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Petrescu C, Mihalache OA, Vilciu C, Petrescu DM, Marian G, Ciobanu CA, Ciobanu AM. Clinical and Sociodemographic Correlations with Neurological Soft Signs in Hospitalized Patients with Schizophrenia: A Preliminary Longitudinal Study. Biomedicines 2024; 12:787. [PMID: 38672143 PMCID: PMC11048323 DOI: 10.3390/biomedicines12040787] [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: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Schizophrenia is a severe, chronic neuropsychiatric disorder characterized by symptoms that profoundly impact behavior, cognition, perception, and emotions, leading to a reduced quality of life and physical impairment. Given the complexity of schizophrenia, there is a pressing need for clinical markers and tools to predict its course, enhance disease staging, facilitate early intervention, improve differential diagnosis, and tailor individualized treatment approaches. Previous studies focused on the relationship between neurological soft signs (NSS) and factors such as age, illness duration, and symptomatology, indicating NSS as state markers improving in parallel with psychotic symptom remission or predicting treatment resistance. However, there is a lack of consensus on NSS assessment tools, hindering routine clinical monitoring despite diagnostic and prognostic potential. The present longitudinal study involved 81 psychiatric inpatients diagnosed with schizophrenia. Patients were assessed at three time points: baseline, 1 month, and 6 months. The examination included the use of scales to evaluate psychotic and neurological symptoms, as well as the identification of adverse extrapyramidal reactions caused by neuroleptic treatment. The progression of NSS was correlated to both the symptomatology and the sociodemographic data of the patients. The main findings from the present investigation revealed a statistical correlation between NSS and psychopathological symptoms, especially with negative symptoms of schizophrenia. However, it is important to note that neuroleptic side effects only had a limited impact on NSS. Therefore, instead of being linked to extrapyramidal symptoms caused by neuroleptics, NSS appears to be more frequently related with symptoms of schizophrenia. Our findings provide further support for their strong association with the course of schizophrenia, independent of treatment side effects, thus emphasizing their potential as reliable assessment tools in both research and clinical settings.
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Affiliation(s)
- Cristian Petrescu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Oana A. Mihalache
- Department of Doctoral Studies, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
| | - Crisanda Vilciu
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
- Neurology Clinic, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
| | - Diana M. Petrescu
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
- Neurology Clinic, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
| | - Gabriela Marian
- Academy of Romanian Scientists, 927180 Bucharest, Romania;
- Department of Psychiatry and Psychology, ‘Titu Maiorescu’ University of Medicine, 040051 Bucharest, Romania
| | - Constantin A. Ciobanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020022 Bucharest, Romania
| | - Adela M. Ciobanu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
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Nathani YL, Faye A, Kirpekar V, Gawande S, Tadke R, Bhave S, Ingole N, Bandre GR. A Study of Neurological Soft Signs and Cognition in Schizophrenia. Cureus 2023; 15:e50925. [PMID: 38249218 PMCID: PMC10800004 DOI: 10.7759/cureus.50925] [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: 08/25/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Neurological soft signs (NSS) are delicate neurological abnormalities that comprise deficits in motor coordination, problems with the sequencing of complex motor acts, and sensory integration difficulties. These are nonspecific with no specific localization in the brain. NSS are found in many patients with Schizophrenia. Cognitive dysfunctions are also present in more than two-thirds of patients with Schizophrenia. This study aims at assessing the NSS and its association with cognitive impairment in patients with Schizophrenia. METHODS A total of 100 Schizophrenia patients were included in the study. The Heidelberg scale was used for assessing the NSS. The Montreal Cognitive Assessment Scale (MoCA) for cognitive impairment, the Positive and Negative Syndrome Scale (PANSS) for Schizophrenia, and the Brief Psychiatric Rating Scale (BPRS) were used to assess the severity. Statistical analysis was performed by Pearson's Chi-square test, Kruskal-Wallis test, Wilcoxon rank tests and Spearman rank correlation along with mean and standard deviation. RESULTS NSS were present in 68% (N=68) of the patients with motor coordination being maximally affected. Cognitive impairment was found in 73% (N=73) of patients with a MoCA score <26. Patients with predominant negative symptoms had higher NSS scores and lower MoCA scores. A "statistically significant" correlation was observed between cognitive impairment and NSS. Most patients with NSS and impaired cognition were in the "markedly ill" category of BPRS. CONCLUSION A significant association was observed between cognitive deficits, negative symptoms, and NSS in Schizophrenia. NSS and cognitive dysfunctions are integral parts of Schizophrenia symptom domains and need to be assessed as the negative symptoms and severity of illness are associated with NSS, especially problems with motor coordination and cognitive dysfunctions.
