colorado Boulder, Department of Psychology and Neuroscience,University of Colorado Boulder, Institute for Cognitive Science
| | | | - Andrea L. Pelletier
- University of Colorado Boulder, Department of Psychology and Neuroscience,University of Colorado Boulder, Center for Neuroscience
| | - Derek J. Dean
- University of Colorado Boulder, Department of Psychology and Neuroscience,University of Colorado Boulder, Center for Neuroscience
| | | | - Tina Gupta
- University of Colorado Boulder, Department of Psychology and Neuroscience
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Levit-Binnun N, Davidovitch M, Golland Y. Sensory and motor secondary symptoms as indicators of brain vulnerability. J Neurodev Disord 2013; 5:26. [PMID: 24063566 PMCID: PMC3849186 DOI: 10.1186/1866-1955-5-26] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 09/04/2013] [Indexed: 01/20/2023] Open
Abstract
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.
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Affiliation(s)
- Nava Levit-Binnun
- Interdisciplinary Center (IDC), Sagol Unit for Applied Neuroscience, School of Psychology, POB 167, Herzliya 46150, Israel.
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32
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Zhao Q, Ma YT, Lui SSY, Liu WH, Xu T, Yu X, Tan SP, Wang ZR, Qu M, Wang Y, Huang J, Cheung EFC, Dazzan P, Chan RCK. Neurological soft signs discriminate schizophrenia from major depression but not bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2013; 43:72-8. [PMID: 23266480 DOI: 10.1016/j.pnpbp.2012.12.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/29/2012] [Accepted: 12/11/2012] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Qing Zhao
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Neurological soft signs as an endophenotype in siblings of deficit versus nondeficit schizophrenic patients. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000412906.79378.cb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lateralized movement-related potential amplitudes differentiate between schizophrenia/schizoaffective disorder and major depression. Clin Neurophysiol 2012; 123:1549-60. [PMID: 22289671 DOI: 10.1016/j.clinph.2011.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/26/2011] [Accepted: 12/30/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether deficits in focal lateralized motor system activation would differentiate between subjects with schizophrenia/schizoaffective disorder and subjects with a major depressive episode. Reductions of Bereitschaftspotential amplitude have been described for both diagnostic groups. METHODS We analyzed multi-channel lateralized movement-related potentials (LMRP) during choice reaction movements in 16 schizophrenic/schizoaffective patients in partial remission with predominant negative symptoms, 18 patients with a non-psychotic major depression and two healthy control groups age-matched to the respective patient groups (20/23 subjects). RESULTS A significant reduction of lateralized potentials over the (pre-)motor areas immediately preceding and around movement execution was found only in subjects with schizophrenia/schizoaffective disorder but not with a major depressive episode. Reduced LMRP amplitudes correlated with negative symptoms (SANS score). Other movement stages (preceding response-locked 'contingent negative variation' during response selection and post-movement evaluation during motor postimperative negative variation) were not affected in the same way. CONCLUSIONS Deficits in focal motor cortex activation during movement execution may reflect rather schizophrenia-specific deficits in fronto-striatal circuits. A general lack of drive and depressed mood did not alter the degree of lateralization of motor activation during movement execution. SIGNIFICANCE Lateralization of movement-related potentials could differentiate psychotic from non-psychotic disorders on the group level.
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Macmanus D, Laurens KR, Walker EF, Brasfield JL, Riaz M, Hodgins S. Movement abnormalities and psychotic-like experiences in childhood: markers of developing schizophrenia? Psychol Med 2012; 42:99-109. [PMID: 21740623 DOI: 10.1017/s0033291711001085] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Both involuntary dyskinetic movements and psychotic-like experiences (PLEs) are reported to be antecedents of schizophrenia that may reflect dysfunctional dopaminergic activity in the striatum. The present study compared dyskinetic movement abnormalities displayed by children with multiple antecedents of schizophrenia (ASz), including speech and/or motor developmental lags or problems, internalising/externalising problems in the clinical range, and PLEs, with those displayed by children with no antecedents (noASz). METHOD The sample included 21 ASz and 31 noASz children, aged 9-12 years old. None had taken psychotropic medication or had relatives with psychosis. The antecedents of schizophrenia were assessed using questionnaires completed by children and caregivers. A trained rater, blind to group status, coded dyskinetic movement abnormalities using a validated tool from videotapes of interviews with the children. RESULTS ASz children reported, on average, 'certain experience' of 2.5 PLEs, while noASz children, by definition, reported none. The ASz children, as compared with noASz children, displayed significantly more dyskinetic movement abnormalities in total, and in the facial and the upper-body regions, after controlling for sex and age. Receiver operator characteristics analyses yielded high area under the curve values for the total score (0.94), facial score (0.91) and upper-body score (0.86), indicating that these scores distinguished between the ASz and noASz children with great accuracy. CONCLUSIONS Brief questionnaires identified children with multiple antecedents of schizophrenia who displayed significantly more involuntary dyskinetic movement abnormalities than children without antecedents. The presence of PLEs and dyskinesias could reflect early disruption of striatal dopamine circuits.
