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Cai D, Wang X, Kong L. The role of neurological soft signs in different mathematical skills in second and third grade children. Psych J 2022; 11:401-408. [PMID: 35023332 DOI: 10.1002/pchj.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/23/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022]
Abstract
Neurological soft signs (NSSs) are subtle motor and sensory deficits, and are associated with poor cognitive abilities. Although cognitive ability has been found to be a significant predictor for academic performance in children, it remains unclear whether NSSs could contribute to academic abilities such as mathematical skills, and its contribution varies according to grade level. Therefore, in this cross-sectional study, we examined the relationships between NSSs and different mathematical skills (calculation fluency, numerical operations, and mathematical problem-solving) in 105 Chinese children (Mean age = 7.76 years, SD age = 0.67 years; 52 from second grade, 53 from third grade; 56 boys and 49 girls) recruited from a primary public school located in Shanghai. The results of regression analyses revealed that NSSs significantly predicted calculation fluency (β = -.32, p < .050), numerical operations (β = -.38, p < .050), and mathematical problem-solving (β = -0.40, p < .010) in second but not third grade, even controlling for cognitive processes. Our results implicate that NSSs could be a potential predictor for mathematical skills in the early years of primary school.
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Affiliation(s)
- Dan Cai
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Xingsong Wang
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Li Kong
- Department of Psychology, Shanghai Normal University, Shanghai, China
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Victor R, Sachin BS, Pathak K, Avinash P, Saxena V. Correlation of neurological soft signs with neuropsychological performance in persons with schizophrenia: A cross-sectional study from North-Eastern India. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_159_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Herold CJ, Duval CZ, Lässer MM, Schröder J. Neurological soft signs (NSS) and cognitive impairment in chronic schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 16:17-24. [PMID: 30671351 PMCID: PMC6305804 DOI: 10.1016/j.scog.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/16/2023]
Abstract
Recent studies indicate that neurological soft signs (NSS) in schizophrenia are associated with generalized cognitive impairments rather than changes in specific neuropsychological domains. However, the majority of studies solely included first-episode patients or patients with a remitting course and did not consider age, course, education or severity of global cognitive deficits as potential confounding variables. Therefore, we examined NSS with respect to cognitive deficits in chronic schizophrenia, i.e. patients who are particularly vulnerable to both, NSS and cognitive impairments. Eighty patients with chronic schizophrenia (43.36 ± 15a) and 60 healthy controls (47.52 ± 14.8a) matched for age, sex and years of education were examined on the Heidelberg NSS scale and a broad neuropsychological battery including short term, working, logical and autobiographic memory (AM), theory of mind (ToM), psychomotor speed and cognitive flexibility. When contrasted with the controls, patients showed significantly higher NSS scores and impairments in all neuropsychological domains but short-term memory. NSS were significantly associated with all neuropsychological domains considered but short-term memory and semantic AM. Except for episodic AM (which was significantly correlated with NSS in patients only) these correlations applied to both groups and were confirmed when age, years of education and severity of global cognitive deficits (Mini Mental State Examination) were controlled for. Results demonstrate that NSS reflect a rather wide range of cognitive impairments in schizophrenia, which also involves episodic AM and ToM. These associations were not accounted for by age, education or severity of global cognitive deficits and facilitate the clinical usage of NSS as a screening instrument.
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Affiliation(s)
- Christina J Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Céline Z Duval
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc M Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
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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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Gong J, Xie J, Chen G, Zhang Y, Wang S. Neurological soft signs in children with attention deficit hyperactivity disorder: Their relationship to executive function and parental neurological soft signs. Psychiatry Res 2015; 228:77-82. [PMID: 25943836 DOI: 10.1016/j.psychres.2015.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 03/29/2015] [Accepted: 04/15/2015] [Indexed: 11/15/2022]
Abstract
The correlations between neurological soft signs (NSS) in children with attention deficit hyperactivity disorder (ADHD) and their executive function, symptoms of inattention, and hyperactivity-impulsivity and the NSS of their parents remain unclear. This study aimed to examine: (1) the prevalence of NSS in children with ADHD and their parents; (2) the correlation between the NSS of children with ADHD and the NSS of their parents; and (3) the correlation between the NSS of children with ADHD and their executive function and symptoms. NSS were assessed with the Cambridge Neurological Inventory (CNI) in 57 children with ADHD (and 80 parents) and 60 healthy children (and 75 parents). Executive function was measured with the Behavioral Rating Inventory of Executive Function (BRIEF). Children with ADHD and their parents had significantly higher NSS than normal children and their parents, respectively, and the NSS of children with ADHD were correlated more strongly with the NSS of their fathers than their mothers. No correlation was found between NSS and BRIEF executive function, but Disinhibition in children with ADHD was significantly correlated with hyperactivity-impulsivity symptoms. Paternal and maternal NSS provided different predictions for child NSS. It may be that NSS are more likely to be genetically transmitted by fathers.