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Affiliation(s)
- Yashika L Nathani
- Psychiatry, Gujarat Medical Education and Research Society Medical College, Vadodara, IND
| | - Abhijeet Faye
- Psychiatry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Vivek Kirpekar
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Sushil Gawande
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Rahul Tadke
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Sudhir Bhave
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Nishikant Ingole
- Pharmacology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Chew QH, Jia S, Sim K. Cerebellar Dysfunction and Relationship With Psychopathology, Cognitive Functioning, Resilience, and Coping in Schizophrenia. J Nerv Ment Dis 2023; 211:876-880. [PMID: 37890027 DOI: 10.1097/nmd.0000000000001706] [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: 10/29/2023]
Abstract
ABSTRACT In this study, we examined the cerebellar dysfunction in schizophrenia by evaluating the clinical, cognitive, resilience, and coping correlates of cerebellar signs (CSs) in 162 subjects (63 patients with schizophrenia and 99 healthy controls). The presence of CS was evaluated based on six clinical tests. Measures to assess the severity of psychopathology, cognitive functioning, resilience, and frequency of coping strategies used were included. Patients had more CS than controls. Patients with more CS were older, had more severe psychopathology, had poorer performance on Brief Assessment of Cognition for Schizophrenia token motor task, and used less self-distraction as a coping strategy than those with fewer CS. Patients without CS used less self-blame coping at higher level of resilience. The association of less self-distraction with more CS may be related to cognitive inflexibility as a result of cerebellar dysfunction. Greater attentiveness to the presence of CS in schizophrenia patients may aid in better management of their psychotic condition.
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Affiliation(s)
- Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | - Shuhong Jia
- Ambulatory Services/Nursing, Institute of Mental Health, Singapore
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Petrescu C, Petrescu DM, Marian G, Focseneanu BE, Iliuta FP, Ciobanu CA, Papacocea S, Ciobanu AM. Neurological Soft Signs in Schizophrenia, a Picture of the Knowledge in the Last Decade: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11101471. [PMID: 37239757 DOI: 10.3390/healthcare11101471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Neurological Soft Signs (NSS) are subtle neurological abnormalities that are more common in schizophrenia patients than in healthy individuals and have been regularly observed in neuroleptic-naive first-episode patients, supporting the hypothesis that they are an intrinsic component of schizophrenia. (2) Methods: a review of articles published in the last ten years (from January 2013 to January 2023) was carried out on articles published in ScienceDirect and PubMed, by following the PRISMA Statement extension for scoping reviews (PRISMA-ScR), which evaluated the impact of NSS in correlation with the symptomatology, neuroleptic treatment, and the cerebral structural changes of patients with schizophrenia. (3) Results: thirty articles were included, among them twelve included MRI structural evaluation and four studies with a longitudinal design. (4) Conclusions: interest in researching NSS has increased in recent years, but questions remain about their origin and relationship to schizophrenia symptoms, thus this study aims to fill in information gaps in the hope that future research will help provide individualized treatment. It is suggested that NSS in schizophrenia might have an inherited genetic relationship pattern, thus being in line with a trait viewpoint. Most of the research revealed that schizophrenia patients had higher NSS scores than healthy controls, however, they were rather similar to their first-degree relatives, thus, also arguing in favor of a trait perspective. The greatest improvement in scores is seen in those with a remitting course, as shown by declining NSS ratings concurrent with symptomatology.
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Affiliation(s)
- Cristian Petrescu
- Department of Psychiatry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Diana M Petrescu
- Neurology Clinic Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gabriela Marian
- Academy of Romanian Scientists, 050045 Bucharest, Romania
- Department of Psychiatry and Psychology, Titu Maiorescu University of Medicine, 040441 Bucharest, Romania
| | - Brindusa E Focseneanu
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
- Department of Psychiatry and Psychology, Titu Maiorescu University of Medicine, 040441 Bucharest, Romania
| | - Floris Petru Iliuta
- Department of Psychiatry and Psychology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | | | - Serban Papacocea
- Department of Neurosurgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adela M Ciobanu
- Department of Psychiatry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
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Vesic K, Gavrilovic A, Mijailović NR, Borovcanin MM. Neuroimmune, clinical and treatment challenges in multiple sclerosis-related psychoses. World J Psychiatry 2023; 13:161-170. [PMID: 37123101 PMCID: PMC10130959 DOI: 10.5498/wjp.v13.i4.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/16/2023] [Accepted: 03/23/2023] [Indexed: 04/18/2023] Open
Abstract
In recent years, epidemiological and genetic studies have shown an association between autoimmune diseases and psychosis. The question arises whether patients with schizophrenia are more likely to develop multiple sclerosis (MS) later in life. It is well known that the immune system plays an important role in the etiopathogenesis of both disorders. Immune disturbances may be similar or very different in terms of different types of immune responses, disturbed myelination, and/or immunogenetic predispositions. A psychotic symptom may be a consequence of the MS diagnosis itself or a separate entity. In this review article, we discussed the timing of onset of psychotic symptoms and MS and whether the use of corticosteroids as therapy for acute relapses in MS is unfairly neglected in patients with psychiatric comorbidities. In addition, we discussed that the anti-inflammatory potential of antipsychotics could be useful and should be considered, especially in the treatment of psychosis that coexists with MS. Autoimmune disorders could precipitate psychotic symptoms, and in this context, autoimmune psychosis must be considered as a persistent symptomatology that requires continuous and specific treatment.