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Affiliation(s)
- D Macmanus
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK.
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Abstract
BACKGROUND Neurological soft signs (NSS) are hypothesized as candidate endophenotypes for schizophrenia, but their prevalence and relations with clinical and demographic data are unknown. The authors undertook a quantification (meta-analysis) of the published literature on NSS in patients with schizophrenia and healthy controls. A systematic search was conducted for published articles reporting NSS and related data using standard measures in schizophrenia and healthy comparison groups. METHOD A systematic search was conducted for published articles reporting data on the prevalence of NSS in schizophrenia using standard clinical rating scales and healthy comparison groups. Meta-analyses were performed using the Comprehensive Meta-analysis software package. Effect sizes (Cohen d) indexing the difference between schizophrenic patients and the healthy controls were calculated on the basis of reported statistics. Potential moderator variables evaluated included age of patient samples, level of education, sample sex proportions, medication doses, and negative and positive symptoms. RESULTS A total of 33 articles met inclusion criteria for the meta-analysis. A large and reliable group difference (Cohen d) indicated that, on average, a majority of patients (73%) perform outside the range of healthy subjects on aggregate NSS measures. Cognitive performance and positive and negative symptoms share 2%-10% of their variance with NSS. CONCLUSIONS NSS occur in a majority of the schizophrenia patient population and are largely distinct from symptomatic and cognitive features of the illness.
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Affiliation(s)
- Raymond C. K. Chan
- Key Laboratory of Mental Health, Institute of Psychology,To whom correspondence should be addressed; Institute of Psychology, Chinese Academy of Sciences, 4A Datun Road, Beijing 100101, China; tel/fax: +86-0-10-64836274, e-mail:
| | - Ting Xu
- Neuropsychology and Applied Cognitive Neurosciences Laboratory, Institute of Psychology,Graduate School, Chinese Academy of Sciences, Beijing, China,School of Information, Renmin University of China, Beijing, China
| | | | - Yue Yu
- Neuropsychology and Applied Cognitive Neurosciences Laboratory, Institute of Psychology,Department of Psychology and Yuanpei College, Peking University, Beijing, China
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neurosciences Laboratory, Institute of Psychology,Key Laboratory of Mental Health, Institute of Psychology
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Mittal VA, Walker EF, Bearden CE, Walder D, Trottman H, Daley M, Simone A, Cannon TD. Markers of basal ganglia dysfunction and conversion to psychosis: neurocognitive deficits and dyskinesias in the prodromal period. Biol Psychiatry 2010; 68:93-9. [PMID: 20227679 PMCID: PMC2891189 DOI: 10.1016/j.biopsych.2010.01.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 01/17/2010] [Accepted: 01/20/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Movement abnormalities and cognitive deficits may represent external markers of an underlying neural process linked with the early etiology of psychosis. As basal ganglia function plays a governing role in both movement and cognitive processes, an understanding of the relationship between these phenomena stands to inform etiologic conceptualizations of vulnerability and psychotic disorders. METHODS In this investigation, trained raters coded movement abnormalities in videotapes from structured interviews of adolescents and young adults with a prodromal risk syndrome (n = 90). The participants were administered a neuropsychological battery including measures of verbal comprehension, perceptual organization, immediate/delayed auditory memory, and an estimate of full-scale intelligence quotient. Diagnostic status was followed for a 2-year period utilizing structured clinical interviews, during which time 24 high-risk participants (26.66%) converted to an Axis I psychotic disorder. RESULTS Elevated dyskinetic movements in the upper-body region were correlated with deficits in domains of verbal comprehension, perceptual organization, and both immediate and delayed auditory memory. Further, discriminant function analyses indicated that baseline movement abnormalities and neurocognitive deficits significantly classified those high-risk participants who would eventually convert to a psychotic disorder (72.3%). CONCLUSIONS Results support a common cortico-striato-pallido-thalamic circuit irregularity, underlying both movement abnormalities and cognitive deficits in individuals at high risk for psychosis. Models incorporating external markers of progressive basal ganglia dysfunction may enhance detection and preventive intervention for those high-risk individuals most in need of treatment.