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Affiliation(s)
- Jingbo Gong
- Department of Applied Psychology, Traditional Chinese Medicine University of Hunan, Changsha 410208, Hunan, China
| | - Jingtao Xie
- Department of Applied Psychology, Traditional Chinese Medicine University of Hunan, Changsha 410208, Hunan, China
| | - Gui Chen
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China
| | - Yajie Zhang
- Department of Applied Psychology, Traditional Chinese Medicine University of Hunan, Changsha 410208, Hunan, China
| | - Suhong Wang
- Department of Neuroscience, The Third Affiliated Hospital of Soochow University, Juqian Road No. 185, Changzhou 213003, China.
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Hirjak D, Wolf RC, Kubera KM, Stieltjes B, Thomann PA. Multiparametric mapping of neurological soft signs in healthy adults. Brain Struct Funct 2014; 221:1209-21. [DOI: 10.1007/s00429-014-0964-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Özçetin A, Poyraz BÇ, Poyraz CA, Bozhüyük E, Bolat N, Balcioğlu İ, Özkiliç AÇ, Genç ZS, Cengiz M. T102C polymorphism of serotonin-2A receptor gene in Turkish schizophrenia patients: Association with cognitive impairment and soft neurological signs. Indian J Psychiatry 2014; 56:359-64. [PMID: 25568476 PMCID: PMC4279293 DOI: 10.4103/0019-5545.146528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM Previous studies have shown an association between the T102C polymorphism of the serotonin-2A receptor gene and schizophrenia. In addition, an association of this polymorphism with clinical phenotypes in schizophrenia such as treatment response and cognitive impairment has been observed. MATERIALS AND METHODS In this case-control study conducted in Turkish Caucasians, we compared T102C polymorphism genotype and allele frequencies in 76 schizophrenic patients and 165 healthy controls. We also investigated interaction of this polymorphism with clinical and cognitive variables in patients. RESULTS No significant difference was observed in the distribution of the three genotypes (T/T, T/C and C/C) and in the allele frequencies in controls and patients with schizophrenia. No evidence of association was detected at various clinical phenotypes including symptom severity, suicidality, treatment response, age of disease onset, number of hospitalizations and history of violence (in co-dominant, dominant, or recessive models). However, as compared to the C/C genotype, patients with 1 or 2 copies of the T allele were characterized by better stroop test performances and less "motor coordination" soft neurological signs. CONCLUSION Further research is needed to elucidate the impact of T102C polymorphism on neurocognitive functions in both healthy and patient populations.
