Clinical significance of neurological abnormalities in psychosis

Neuropsychological profiles in first-episodes psychosis and their relationship with clinical, metacognition and social cognition variables

An increasing interest in the assessment of neuropsychological performance variability in people with first-episode psychosis (FEP) has emerged. However, its association with clinical and functional outcomes requires further study. Furthermore, FEP neuropsychological subgroups have not been characterized by clinical insight or metacognition and social cognition domains. The aim of this exploratory study was to identify specific groups of patients with FEP based on neuropsychological variables and to compare their sociodemographic, clinical, metacognition and social cognition profiles. A sample of 149 FEP was recruited from adult mental health services. Neuropsychological performance was assessed by a neuropsychological battery (WAIS-III; TMT; WSCT; Stroop Test; TAVEC). The assessment also included sociodemographic characteristics, clinical, functional, metacognition and social cognition variables. Two distinct neuropsychological profiles emerged: one neuropsychological impaired cluster (N = 56) and one relatively intact cluster (N = 93). Significant differences were found between both profiles in terms of sociodemographic characteristics (age and level of education) (p = 0.001), clinical symptoms (negative, positive, disorganized, excitement and anxiety) (p = 0.041-0.001), clinical insight (p = 0.038-0.017), global functioning (p = 0.014), as well as in social cognition domains (emotional processing and theory of mind) (p = 0.001; p = 0.002). No significant differences were found in metacognitive variables (cognitive insight and 'jumping to conclusions' bias). Relationship between neurocognitive impairment, social cognition and metacognition deficits are discussed. Early identifying of neuropsychological profiles in FEP, characterized by significant differences in clinical and social cognition variables, could provide insight into the prognosis and guide the implementation of tailored early-intervention.

Treatment response of neurological soft signs in drug-naïve patients with a first psychotic episode

BACKGROUND

Neurological soft signs (NSS) are intrinsic features of psychosis that appear years before beginning a drug treatment. However, whether NSS respond to antipsychotics and whether these changes are clinically reliable and significant remains to be seen.

OBJECTIVE

We sought to determine the effect of antipsychotics on NSS in a first-episode psychosis (FEP) sample who had never exposed to antipsychotics.

METHODS

We included 100 antipsychotic-naïve patients with FEP in this study. 77 patients completed the study assessments at baseline, 1 month and 6 months. The Neurological Evaluation Scale (NES) evaluated NSS. Patients were alternatively selected to receive risperidone or olanzapine treatments and continued participation in their mental health setting during follow-up with one of four treatment groups: risperidone, olanzapine, mixed antipsychotics or no medication. We also included a control group of 28 healthy volunteers.

RESULTS

Treatment groups showed a statistically significant improvement on total NES scores and most NES subscales except for 'frontal signs', regardless of antipsychotic allocation. NSS changes were reliable; however, there was great variation in the total NES scores between treatment groups, ranging from 4% to 24%. Clinically meaningful changes (CMCs) on total NES scores ranged from 25% to 50%. Six patients (7.8%) demonstrated a reliable change (RC) and CMC on total NES scores.

CONCLUSIONS

NSS improved significantly over follow up regardless of the treatment regimen assigned to antipsychotic-naïve patients with a FEP. However, only 6 (7.8%) achieved a reliable and clinically meaningful improvement. The pattern of response of NSS to antipsychotic drugs evidenced both state and trait characteristics.

Neurological soft signs and psychometrically identified schizotypy in a sample of young conscripts

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.