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Affiliation(s)
- Katarina Vesic
- Department of Neurology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Aleksandar Gavrilovic
- Department of Neurology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Nataša R Mijailović
- Department of Pharmacy, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Milica M Borovcanin
- Department of Psychiatry, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
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Basavaraju R, France J, Sigmon HC, Girgis RR, Brucato G, Lieberman JA, Small SA, Provenzano FA. Increased parietal and occipital lobe gyrification predicts conversion to syndromal psychosis in a clinical high-risk cohort. Schizophr Res 2023; 255:246-255. [PMID: 37043842 DOI: 10.1016/j.schres.2023.03.027] [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: 07/23/2021] [Revised: 02/15/2023] [Accepted: 03/12/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Local gyrification index (lGI), indicative of the degree of cortical folding is a proxy marker for early cortical neurodevelopmental abnormalities. We studied the difference in lGI between those who do and do not convert to psychosis (non-converters) in a clinical high-risk (CHR) cohort, and whether lGI predicts conversion to psychosis. METHODS Seventy-two CHR participants with attenuated positive symptom syndrome were followed up for two years. The difference in baseline whole-brain lGI was examined on the T1-weighted MRIs between, i)CHR (N = 72) and healthy controls (N = 19), ii)Converters to psychosis (N = 24) and non-converters (N = 48), adjusting for age and sex, on Freesurfer-6.0. The significant cluster obtained in the converters versus non-converters comparison was registered as a region of interest to individual images of all 72 participants and lGI values were extracted from this region. A cox proportional hazards model was applied with these values to study whether lGI predicts conversion to psychosis. RESULTS lGI was not different between CHR and healthy controls. lGI was increased in converters in the right-sided inferior parietal and lateral occipital areas (corrected cluster-wise-p-value = 0.009, cohen's f = 0.42) compared to non-converters, which significantly increased the risk of onset of psychosis (p = 0.029, hazard ratio = 1.471). CONCLUSIONS Increased gyrification in the right-sided inferior parietal and lateral occipital area differentiates converters to psychosis in CHR, significantly increasing the risk of conversion to psychosis. This measure may reflect underlying traits in parts of the brain that develop earliest in-utero (parietal and occipital), conferring a heightened vulnerability to convert to syndromal psychosis subsequently.
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Affiliation(s)
- Rakshathi Basavaraju
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Jeanelle France
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Hannah C Sigmon
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Ragy R Girgis
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University Medical Center, USA
| | - Gary Brucato
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University Medical Center, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University Medical Center, USA
| | - Scott A Small
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Frank A Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
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Chrobak AA, Soltys Z, Dudek D, Siwek M. Neurological and cerebellar soft signs in bipolar disorder: The role of staging, type and history of psychotic symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2023; 121:110673. [PMID: 36349610 DOI: 10.1016/j.pnpbp.2022.110673] [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: 06/07/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
AIM Bipolar disorder (BD) patients show neurological abnormalities in form of neurological and cerebellar soft signs (NSS and CSS). NSS represents heterogeneous group of symptoms representing i.a. deficits of motor coordination, sequencing of complex motor acts and sensory integration. CSS were introduced as group of the neurological deficits of posture, gait, kinetic functions, eye movements and speech, associated more specifically to cerebellar abnormalities than NSS. Studies show significant effect size variability of those symptoms in BD group suggesting the existence of differing subpopulations. The aim of our study was to evaluate the effect of BD type, stage and the history of psychotic symptoms (HoPS) on the severity of CSS and NSS as none of the previous studies had verified the role of those categories. METHODS This study involved 181 participants: 116 euthymic BD patients (66 BD I, 50 BD II) and 65 healthy controls (HC). CSS was assessed with the International Cooperative Ataxia Rating Scale and NSS with Neurological Evaluation Scale. Patients were divided into early and late stage of the disorder according to Kapczinski's criteria. Rater was blind to patients' stage, type and HoPS. RESULTS Staging was related to vast majority of CSS and NSS scores. HoPS was related to oculomotor deficits. The effect of BD type was the least significant. Late stage BD showed more severe CSS and NSS than HC in every measure. There were no differences between early stage BD and HC, apart of posture and gait disturbances. Except of sensory integration scores, late stage BD showed higher CSS and NSS rates than early stage patients. CONCLUSION In this hitherto the largest study of neurological abnormalities in BD we have shown significant role of staging in CSS and NSS severity. Progression criteria based on inter-episode psychosocial functioning may stand as unrecognised factor responsible for variability observed in previous studies evaluating neurological abnormalities in BD. Our study suggests that in clinical practice NSS and CSS may be potentially used as easy-to-assess biological marker of BD staging. Observed severity of neurological impairments of BD patients may more likely correspond to the disease progression than to BD type and HoPS.