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Affiliation(s)
- Adnan Özçetin
- Department of Psychiatry, Bolu İzzet Baysal Medical School, Bolu, Turkey
| | - Burç Çağrı Poyraz
- Department of Psychiatry, University of Istanbul, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, University of Istanbul, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Erol Bozhüyük
- Department of Psychiatry, Kahramanmaraş State Hospital, Kahramanmaraş, Turkey
| | - Nurullah Bolat
- Department of Child and Adolescent Psychiatry, Diyarbakır Pediatric Hospital, Diyarbakır, Turkey
| | - İbrahim Balcioğlu
- Department of Psychiatry, University of Istanbul, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Anıl Çağla Özkiliç
- Department of Medical Biology, University of Istanbul, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Zehra Seda Genç
- Department of Medical Biology, University of Istanbul, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Müjgan Cengiz
- Department of Medical Biology, University of Istanbul, Cerrahpaşa Medical School, Istanbul, Turkey
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Bersani G, Clemente R, Gherardelli S, Bersani FS, Manuali G. Obstetric complications and neurological soft signs in male patients with schizophrenia. Acta Neuropsychiatr 2012; 24:344-8. [PMID: 25287176 DOI: 10.1111/j.1601-5215.2011.00636.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bersani G, Clemente R, Gherardelli S, Bersani FS, Manuali G. Obstetric complications and neurological soft signs in male patients with schizophrenia.Objective: The study investigated the relationship between neurological soft signs (NSS) and obstetric complications (OCs) in patients with schizophrenia.Methods: Sixty-three male patients with schizophrenia were divided into two subgroups, based on the OCs presence or absence, which were compared in relation to NSS prevalence. After that, a Person's correlation test was performed to explore the correlation between NSS and OCs severity.Results: The subgroup with OCs showed more NSS, but there were not significant correlations between NSS and OCs severity.Conclusions: It seems that any OC, without distinction in typology and severity, could unspecifically impair the neurodevelopment and inducing NSS expression. Our findings confirm the hypothesis that neurodevelopment alterations, such as those probably induced by OCs, can contribute to a premorbid brain dysfunctional state expressed by NSS.
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Affiliation(s)
- Giuseppe Bersani
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Roberta Clemente
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Simona Gherardelli
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Francesco Saverio Bersani
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Giorgiana Manuali
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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Mandarelli G, Parmigiani G, Tarsitani L, Frati P, Biondi M, Ferracuti S. The Relationship Between Executive Functions and Capacity to Consent to Treatment in Acute Psychiatric Hospitalization. J Empir Res Hum Res Ethics 2012; 7:63-70. [DOI: 10.1525/jer.2012.7.5.63] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the acknowledged influence of cognition on patients' capacity to consent to treatment, the specific neuropsychological domains involved remain elusive, as does the role of executive functions. We investigated possible associations between executive functions and decisional capacity in a sample of acute psychiatric inpatients. Patients were recruited and evaluated through the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the 24-item Brief Psychiatric Rating Scale (BPRS), the Mini-Mental State Examination (MMSE), and the Wisconsin Card Sorting Test (WCST). Patients with poor executive functioning performed worse in MacCAT understanding, appreciation, and expression of a choice, compared with good performers. These findings point to the importance of cognition in decisional capacity processes. In addition, the strong association found between learning abilities and informed consent decision-making provide empirical evidence indicating possible cognitive enhancement strategies that may improve psychiatric patients' competency.
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Theleritis C, Vitoratou S, Smyrnis N, Evdokimidis I, Constantinidis T, Stefanis NC. Neurological soft signs and psychometrically identified schizotypy in a sample of young conscripts. Psychiatry Res 2012; 198:241-7. [PMID: 22503357 DOI: 10.1016/j.psychres.2012.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 12/06/2011] [Accepted: 03/06/2012] [Indexed: 11/26/2022]
Abstract
There is growing interest in the connection between neurological soft signs (NSS) and schizophrenia spectrum disorders such as schizotypal personality disorder. The association between NSS and schizotypy was investigated in a subgroup of 169 young healthy male military conscripts included in the Athens Study of Psychosis Proneness and Incidence of Schizophrenia. During their first 2 weeks in the National Basic Air Force Training Centre (T(1)-first assessment), subjects completed the Schizotypal Personality Questionnaire (SPQ), the Symptom Checklist-90-Revised (SCL-90-R), and the Raven's Progressive Matrices (RPM). Then, 2 years later (T(2)-second assessment), at the time of military discharge, they were tested for NSS with the Neurological Evaluation Scale (NES) and reevaluated with the SPQ, the SCL-90-R and additionally the Structured Clinical Interview for Personality Disorders (SCID-II) for the Diagnostic and Statistical Manual of Mental Disorders Third Edition, Revised (DSM-III-R). NSS were more prominent in conscripts with high schizotypy; scores on Sequencing of Complex Motor Acts (SCMA) and the "Other Soft Signs" (OSS) subscales were correlated with high schizotypy at both T(1) and T(2). Increased levels of SCMA as well as the total NSS score were correlated at both T(1) and T(2) with the interpersonal SPQ factor (reflecting negative schizotypy). The findings support the proposal that negative schizotypy might be associated with subtle neurodevelopmental abnormalities.