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Affiliation(s)
- Vijay A Mittal
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA.
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Abstract
Schizophrenia (SZ) is a complex, heterogeneous, and disabling psychiatric disorder that impairs multiple aspects of human cognitive, perceptual, emotional, and behavioral functioning. SZ is relatively frequent (prevalence around 1%), with onset usually during adolescence or early adulthood, and has a deteriorating course. The rapidly growing area of neuroimaging research has has found clear evidence of many cortical and subcortical abnormalities in individuals with SZ. In this article the most recent findings from multiple studies on neurological disorders in SZ are reviewed, and the authors make a strong argument for a neurological basis of the schizophrenic process.
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Affiliation(s)
- Arman Danielyan
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45244, USA
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Demjaha A, Morgan K, Morgan C, Landau S, Dean K, Reichenberg A, Sham P, Fearon P, Hutchinson G, Jones PB, Murray RM, Dazzan P. Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11? Psychol Med 2009; 39:1943-1955. [PMID: 19627645 DOI: 10.1017/s0033291709990651] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is good evidence that psychotic symptoms segregate into symptom dimensions. However, it is still unclear how these dimensions are associated with risk indicators and other clinical variables, and whether they have advantages over categorical diagnosis in clinical practice. We investigated symptom dimensions in a first-onset psychosis sample and examined their associations with risk indicators and clinical variables. We then examined the relationship of categorical diagnoses to the same variables. METHOD We recruited 536 patients as part of a population-based, incidence study of psychosis. Psychopathology was assessed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). A principal axis factor analysis was performed on symptom scores. The relationship of dimension scores with risk indicators and with clinical variables was then examined employing regression analyses. Finally, regression models were compared to assess the contribution of dimensions versus diagnosis in explaining these variables. RESULTS Factor analysis gave rise to a five-factor solution of manic, reality distortion, negative, depressive and disorganization symptom dimensions. The scores of identified dimensions were differentially associated with specific variables. The manic dimension had the highest number of significant associations; strong correlations were observed with shorter duration of untreated psychosis, acute mode of onset and compulsory admission. Adding dimensional scores to diagnostic categories significantly increased the amount of variability explained in predicting these variables; the reverse was also true but to a lesser extent. CONCLUSIONS Categorical and dimensional representations of psychosis are complementary. Using both appears to be a promising strategy in conceptualising psychotic illnesses.
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Affiliation(s)
- A Demjaha
- Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK.
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Schiffman J, Sorensen HJ, Maeda J, Mortensen EL, Victoroff J, Hayashi K, Michelsen NM, Ekstrom M, Mednick S. Childhood motor coordination and adult schizophrenia spectrum disorders. Am J Psychiatry 2009; 166:1041-7. [PMID: 19605535 PMCID: PMC3699872 DOI: 10.1176/appi.ajp.2009.08091400] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined whether motor coordination difficulties assessed in childhood predict later adult schizophrenia spectrum outcomes. METHOD A standardized childhood neurological examination was administered to a sample of 265 Danish children in 1972, when participants were 10-13 years old. Adult diagnostic information was available for 244 members of the sample. Participants fell into three groups: children whose mothers or fathers had a psychiatric hospital diagnosis of schizophrenia (N=94); children who had at least one parent with a psychiatric record of hospitalization for a nonpsychotic disorder (N=84); and children with no parental records of psychiatric hospitalization (N=66). Psychiatric outcomes of the offspring were assessed through psychiatric interviews in 1992 when participants were 31-33 years of age, as well as through a scan of national psychiatric registers completed in May 2007. RESULTS Children who later developed a schizophrenia spectrum disorder (N=32) displayed significantly higher scores on a scale of coordination deficits compared with those who did not develop a mental illness in this category (N=133). CONCLUSIONS Results from this study provide further support for the neurodevelopmental hypothesis of schizophrenia and underscore the potential role of cerebellar and/or basal ganglia abnormalities in the etiology and pathophysiology of schizophrenia.
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Affiliation(s)
- Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, USA.