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Affiliation(s)
- Adrian Andrzej Chrobak
- Jagiellonian University Medical College, Department of Adult Psychiatry, Kopernika St. 21a, 31-501 Cracow, Poland
| | - Zbigniew Soltys
- Jagiellonian University, Institute of Zoology and Biomedical Research, Laboratory of Experimental Neuropathology, Gronostajowa 9, 30-387 Cracow, Poland
| | - Dominika Dudek
- Jagiellonian University Medical College, Department of Adult Psychiatry, Kopernika St. 21a, 31-501 Cracow, Poland
| | - Marcin Siwek
- Jagiellonian University Medical College, Department of Affective Disorders, Kopernika St. 21a, 31-501 Cracow, Poland.
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Chrobak AA, Rybakowski JK, Abramowicz M, Perdziak M, Gryncewicz W, Dziuda S, Fafrowicz M, Czarnecki P, Soltys Z, Ceglarek A, Ober JK, Marek T, Dudek D, Siwek M. Vergence eye movements impairments in schizophrenia and bipolar disorder. J Psychiatr Res 2022; 156:379-389. [PMID: 36323140 DOI: 10.1016/j.jpsychires.2022.10.042] [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: 04/06/2022] [Revised: 09/07/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
One of the most evaluated eye tracking tasks in schizophrenia (SZ) and bipolar disorder (BD) are smooth pursuit eye movements. They rely on the maintenance of slowly moving object on the fovea. While most of the studies evaluated tracking of a target that moves in the fronto-parallel plane, only two assessed vergence eye movements (VEM), which relies on the pursuit of object that moves in depth. The aim of our study was to compare VEM performance in SZ and BD. We evaluated 28 SZ patients, 32 BD patients and 25 healthy controls (HC). Participants underwent thorough optometric examination before eye tracking task. VEM were measured with the use of infrared eye tracker and dedicated vergence stimuli generator. SZ patients showed higher mean break and recovery points of fusion and shorter correct tracking time than HC. BD individuals revealed tracking accuracy deficits and higher number of saccades than HC. Compared to BD, SZ patients showed decrease of maximal convergence and divergence. Moreover, they presented tracking accuracy deficits of non-dominant eye: altered eyes positioning error during convergence and divergence gain. Exploratory analysis revealed significant gender differences between groups in terms of binocular VEM parameters. In this study we have recognized pattern of eye movement disturbances differentiating abovementioned groups. SZ patients showed decreased vergence tracking range with shorter tracking time and impaired accuracy of non-dominant eye, while BD patients showed higher number of saccades with decreased tracking accuracy. Neuroimaging studies are necessary to identify neuronal underpinnings of VEM impairments in SZ and BD.