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Affiliation(s)
- Christos Theleritis
- University Mental Health Research Institute, 2 Soranou Efesiou Str., Papagou 156 01, Athens, Greece
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Dazzan P, Chan RCK. Which neurological abnormalities and neuropsychological impairments share the same substrate in psychosis? CHINESE SCIENCE BULLETIN 2011. [DOI: 10.1007/s11434-011-4737-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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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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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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Dibben CRM, Rice C, Laws K, McKenna PJ. Is executive impairment associated with schizophrenic syndromes? A meta-analysis. Psychol Med 2009; 39:381-392. [PMID: 18588741 DOI: 10.1017/s0033291708003887] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A key neuropsychological proposal in schizophrenia is that negative and disorganization symptoms are associated with different patterns of impairment on executive tasks. METHOD Studies reporting correlations between positive, negative or disorganization symptoms and any type of executive test were meta-analysed. The influence of moderating factors was also examined, including age, treatment and stage of illness and whether symptoms were relapsing or persistent. The magnitudes of the correlations were compared with those for general intellectual impairment. RESULTS Pooled correlations between executive impairment and both negative symptoms and disorganization were significant in the small-to-moderate range. That for positive symptoms ('reality distortion'), however, was close to zero. The pattern of correlations among different executive tests differed significantly for negative symptoms and disorganization. Patients with stable clinical pictures showed significantly higher correlations with executive impairment than those with relapsing and remitting illnesses. Both negative symptoms and disorganization also correlated significantly with general intellectual function as indexed by current IQ. CONCLUSIONS Meta-analysis supports the view that negative symptoms and disorganization are associated with partially dissociable patterns of executive impairment. However, co-existent general intellectual impairment has been an important confounding factor in the studies to date.
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Neuroanatomical correlates of neurological soft signs in antipsychotic-naive schizophrenia. Psychiatry Res 2008; 164:215-22. [PMID: 19019637 DOI: 10.1016/j.pscychresns.2007.12.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 10/28/2007] [Accepted: 12/22/2007] [Indexed: 11/23/2022]
Abstract
Recent imaging studies suggest that the so-called "soft" neurological signs in schizophrenia might have neuroanatomical validity. We examined gray matter volume correlates of neurological soft signs (NSS) in antipsychotic-naive schizophrenia patients using an automated image analysis technique. NSS were assessed using a modified neurological evaluation scale with good inter-rater reliability. Magnetic resonance images of 30 schizophrenia patients and 27 age-, sex-, education- and handedness-matched healthy controls were processed using optimized voxel-based morphometry (VBM). Logistic regression analysis showed that only the Motor Sequencing Signs (MSS) sub-score was a significant predictor of subject's status among the NSS sub-scores. Optimized VBM analysis showed that the MSS sub-score had a significant negative correlation with total and regional gray matter volumes (prefrontal, posterior cingulate, temporal cortices, putamen, and cerebellum) in schizophrenia patients but not in controls. Prefrontal and temporal cortices, putamen and cerebellum had significant volume deficits in patients. Cortical and cerebellar correlates of the sub-score MSS support the concept of "cognitive dysmetria" in schizophrenia.
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Hyde TM, Goldberg TE, Egan MF, Lener MC, Weinberger DR. Frontal release signs and cognition in people with schizophrenia, their siblings and healthy controls. Br J Psychiatry 2007; 191:120-5. [PMID: 17666495 DOI: 10.1192/bjp.bp.106.026773] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Frontal release signs, a subset of neurological soft signs, are common in schizophrenia. AIMS To explore the relationship between frontal release signs and neuropsychological tests of frontal lobe function in people with schizophrenia, their siblings and healthy controls. METHOD Neuropsychological tests and frontal release signs were measured in a cohort of index cases (n=302), their siblings (n=240) and healthy controls (n=346). RESULTS The mean total score of frontal release signs was 1.5 (s.d.=1.58) in the schizophrenia group, 0.54 (s.d.=0.92) for siblings and 0.42 (s.d.=0.77) for controls. Schizophrenia group scores were greater than healthy control or sibling cohort scores (P < 0.0001), which did not differ. In all three cohorts, right grasp reflex scores positively correlated with number of perseverative errors on the Wisconsin Card Sort Task (P < 0.05). In the schizophrenia group, frontal release signs scores showed an inverse correlation with IQ (R=-0.199, P < 0.0005). CONCLUSIONS Our findings of relationships between frontal release signs and cognitive assays of cortical dysfunction and the increased frequency of these signs in people with schizophrenia implicate a cortical origin for these clinical signs and evidence of frontal lobe dysfunction in this disorder.