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Non-therapeutic risk factors for onset of tardive dyskinesia in schizophrenia: A meta-analysis. Mov Disord 2009; 24:2309-15. [DOI: 10.1002/mds.22707] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Picard HJ, Amado I, Bourdel MC, Landgraf S, Olié JP, Krebs MO. Correlates between neurological soft signs and saccadic parameters in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:676-81. [PMID: 19303908 DOI: 10.1016/j.pnpbp.2009.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 02/27/2009] [Accepted: 03/16/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Neurological Soft Signs (NSS) and impairments in oculomotor saccadic paradigms are both frequent in patients with schizophrenia but their correlation has never been explored. METHODS 78 patients with DSM-IV schizophrenia (including 43 non-treated) and 41 matched healthy controls were tested for NSS, and on three saccadic tasks: prosaccades, predictive saccades and memory-guided saccades) using infrared oculometry. We analyzed correlations between NSS scores and latencies in all three tasks, rate of errors in memory-guided saccades, and rate of anticipated predictive saccades. RESULTS No correlations were found in healthy controls. In the patient group, the NSS total and motor coordination scores were positively correlated with three saccadic variables: the latency of prosaccades (r=0.36, p<0.01 and r=0.36, p<0.01 respectively), of memory-guided saccades (r=0.35, p<0.01 and r=0.32, p<0.05 respectively) and, negative correlations were found, with the rate of anticipated predictive saccades (r=-0.33, p<0.01; r=-0.35, p<0.01 respectively). NSS total, motor coordination and sensory integration scores were correlated to the latency of non-anticipated predictive saccades (r=0.34, p<0.01; r=0.24, p<0.05 and r=0.40, p<0.001 respectively). The NSS total, motor integration and sensory integration scores were correlated with the rate of errors in memory-guided saccades (r=0.38, p<0.01; r=0.37, p<0.01 and r=0.34, p<0.01 respectively). CONCLUSIONS These results support a common pathological mechanism with partial overlapping neural substrates between NSS and saccades in schizophrenia.
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Affiliation(s)
- Hernàn J Picard
- INSERM, Laboratoire de Physiopathologie des Maladies Psychiatriques, Centre Psychiatrie et Neurosciences, U894, Paris, France.
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Hui CLM, Wong GHY, Chiu CPY, Lam MML, Chen EYH. Potential Endophenotype for Schizophrenia: Neurological Soft Signs. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n5p408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Neurological soft signs (NSS) are suggested as a candidate endophenotype for schizophrenia. This article aims to review relevant literature and discuss the role of NSS in understanding schizophrenia.
Methods: This is an update on a review article published in 2003. Articles from 2003 onwards were specifically reviewed and discussed with relevance to the role of NSS as endophenotype for schizophrenia.
Results: Consistent data suggest an excess of NSS in schizophrenic patients. NSS appear to be related to schizophrenic symptoms, in particular negative symptoms and disorganisation. Information on NSS and demographic correlates is scarce, and the confounding effects between age, education and intelligence on NSS constitute an important gap in current knowledge. Longitudinal data suggest NSS as both a trait and state variable in the course of disease. NSS are not specific with regard to diagnosis, although there are claims that individual sub-components may be more specific. The weight of evidence raises question on the specificity of NSS for schizophrenia.
Conclusions: The usefulness and feasibility of NSS as a specific endophenotype target for schizophrenia is unclear. However, NSS remain an important feature and symptom correlate of schizophrenia. Future research should focus on delineating the effects of NSS from those of confounding demographic variables, and the stability of NSS over the course of illness to elucidate its role in schizophrenia.
Key words: Diagnostic specificity, Neurological examination abnormalities, Psychotic symptoms, Review, Trait
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Ruiz-Veguilla M, Gurpegui M, Barrigón ML, Ferrín M, Marín E, Rubio JL, Gutiérrez B, Pintor A, Cervilla J. Fewer neurological soft signs among first episode psychosis patients with heavy cannabis use. Schizophr Res 2009; 107:158-64. [PMID: 18805673 DOI: 10.1016/j.schres.2008.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 07/18/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although neurological soft signs (NSS) have been consistently associated with schizophrenia and a variety of risk factors, few studies have focused on the association between NSS and environmental factors such as cannabis use, particularly in patients with first episode psychosis. METHODS We administered the Neurological Evaluation Scale (NES) to 92 patients during their first episode of functional psychosis. Psychopathology was assessed with the Positive And Negative Syndrome Scale (PANSS) and the family history of psychotic disorder was established on the basis of the Family Interview for Genetic Studies (FIGS). We also assessed lifetime cannabis and cocaine use utilizing that specific section of the Composite International Diagnostic Interview. The outcome variable was the presence of high NSS, defined by a score above the median split of the NES score (>21). RESULTS Most patients (80/92, 87%) presented a non-affective psychosis. The presence of high NSS showed a significant independent association with not having been a heavy cannabis user (OR=8.3; 95% CI, 2.4-33.3), family history of psychosis (OR=4.3; 95% CI, 1.2-14.9), male sex (OR=4.0; 95% CI, 1.2-14.0), lower score in verbal fluency and higher score in negative symptoms (both p<0.01). CONCLUSION Our cross-sectional results support the hypothesis that potentially different pathways associated with the emergence of first episode psychosis may exist, including neurological premorbid alteration and environmental cannabis abuse.