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Affiliation(s)
- Adrian Andrzej Chrobak
- Jagiellonian University Medical College, Department of Adult Psychiatry, Kopernika St. 21a, 31-501, Cracow, Poland
| | - Janusz Kazimierz Rybakowski
- Poznan University of Medical Sciences, Department of Adult Psychiatry, Szpitalna St. 27/33, 61-572, Poznań, Poland
| | - Maria Abramowicz
- Poznan University of Medical Sciences, Department of Adult Psychiatry, Szpitalna St. 27/33, 61-572, Poznań, Poland
| | - Maciej Perdziak
- Poznan University of Medical Sciences, Department of Optometry, Chair of Ophthalmology and Optometry, Rokietnicka St. 5D, 60-806, Poznań, Poland
| | - Wojciech Gryncewicz
- Polish Academy of Sciences, Nałęcz Institute of Biocybernetics and Biomedical Engineering, Księcia Trojdena St. 4, 02-109, Warsaw, Poland
| | - Sebastian Dziuda
- Poznan University of Medical Sciences, Department of Adult Psychiatry, Szpitalna St. 27/33, 61-572, Poznań, Poland
| | - Magdalena Fafrowicz
- Jagiellonian University, Institute of Applied Psychology, Department of Cognitive Neuroscience and Neuroergonomics, Łojasiewicza St. 4, 30-348, Cracow, Poland
| | - Paweł Czarnecki
- Polish Academy of Sciences, Nałęcz Institute of Biocybernetics and Biomedical Engineering, Księcia Trojdena St. 4, 02-109, Warsaw, Poland
| | - Zbigniew Soltys
- Jagiellonian University, Institute of Zoology and Biomedical Research, Laboratory of Experimental Neuropathology, Gronostajowa 9, 30-387, Cracow, Poland
| | - Anna Ceglarek
- Jagiellonian University, Institute of Applied Psychology, Department of Cognitive Neuroscience and Neuroergonomics, Łojasiewicza St. 4, 30-348, Cracow, Poland
| | - Jan Krzysztof Ober
- Poznan University of Medical Sciences, Department of Optometry, Chair of Ophthalmology and Optometry, Rokietnicka St. 5D, 60-806, Poznań, Poland
| | - Tadeusz Marek
- Jagiellonian University, Institute of Applied Psychology, Department of Cognitive Neuroscience and Neuroergonomics, Łojasiewicza St. 4, 30-348, Cracow, Poland
| | - Dominika Dudek
- Jagiellonian University Medical College, Department of Adult Psychiatry, Kopernika St. 21a, 31-501, Cracow, Poland
| | - Marcin Siwek
- Jagiellonian University Medical College, Department of Affective Disorders, Kopernika St. 21a, 31-501, Cracow, Poland.
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Sabe M, Sentissi O. Psychotic symptoms prior or concomitant to diagnosis of multiple sclerosis: a systematic review of case reports and case series. Int J Psychiatry Clin Pract 2022; 26:287-293. [PMID: 34487465 DOI: 10.1080/13651501.2021.1973506] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to examine the clinical features of psychotic symptoms preceding or concomitant to multiple sclerosis (MS) diagnosis. METHOD From the 1st to 10th of January 2020 a systematic review was conducted through an electronic search of different databases. Results were limited to English, French, German, Italian and Spanish language articles. RESULTS We identified 599 titles, and included 32 cases from case-report and case series. One case report from our department was added. The mean age of first psychiatric symptoms was 25.8 ± 10.2 years, the mean age of MS diagnosis was 31.2 ± 10.7 years and the mean delay until MS diagnosis was 2.7 ± 3 years. Most reported symptoms were delusions (81%), auditory hallucinations (59%) and visual hallucinations (50%). Upon the MS diagnosis, immunosuppressive therapy was significantly more effective for psychotic symptoms than antipsychotics (OR = 9.0; 95%CI: 2.15-37; p = 0.002). Diffuse periventricular lesions were found in 95.6% of cases, with mostly temporal or frontal predominant lesions. In cases affected by predominant temporal lesions, 83% of cases presented visual hallucinations (p < 0.05). CONCLUSION Poor response or resistance to antipsychotics treatment should alert clinicians on the need to consider a differential diagnosis. Considering the impact of delay in MS diagnosis further research regarding this subject is warranted.KEY POINTSInsight into the occurrence of psychotic symptoms in multiple sclerosis (MS) is mainly limited to case reports and case series.Delay in MS management between initial psychotic symptoms and the MS diagnosis is 2.73 ± 3 years and 0.8 ± 1.2 years for patients presenting a first episode of psychosis.The resistance and poor response to antipsychotics found in most cases (75%) were associated with an excellent improvement (95%) of both psychiatric and neurologic symptoms with corticosteroids.Prospective studies are needed to investigate the spectrum of psychosis in MS.
