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Risk factors, pre-morbid functioning and episode correlates of neurological soft signs in drug-naive patients with schizophrenia-spectrum disorders

Published online by Cambridge University Press:  22 September 2010

V. Peralta ,
E. G. de Jalón ,
M. S. Campos ,
V. Basterra ,
A. Sanchez-Torres  and
M. J. Cuesta
V. Peralta*
Affiliation:
Psychiatry Section B, Complejo Hospitalario de Navarra, Pamplona, Spain
E. G. de Jalón
Affiliation:
Psychiatry Section B, Complejo Hospitalario de Navarra, Pamplona, Spain
M. S. Campos
Affiliation:
Psychiatry Section B, Complejo Hospitalario de Navarra, Pamplona, Spain
V. Basterra
Affiliation:
Psychiatry Section B, Complejo Hospitalario de Navarra, Pamplona, Spain
A. Sanchez-Torres
Affiliation:
Psychiatry Section B, Complejo Hospitalario de Navarra, Pamplona, Spain
M. J. Cuesta
Affiliation:
Psychiatry Section B, Complejo Hospitalario de Navarra, Pamplona, Spain
*
*Address for correspondence: V. Peralta, M.D., Ph.D., Psychiatry Section B, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008 Pamplona, Spain. (Email: victor.peralta.martin@cfnavarra.es)
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Abstract

Background

There is a lack of consistent evidence regarding associations of neurological soft signs (NSS) with illness-related variables in schizophrenia. This study examined NSS in first-episode psychotic patients with respect to their factor structure and associations with risk factors, pre-morbid characteristics, psychopathology and spontaneous extrapyramidal syndromes.

Method

First-episode, drug-naive patients with schizophrenia-spectrum disorders (n=177) were assessed for NSS using the Neurological Evaluation Scale, and its 26 constituting items were factor analysed. The identified neurological dimensions were then entered into hierarchical regression models as outcome dependent variables of a set of predictors including risk factors (familial loading for schizophrenia, obstetric complications), pre-morbid characteristics (neurodevelopmental delay, symptoms of attention deficit–hyperactivity disorder, pre-morbid functioning), psychopathological domains (reality distortion, disorganization, negative symptoms, mania, depression, catatonia) and spontaneous extrapyramidal syndromes (parkinsonism, dyskinesia, akathisia).

Results

Five neurological domains were identified: sequencing, release signs, sensory integration, abnormal movements and coordination. Multivariate analyses showed independent associations (p<0.01) of sequencing with familial liability to schizophrenia, deterioration of pre-morbid adjustment and parkinsonism; release signs with obstetric complications, catatonic symptoms and parkinsonism; sensory integration with familial liability to schizophrenia; abnormal movements with familial liability to schizophrenia, obstetric complications, parkinsonism and dyskinesia; and coordination with neurodevelopmental delay. The empirically derived factors explained additional variance over and above that explained by subscale scores across the examined variables.

Conclusions

Familial liability to schizophrenia, obstetric complications, neurodevelopmental delay, deterioration in pre-morbid functioning and observable motor disorders appear to contribute independently to domains of neurological dysfunction. The findings support a neurodevelopmental model of NSS in schizophrenia.

Keywords

Extrapyramidal symptomsneurodevelopmentneurological soft signspsychopathologyschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1279 - 1289
Copyright
Copyright © Cambridge University Press 2010