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Affiliation(s)
- Miguel Ruiz-Veguilla
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, and Psychiatry Service, San Cecilio University Hospital, Granada, Spain
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Mayoral M, Bombín I, Zabala A, Robles O, Moreno D, Parellada M, Ruiz-Sancho A, Arango C. Neurological soft signs in adolescents with first episode psychosis: two-year followup. Psychiatry Res 2008; 161:344-8. [PMID: 18990454 DOI: 10.1016/j.psychres.2007.07.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 07/11/2007] [Accepted: 07/14/2007] [Indexed: 11/30/2022]
Abstract
Neurological soft signs were assessed in 24 first episodes of early onset psychosis and 30 healthy adolescents over a 2-year period. Patients presented more neurological soft signs than controls and showed a significant decrease in some Neurological Evaluation Scale scores over the followup period. This decrease in the patient group was influenced by changes in symptomatology.
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Affiliation(s)
- María Mayoral
- Department of Psychiatry, Adolescent Unit, Gregorio Marañón University General Hospital, Madrid, Spain
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De Masi S, Sampaolo L, Mele A, Morciano C, Cappello S, Meneghelli A, De Girolamo G. The Italian guidelines for early intervention in schizophrenia: development and conclusions. Early Interv Psychiatry 2008; 2:291-302. [PMID: 21352163 DOI: 10.1111/j.1751-7893.2008.00091.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The effectiveness of early intervention in schizophrenia is still under discussion. The guidelines described in the present paper were aimed at contributing to the current debate by providing Italian practitioners, families, patients and health managers with evidence-based information on early intervention. They also examined the diagnostic tools that are currently available for assessing different stages of psychotic disorders. METHODS A multidisciplinary panel of experts (the Guidelines Development Group) used a set of key-questions to develop an explicit search strategy to conduct a systematic review of the literature published from January 2000 to June 2006. Trained personnel then selected papers from those yielded by the literature search. The Guidelines Development Group's final recommendations were scaled according to the Italian National Guidelines System grading system. RESULTS The evidence available up to the time of the literature search does not allow for recommendation of early intervention targeting prodromal or at-risk patients to prevent progression from the prodromal phase to acute, full-blown psychosis, nor to improve prognosis. Conversely, identification and timely treatment of first-episode psychotic patients through specific early intervention programmes are highly recommended. CONCLUSIONS The Italian Guidelines on early intervention in schizophrenia are based on a comprehensive assessment of an updated, large-scale body of literature. They draw specific, evidence-based conclusions to assist clinicians and stakeholders in the planning and implementation of appropriate intervention programmes. Further research is needed to ascertain the effectiveness of early intervention in delaying or preventing the conversion to psychosis and improving prognosis in prodromal or at-risk patients. Further investigation is also required for first-episode and critical period patients.