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Affiliation(s)
- Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
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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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Chrobak AA, Krupa A, Dudek D, Siwek M. How soft are neurological soft signs? Content overlap analysis of 71 symptoms among seven most commonly used neurological soft signs scales. J Psychiatr Res 2021; 138:404-412. [PMID: 33962127 DOI: 10.1016/j.jpsychires.2021.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neurological soft signs (NSS) are described as subtle, non-localizable neurological abnormalities that cannot be related to impairment of a specific brain region or are not believed to be typical for any specific neurological disease. Crucial issue concerning research on NSS are the instruments with which they are assessed, since the results and the conclusions of the studies are mediated by the characteristics of such instruments. There is common, silent and unverified assumption that NSS rating scales may be used as interchangeable measure of the same phenomenon. AIM To investigate the differences in item content and the interchangeability of commonly used NSS scales. METHODS A content analysis was carried out to determine symptom overlap among the chosen seven most often used scales using the Jaccard index (0 = no overlap, 1 = full overlap) according to the methodology of Fried 2017. RESULTS 71 NSSs were distinguished from 167 items used in 7 above mentioned instruments. Mean overlap among all scales is low (0.27), overlap among specific scales ranges from 0.1 to 0.5. CONCLUSIONS The diversity of NSS in analyzed tools causes the low overlap between scales, leading to uncertainty as to whether they measure the same phenomena. This limits the reproducibility of studies and impedes the possibility of unifying the knowledge stemming from existing data. We argue that the non-localizable nature of NSS is yet to be examined.
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Affiliation(s)
- Adrian Andrzej Chrobak
- Department of Adult Psychiatry, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika St 21A, 31-501, Cracow, Poland
| | - Anna Krupa
- Department of Psychiatry, Jagiellonian University Medical College, Kopernika St 21A, 31-501, Cracow, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika St 21A, 31-501, Cracow, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika St 21A, 31-501, Cracow, Poland.
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12
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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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Feng Y, Wang Z, Lin G, Qian H, Gao Z, Wang X, Li M, Hu X, Li Y. Neurological soft signs and neurocognitive deficits in remitted patients with schizophrenia, their first-degree unaffected relatives, and healthy controls. Eur Arch Psychiatry Clin Neurosci 2020; 270:383-391. [PMID: 31123823 DOI: 10.1007/s00406-019-01024-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 05/15/2019] [Indexed: 01/10/2023]
Abstract
Neurological soft signs (NSS) and neurocognitive deficits (ND) are highly prevalent in schizophrenia, and have been separately proposed as candidate endophenotypes of schizophrenia. However, few relevant studies focus on remitted patients with schizophrenia (RP) and integrate NSS and ND as a composite endophenotype. This study aimed to explore the NSS and ND and examine the comparative relationship between them in RP, their first-degree unaffected relatives (FDR), and healthy controls, furthermore, to seek potential endophenotypes subitems of NSS and ND and create a composite endophenotype. 86 RP, 86 FDR, and 86 healthy controls were included. NSS and ND were independently assessed with Cambridge Neurological Inventory and MATRICSTM Consensus Cognitive Battery. RP had more NSS and ND than FDR in all subitems except disinhibition, information processing speed, working memory, and visual memory. Similarly, FDR presented poorer performance than controls in all subscales except disinhibition, sensory integration, working memory, and visual memory. Six subitems of NSS and ND met the criteria of endophenotype and the three groups were most accurately classified (71.2%) with these subitems working as a composite endophenotype. Moreover, information processing speed, attention, and social cognition were associated with sensory integration in RP and FDR. These findings add evidences that certain subitems of NSS and ND might be the endophenotypes of schizophrenia and integrating these endophenotypes may prove useful in identifying schizophrenia and high-risk individuals. Furthermore, sensory integration and specific cognitive domains covary, hence suggesting an overlap of compromised underlying neural systems.
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Affiliation(s)
- Yingying Feng
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Zongqin Wang
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Guorong Lin
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Hong Qian
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Zuohui Gao
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xiaoli Wang
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Mingcao Li
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xiaohua Hu
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China.
| | - Yi Li
- Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
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14
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Naguy A. Schizophrenia neuro exam: The oft-times-overlooked motor symptom domain. Asia Pac Psychiatry 2020; 12:e12372. [PMID: 31657520 DOI: 10.1111/appy.12372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/05/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmed Naguy
- Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Shuwaikh, State of Kuwait
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15
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Kilian S, Burns JK, Seedat S, Asmal L, Chiliza B, Du Plessis S, Olivier MR, Kidd M, Emsley R. Factors Moderating the Relationship Between Childhood Trauma and Premorbid Adjustment in First-Episode Schizophrenia. PLoS One 2017; 12:e0170178. [PMID: 28107388 PMCID: PMC5249082 DOI: 10.1371/journal.pone.0170178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/30/2016] [Indexed: 12/14/2022] Open
Abstract
Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.