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Affiliation(s)
- Thomas M Hyde
- Clinical Brain Disorders Branch, Intramural Research Program, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20892, USA.
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Rüsch N, Spoletini I, Wilke M, Bria P, Di Paola M, Di Iulio F, Martinotti G, Caltagirone C, Spalletta G. Prefrontal-thalamic-cerebellar gray matter networks and executive functioning in schizophrenia. Schizophr Res 2007; 93:79-89. [PMID: 17383859 DOI: 10.1016/j.schres.2007.01.029] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 01/31/2007] [Accepted: 01/31/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Poor executive functioning is a core deficit in schizophrenia and has been linked to frontal lobe alterations. We aimed to identify (1) prefrontal cerebral areas in which decreased volume is linked to executive dysfunction in schizophrenia; and (2) areas throughout the brain that are volumetrically related to the prefrontal area identified in the first analysis, thus detecting more extended volumetric networks associated with executive functioning. METHOD Fifty-three outpatients with schizophrenia and 62 healthy controls, matched for age, gender and handedness, were recruited. High-resolution images were acquired on a 1.5 tesla scanner and regional gray and white matter volumes were analyzed by voxel-based morphometry within SPM5 (statistical parametric mapping, University College London, UK). Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). RESULTS Twenty-one patients with poor executive functioning showed reduced dorsolateral prefrontal and anterior cingulate gray matter volume as compared to 30 patients with high WCST performance, with a maximum effect in the left dorsolateral prefrontal cortex. Left dorsolateral prefrontal gray matter volume predicted WCST performance after controlling for possible confounding effects of global cognitive functioning, verbal attention span, negative symptoms, illness duration and education. In this area, both patient groups had less gray matter than healthy controls. Left dorsolateral prefrontal gray matter volume was positively related to dorsal prefrontal, anterior cingulate and parietal gray matter volume; and negatively related to thalamic, cerebellar, pontine and right parahippocampal gray matter volume. CONCLUSIONS Volumetric alterations in prefrontal-thalamic-cerebellar gray matter networks may lead to executive dysfunction in schizophrenia.
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Brand M, Recknor EC, Grabenhorst F, Bechara A. Decisions under ambiguity and decisions under risk: Correlations with executive functions and comparisons of two different gambling tasks with implicit and explicit rules. J Clin Exp Neuropsychol 2007; 29:86-99. [PMID: 17162725 DOI: 10.1080/13803390500507196] [Citation(s) in RCA: 342] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We conducted two experiments with healthy subjects to investigate the possible relationships between Iowa Gambling Task (IGT) performance and executive functions as well as IGT performance and decision-making in a task with explicit rules, the Game of Dice Task (GDT). Results indicated that only the last trials of the IGT were correlated with executive functions and GDT performance. We suggest that the IGT taps into two mechanisms of decision-making: decisions under ambiguity in the first trials and decisions under risk in the latter trials. Results have impact on the interpretation of deficient IGT performance in patients with frontal lobe dysfunctions.
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Affiliation(s)
- Matthias Brand
- Department of Physiological Psychology, University of Bielefeld, Bielefeld, Germany
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Cimmer C, Szendi I, Csifcsák G, Szekeres G, Ambrus Kovács Z, Somogyi I, Benedek G, Janka Z, Kéri S. Abnormal neurological signs, visual contrast sensitivity, and the deficit syndrome of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:1225-30. [PMID: 16644085 DOI: 10.1016/j.pnpbp.2006.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study was designed to investigate the relationship between abnormal neurological signs, visual contrast sensitivity, and the deficit syndrome of schizophrenia. Visual contrast sensitivity for counterphase-modulated low spatial frequency gratings was measured in 32 non-deficit and 12 deficit schizophrenia patients and 20 healthy controls subjects. Abnormal neurological signs were evaluated with the Neurological Evaluation Scale (NES). Compared with the controls, patients with schizophrenia displayed impaired visual contrast sensitivity, which was associated with sensory integration deficits, as measured with the NES. The deficit syndrome was predicted by negative symptoms and sensory integration deficits. These results suggest that early-stage perceptual dysfunctions, which may reflect the abnormality of precortical magnocellular visual pathways, are related to a specific group of abnormal neurological signs.