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Neurological soft signs as candidate endophenotypes for schizophrenia: A shooting star or a Northern star? Neurosci Biobehav Rev 2008; 32:957-71. [DOI: 10.1016/j.neubiorev.2008.01.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Revised: 01/23/2008] [Accepted: 01/24/2008] [Indexed: 12/14/2022]
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Picard H, Amado I, Mouchet-Mages S, Olié JP, Krebs MO. The role of the cerebellum in schizophrenia: an update of clinical, cognitive, and functional evidences. Schizophr Bull 2008; 34:155-72. [PMID: 17562694 PMCID: PMC2632376 DOI: 10.1093/schbul/sbm049] [Citation(s) in RCA: 202] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The role of the cerebellum in schizophrenia has been highlighted by Andreasen's hypothesis of "cognitive dysmetria," which suggests a general dyscoordination of sensorimotor and mental processes. Studies in schizophrenic patients have brought observations supporting a cerebellar impairment: high prevalence of neurological soft signs, dyscoordination, abnormal posture and propioception, impaired eyeblink conditioning, impaired adaptation of the vestibular-ocular reflex or procedural learning tests, and lastly functional neuroimaging studies correlating poor cognitive performances with abnormal cerebellar activations. Despite those compelling evidences, there has been, to our knowledge, no recent review on the clinical, cognitive, and functional literature supporting the role of the cerebellum in schizophrenia. We conducted a Medline research focusing on cerebellar dysfunctions in schizophrenia. Emphasis was given to recent literature (after 1998). The picture arising from this review is heterogeneous. While in some domains, the role of the cerebellum seems clearly defined (ie, neurological soft signs, posture, or equilibrium), in other domains, the cerebellar contribution to schizophrenia seems limited or indirect (ie, cognition) if present at all (ie, affectivity). Functional models of the cerebellum are proposed as a background for interpreting these results.
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Affiliation(s)
- Hernàn Picard
- INSERM U796, Pathophysiology of psychiatric diseases, University Paris Descartes, Sainte-Anne Hospital, Paris, France.
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Krebs MO, Mouchet S. Signes neurologiques mineurs et schizophrénie : revue des données actuelles. Rev Neurol (Paris) 2007; 163:1157-68. [DOI: 10.1016/s0035-3787(07)78400-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 04/21/2007] [Accepted: 05/22/2007] [Indexed: 10/22/2022]
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Mehler-Wex C, Riederer P, Gerlach M. Dopaminergic dysbalance in distinct basal ganglia neurocircuits: implications for the pathophysiology of Parkinson's disease, schizophrenia and attention deficit hyperactivity disorder. Neurotox Res 2007; 10:167-79. [PMID: 17197367 DOI: 10.1007/bf03033354] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The basal ganglia form a forebrain system that collects signals from a large part of the neocortex, redistributes these cortical inputs both with respect to one another and with respect to inputs from the limbic system, and then focuses the inputs of this redistributed, integrated signals into particular regions of the frontal lobes and brainstem involved in aspects of motor planning and motor memory. Movement disorders associated with basal ganglia dysfunction comprise a spectrum of abnormalities that range from the hypokinetic disorder (from which Parkinson's disease, PD, is the best-known-example) at one extreme to the hyperkinetic disorder (exemplified by Huntington's disease and hemiballism) at the other. In addition to disorders of movement, major mental disorders including schizophrenic-like states and attention deficit hyperactivity disorder (ADHD) have been linked to abnormalities in the basal ganglia and their allied nuclei. In this paper we discuss recent evidence indicating that a dopamine-induced dysbalance of basal ganglia neurocircuitries may be an important pathophysiological component in PD, schizophrenia and ADHD. According to our model, the deprivation of dopaminergic nigro-striatal input, as in PD, reduces the positive feedback via the direct system, and increases the negative feedback via the indirect system. The critical consequences are an overactivity of the basal ganglia output sites with the resulting inhibition of thalamo-cortical drive. In schizophrenia the serious cognitive deficits might be partly a result of a hyperactivity of the inhibitory dopamine D(2) transmission system. Through this dysinhibition, the thalamus exhibits hyperactivity that overstimulates the cortex resulting in dysfunctions of perception, attention, stimulus distinction, information processing and affective regulation (inducing hallucinations and delusions) and motor disabilities. Recent studies have strongly suggested that a disturbance of the dopaminergic system is also involved in the pathophysiology of ADHD. The most convincing evidence comes from the demonstration of the efficacy of psychostimulants such as the dopamine transporter (DAT) blocker methylphenidate in the symptomatic treatment of ADHD. Genetic studies have shown an association between ADHD and genes involved in dopaminergic neurotransmission (for example the dopamine receptor genes DRD4 and DRD5, and the DAT gene DAT1). DAT knockout mice display a phenotype with increased locomotor activity, which is normalized by psychostimulant treatment. Finally, imaging studies demonstrated an increased density of DAT in the striatum of ADHD patients. Which system is disturbed and whether this system is hyper- or hypoactive is not unambiguously known yet.
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Affiliation(s)
- C Mehler-Wex
- Department of Child and Adolescent Psychiatry and Psychotherapy, Julius-Maximilians-University, Wuerzburg, Germany
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