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References

Andreasen, NC, Flaum, M, Arndt, S (1992). The Comprehensive Assessment of Symptoms and History (CASH): an instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615–623.CrossRefGoogle ScholarPubMed
Arango, C, Kirkpatrick, B, Buchanan, RW (2000). Neurological signs and the heterogeneity of schizophrenia. American Journal of Psychiatry 157, 560–565.CrossRefGoogle ScholarPubMed
Bachman, S, Bottmer, C, Schröder, J (2005). Neurological soft signs in first-episode schizophrenia. American Journal of Psychiatry 162, 2337–2343.CrossRefGoogle Scholar
Barnes, TRE (1989). A rating scale for drug-induced akathisia. British Journal of Psychiatry 154, 534–537.CrossRefGoogle ScholarPubMed
Bombin, I, Arango, C, Buchanan, RW (2005). Significance and meaning of neurological soft signs in schizophrenia: two decades later. Schizophrenia Bulletin 31, 962–977.CrossRefGoogle Scholar
Browne, S, Clarke, M, Gervin, M, Lane, A, Waddington, JL, Larkin, C, O'Callaghan, E (2000). Determinants of neurological dysfunction in first episode schizophrenia. Psychological Medicine 30, 1433–1441.CrossRefGoogle ScholarPubMed
Buchanan, RW, Heinrichs, DW (1989). The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Research 27, 335–350.CrossRefGoogle Scholar
Cannon, M, Jones, P, Gilvarry, C, Rifkin, L, McKenzie, K, Foerster, A, Murray, RM (1997). Premorbid social functioning in schizophrenia and bipolar disorder: similarities and differences. American Journal of Psychiatry 154, 1544–1550.Google ScholarPubMed
Cannon, M, Tarrant, CJ, Huttunen, MO, Jones, P (2009). Childhood development and later schizophrenia: evidence from genetic high-risk and birth cohort studies. In The Epidemiology of Schizophrenia (ed. Murray, R. M., Jones, P. B., Susser, E., van Os, J. and Cannon, M.), pp. 100–123. Cambridge University Press: Cambridge, UK.Google Scholar
Chan, RZK, Gottesman, II (2008). Neurological soft signs as candidate endophenotypes for schizophrenia: a shooting star or Northern star? Neuroscience and Behavioral Reviews 32, 957–971.CrossRefGoogle ScholarPubMed
Chan, RZK, Xu, T, Heinrichs, W, Yu, Y, Wang, Y (2009). Neurological soft signs in schizophrenia: a meta-analysis. Schizophrenia Bulletin. Published online: 17 April 2009. doi:10.1093/schbul/sbp011.Google ScholarPubMed
Chen, EYH, Kwok, CL, Au, JWY, Chen, RYL, Lau, BST (2000). Progressive deterioration of soft neurological signs in chronic schizophrenic patients. Acta Psychiatrica Scandinavica 102, 342–349.CrossRefGoogle ScholarPubMed
Compton, MT, Bercu, Z, Bollini, A, Walker, E (2006). Factor structure of the Neurological Assessment Scale in predominantly African American sample of patients with schizophrenia, unaffected relatives, and non-psychiatric controls. Schizophrenia Research 84, 365–377.CrossRefGoogle ScholarPubMed
Cuesta, MJ, Peralta, V, Zarzuela, A, Calvo, R, García, M, Serrano, F (2002). Neurological soft signs in psychosis: threshold criteria for discriminating normal controls and for predicting cognitive impairment. Schizophrenia Research 58, 263–271.CrossRefGoogle ScholarPubMed
Dazzan, P, Lloyd, T, Morgan, KD, Zanelli, J, Morgan, C, Orr, K, Hutchinson, G, Fearon, P, Allin, M, Rifkin, L, McGuire, PK, Doody, GA, Holloway, J, Leff, J, Harrison, G, Jones, PB, Murray, RM (2008). Neurological abnormalities and cognitive ability in first-episode psychosis. British Journal of Psychiatry 193, 197–202.CrossRefGoogle ScholarPubMed
Dazzan, P, Morgan, KD, Orr, KG, Hutchinson, G, Chitnis, X, Suckling, J, Fearon, P, Salvo, J, McGuire, PK, Mallet, RM, Jones, PB, Leff, J, Murray, RM (2004). The structural brain correlates of neurological soft signs in AESOP first-episode psychoses study. Brain 127, 143–153.CrossRefGoogle ScholarPubMed
Dazzan, P, Murray, RM (2002). Neurological soft signs in first-episode psychosis: a systematic review. British Journal of Psychiatry 181, 50–57.CrossRefGoogle Scholar