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Affiliation(s)
- S. Kilian
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - J. K. Burns
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
- Institute for Health Research, University of Exeter, Exeter, United Kingdom
| | - S. Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - L. Asmal
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - B. Chiliza
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - S. Du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M. R. Olivier
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M. Kidd
- Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
| | - R. Emsley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Papiol S, Fatjó-Vilas M, Schulze TG. Neurological soft signs in patients with schizophrenia: current knowledge and future perspectives in the post-genomics era. ACTA ACUST UNITED AC 2016. [DOI: 10.3402/tdp.v4.30071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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17
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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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18
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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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Bosia M, Pigoni A, Zagato L, Merlino L, Casamassima N, Lorenzi C, Pirovano A, Smeraldi E, Manunta P, Cavallaro R. ADDing a piece to the puzzle of cognition in schizophrenia. Eur J Med Genet 2016; 59:26-31. [DOI: 10.1016/j.ejmg.2015.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 12/02/2015] [Accepted: 12/21/2015] [Indexed: 12/18/2022]
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20
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Tremolizzo L, Ferrario S, Pellegrini A, Fumagalli L, Ferrarese C, Appollonio I. Neurological soft signs in primary headache patients. Neurosci Lett 2015; 595:41-4. [PMID: 25849527 DOI: 10.1016/j.neulet.2015.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/04/2015] [Accepted: 04/03/2015] [Indexed: 12/13/2022]
Abstract
Neurological soft signs (NSS) are semeiotic anomalies not assessed by the standard neurological examination, primarily developed in psychiatric settings and recently proposed as potential markers of minor brain circuit alterations, especially the cerebellar-thalamic-prefrontal network. Primary headache patients present with normal neurological examination and frequent psychiatric comorbidity. Aim of this exploratory study consisted in assessing NSS in 20 episodic frequent migraine (MH) and in 10 tension-type headache (ETTH) outpatients compared to 30 matched healthy controls. NSS were assessed by the Heidelberg scale; clinical characteristics and brain MRI were additionally obtained in all patients. NSS were increased by ∼70 and ∼90% in ETTH and MH, respectively, with respect to controls (p<0.001) and the difference remained significant even after controlling for age and education. Headache type and characteristics did not influence NSS presentation, while headache patients with white matter hyperintensities (WMH) at brain MRI had higher NSS scores compared both to normal controls and patients without WMH. NSS identify a subset of primary headache patients sharing the same comorbidities or minimal brain anomalies, suggesting that tailored prophylactic options might apply.
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Affiliation(s)
- L Tremolizzo
- Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy.
| | - S Ferrario
- Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy
| | - A Pellegrini
- Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy
| | - L Fumagalli
- Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy
| | - C Ferrarese
- Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy
| | - I Appollonio
- Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy
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Debnath M, Venkatasubramanian G, Berk M. Fetal programming of schizophrenia: select mechanisms. Neurosci Biobehav Rev 2015; 49:90-104. [PMID: 25496904 PMCID: PMC7112550 DOI: 10.1016/j.neubiorev.2014.12.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 12/16/2022]
Abstract
Mounting evidence indicates that schizophrenia is associated with adverse intrauterine experiences. An adverse or suboptimal fetal environment can cause irreversible changes in brain that can subsequently exert long-lasting effects through resetting a diverse array of biological systems including endocrine, immune and nervous. It is evident from animal and imaging studies that subtle variations in the intrauterine environment can cause recognizable differences in brain structure and cognitive functions in the offspring. A wide variety of environmental factors may play a role in precipitating the emergent developmental dysregulation and the consequent evolution of psychiatric traits in early adulthood by inducing inflammatory, oxidative and nitrosative stress (IO&NS) pathways, mitochondrial dysfunction, apoptosis, and epigenetic dysregulation. However, the precise mechanisms behind such relationships and the specificity of the risk factors for schizophrenia remain exploratory. Considering the paucity of knowledge on fetal programming of schizophrenia, it is timely to consolidate the recent advances in the field and put forward an integrated overview of the mechanisms associated with fetal origin of schizophrenia.
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Affiliation(s)
- Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health & Neurosciences, Bangalore 560029, India.
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Neurobiology Research Centre and Department of Psychiatry, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, India
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia; Department of Psychiatry, The Florey Institute of Neuroscience and Mental Health, and Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia
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22
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Sá F, Marques A, Rocha NBF, Trigueiro MJ, Campos C, Schröder J. Kinematic parameters of throwing performance in patients with schizophrenia using a markerless motion capture system. Somatosens Mot Res 2014; 32:77-86. [PMID: 25365543 DOI: 10.3109/08990220.2014.969838] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Motor dysfunction is consistently reported but understudied in schizophrenia. It has been hypothesized that this abnormality may reflect a neuro-developmental disorder underlying this illness. The main goal of this study was to analyze movement patterns used by participants with schizophrenia and healthy controls during overarm throwing performance, using a markerless motion capture system. Thirteen schizophrenia patients and 16 healthy control patients performed the overarm throwing task in a markerless motion capture system. Participants were also examined for the presence of motor neurological soft signs (mNSS) using the Brief Motor Scale. Schizophrenia patients demonstrated a less developed movement pattern with low individualization of components compared to healthy controls. The schizophrenia group also displayed a higher incidence of mNSS. The presence of a less mature movement pattern can be an indicator of neuro-immaturity and a marker for atypical neurological development in schizophrenia. Our findings support the understanding of motor dysfunction as an intrinsic part of the disorder of schizophrenia.