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Affiliation(s)
- Csongor Cimmer
- University of Szeged, Department of Psychiatry, Szeged, Hungary
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21
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Ritsner MS, Blumenkrantz H, Dubinsky T, Dwolatzky T. The detection of neurocognitive decline in schizophrenia using the Mindstreams Computerized Cognitive Test Battery. Schizophr Res 2006; 82:39-49. [PMID: 16377157 DOI: 10.1016/j.schres.2005.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 10/23/2005] [Accepted: 10/25/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Mindstreams Computerized Cognitive Test Battery (Mindstreams) is a standardized computer-based battery that was designed for widespread clinical and research use. The capability of Mindstreams to test cognitive impairment in schizophrenia has yet to be evaluated. The aim of the present study was to determine the ability of Mindstreams in detecting cognitive dysfunction in schizophrenia patients and to compare it to the Cambridge Neuropsychological Test Automated Battery (CANTAB). METHOD Fifty-five schizophrenia patients and 63 healthy subjects were enrolled in the study. The Positive and Negative Syndrome Scale (PANSS) was used to quantify symptom severity. Neurocognitive functions were assessed using Mindstreams and CANTAB. RESULTS The schizophrenia patients scored significantly more poorly than healthy subjects on all tests comprising the Mindstreams battery. Comparable tasks of the Mindstreams and CANTAB batteries significantly correlated on raw scores and the standardized cognitive indices. The Mindstreams executive function tasks had significant correlations with the PANSS negative, autistic preoccupation and activation cluster scores, and with global functioning. Two-week test-retest reliability correlations were all significant (N=17, p<0.05-p<0.001). CONCLUSIONS This study indicates that Mindstreams is reliable in assessing the cognitive function of patients with schizophrenia and may play a role in standardizing the cognitive assessment of these patients in clinical and research settings.
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Affiliation(s)
- Michael S Ritsner
- Cognitive and Psychobiology Research Laboratory, Sha'ar Menashe Mental Health Center, Mobile Post Hefer 38814, Israel
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Bersani G, Gherardelli S, Clemente R, Di Giannantonio M, Grilli A, Conti CMV, Exton MS, Conti P, Doyle R, Pancheri P. Neurologic soft signs in schizophrenic patients treated with conventional and atypical antipsychotics. J Clin Psychopharmacol 2005; 25:372-5. [PMID: 16012282 DOI: 10.1097/01.jcp.0000169268.44421.cf] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurologic soft signs (NSS) are considered a somatic feature associated with schizophrenia (DSM-IV) that are present in neuroleptic-treated, as well as untreated or first-episode patients. The aim of this study was to determine the incidence and severity of NSS in groups of schizophrenic patients treated with either a conventional neuroleptic medication, haloperidol (n = 37), or atypical antipsychotic medications, risperidone (n = 19), clozapine (n = 34), and olanzapine (n = 18). NSS were assessed with the Neurological Evaluation Scale (NES), whereas extrapyramidal symptoms (EPS), which occur more commonly with conventional neuroleptic treatment, were evaluated using the Simpson-Angus Scale. NES scores were not significantly different between groups. Slight differences were found for 2 items only. The haloperidol group showed higher scores for the "Romberg test," whereas the clozapine group showed higher scores for "short-term memory." There were significant correlations between EPS and NES total score in the haloperidol and risperidone groups. These results demonstrate an overall overlapping of NSS among the groups, confirming their substantial independence from neurologic implications of neuroleptic treatment.
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Affiliation(s)
- Giuseppe Bersani
- Psychiatric Clinic III, Department of Psychiatric Sciences and Psychological Medicine, University of Rome La Sapienza, Via de Torre Argentina 21, 00100 Rome, Italy.
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