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Affiliation(s)
- Fátima Sá
- Polytechnic Institute of Porto, School of Allied Health Sciences , Porto , Portugal and
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Bourgou Gaha S, Halayem Dhouib S, Amado I, Bouden A. [Neurological soft signs in early onset schizophrenia]. L'ENCEPHALE 2014; 41:209-14. [PMID: 24854724 DOI: 10.1016/j.encep.2014.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 01/16/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Neurological soft signs (NSS) are subtle neurological abnormalities that cannot be linked to the achievement of a specific region of the central nervous system and which are not part of a particular neurological syndrome. These signs are observed in the case of diseases supporting the neurodevelopmental model such as schizophrenia in general and its early form defined notably by an age of onset of less than 18 years. Indeed, the NSS belong to a set of clinical, cognitive, electrophysiological and neuroanatomical markers reflecting neurodevelopmental brain abnormalities in patients with schizophrenia. OBJECTIVE The objectives of our study were to determine the prevalence, the scores, and the nature of neurological soft signs (NSS) in adolescent patients suffering from early onset schizophrenia diagnosis in comparison to healthy controls, and to explore the correlations between NSS and the demographic, clinical and therapeutic features of these patients. MATERIALS AND METHODS Twelve adolescents were recruited in the Child Psychiatry Department at the Razi Hospital (Tunisia), with the diagnosis of schizophrenia according to the DSM-IV supplemented by the Kiddie SAD PL. They were matched by age and educational level with twelve healthy controls without psychiatric family or personal history. The clinical status of the patients was assessed using the Positive and Negative Syndrome Scale (PANSS). Neurological soft signs (NSS) were rated with the Neurological Soft Signs Examination (NSSE) by Krebs et al. (2000) for the two groups. This scale is composed of 23 items exploring motor coordination, motor integrative function, sensory integration, involuntary movements and quality of lateralization. RESULTS The mean age of our population was 14.7 years. The average age of onset of the disease was 12.2 years. The sex-ratio was 1.4. Educational level was 7.4 years. The PANSS mean total score was 74.3. The mean daily dose, in chlorpromazine equivalents, was 523.9 mg/day. Four patients received a strict monotherapy of antipsychotics, while the other patients were receiving an association of two neuroleptics. The prevalence of NSS was 100% (cut-off point=11) with a mean total score of 29.3±4.1. The highest score was for the motor coordination (10.1). As for the control group, the mean total score was 7±1.3. A highly significant difference was found between patients and controls for all sub-scores of NSS. Negative correlations were found in patients, between age and neurological soft signs total score (P=0.05; r=-0.57) and also with sensory integration score (P=0.04; r=-0.58). The NSS total score was also correlated with low educational level (P=0.03; r=-0.61). There was no correlation between neurological soft signs scores and PANSS scores or the daily dose of antipsychotics. CONCLUSION The prevalence and NSS scores are high among young people with early onset schizophrenia diagnosis illustrating the existence of structural abnormalities of the brain, themselves consequences of early neurodevelopmental disturbances, which would support the neurodevelopmental hypothesis concerning this pathology.
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Affiliation(s)
- S Bourgou Gaha
- Service de pédopsychiatrie, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Unité de recherche UR 02/04 : processus cognitifs en pathologie psychiatrique, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie.
| | - S Halayem Dhouib
- Service de pédopsychiatrie, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Unité de recherche UR 02/04 : processus cognitifs en pathologie psychiatrique, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, rue Jbel lakhdhar, Tunis, Tunisie
| | - I Amado
- Service hospitalo-universitaire, hôpital Saint-Anne, 1, rue Cabanis, 75014 Paris, France; UMR894, Inserm, laboratoire de physiopathologie des maladies psychiatriques, 2 ter, rue d'Alésia, 75014 Paris, France; Faculté de médecine Paris Descartes, 15, rue de l'école de médecine, 75006 Paris, France
| | - A Bouden
- Service de pédopsychiatrie, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Unité de recherche UR 02/04 : processus cognitifs en pathologie psychiatrique, hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, rue Jbel lakhdhar, Tunis, Tunisie
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