Goldstein, G, Sanders, RD, Forman, SD, Tarpey, T, Gurklis, JA, Van Kammen, DP, Keshavan, MS (2005). The effects of antipsychotic medication on factor structure of neurological examination abnormalities in schizophrenia. Schizophrenia Research 75, 55–64.CrossRefGoogle ScholarPubMed
Griffiths, TD, Sigmundsson, T, Takei, N, Rowe, D, Murray, RM (1998). Neurological abnormalities in familial and sporadic schizophrenia. Brain 121, 191–203.CrossRefGoogle ScholarPubMed
Gupta, S, Andreasen, NC, Arndt, S, Flaum, M, Schultz, S, Hubbard, WC, Smith, M (1995). Neurological soft signs in neuroleptic-naive and neuroleptic treated schizophrenic patients and normal comparison subjects. American Journal of Psychiatry 152, 191–196.Google ScholarPubMed
Guy, W (1976). ECDEU Assessment Manual for Psychopharmacology. Publication no. ADM 76-338, pp 534–537. US Department of Health, Education, and Welfare: Washington, DC.Google Scholar
Heinrichs, DW, Buchanan, RW (1988). Significance and meaning of neurological signs in schizophrenia. American Journal of Psychiatry 145, 11–18.Google ScholarPubMed
Janssen, J, Diaz-Caneja, A, Reig, S, Bombín, I, Mayoral, M, Parellada, M, Graell, M, Moreno, D, Zabala, A, Vázquez, VG, Desco, M, Arango, C (2009). Brain morphology and neurological soft signs in adolescents with first-episode psychosis. British Journal of Psychiatry 195, 227–233.CrossRefGoogle ScholarPubMed
Jones, P, Rodgers, B, Murray, RM, Marmot, M (1994). Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344, 1398–1402.CrossRefGoogle ScholarPubMed
Keshavan, MS, Sanders, RD, Sweeney, JA, Diwadkar, VA, Goldstein, G, Pettegrew, JW, Schooler, NR (2003). Diagnostic specificity and neuroanatomical validity of neurological abnormalities in first-episode psychoses. American Journal of Psychiatry 160, 1298–1304.CrossRefGoogle ScholarPubMed
Krebs, MO, Gut-Fayand, A, Bourdel, M-C, Dischamp, J, Olié, JP (2000). Validation and factorial structure of a standardized neurological examination assessing neurological soft signs in schizophrenia. Schizophrenia Research 45, 245–260.CrossRefGoogle ScholarPubMed
Madsen, AL, Vorstrup, S, Rubin, P, Larsen, JK, Hemmingsen, R (1999). Neurological abnormalities in schizophrenic patients: a prospective follow-up study 5 years after first admission. Acta Psychiatrica Scandinavica 100, 119–125.CrossRefGoogle ScholarPubMed
McNeil, TF, Sjöström, K (1995). McNeil–Sjöström Scale for Obstetric Complications. Lund University Department of Psychiatry, Malmö University Hospital: Malmö, Sweden.Google Scholar
Peralta, V, Cuesta, MJ (2001). How many and which are the psychopathological dimensions in schizophrenia? Issues influencing their ascertainment. Schizophrenia Research 49, 269–285.CrossRefGoogle ScholarPubMed
Peralta, V, Cuesta, MJ, Serrano, JF (2006). Obstetric complications and neurological abnormalities in neuroleptic-naïve psychotic patients. European Archives of Psychiatry and Clinical Neurosciences 256, 407–413.CrossRefGoogle ScholarPubMed
Picchioni, MM, Toulopoulou, R, Landau, S, Davies, N, Ribchester, T, Murray, RM (2006). Neurological abnormalities in schizophrenia twins. Biological Psychiatry 59, 341–348.CrossRefGoogle Scholar
Sanders, RD, Allen, DN, Forman, SD, Tarpey, T, Keshavan, M, Goldstein, G (2005). Confirmatory factor analysis of the Neurological Evaluation Scale in unmedicated schizophrenia. Schizophrenia Research 133, 65–71.Google ScholarPubMed
Scheuerecker, J, Ufer, S, Käpernick, M, Wiesman, M, Brückmann, H, Kraft, E, Seifert, D, Koutsouleris, N, Möller, HJ, Meisenzahl, EM (2008). Cerebral network deficits in post-acute catatonic schizophrenic patients measured by fMRI. Journal of Psychiatric Research 43, 607–614.CrossRefGoogle ScholarPubMed
Simpson, GM, Angus, JW (1970). A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica 212, 11–19.CrossRefGoogle ScholarPubMed
Thomann, PA, Wüstenberg, T, Dos Santos, V, Bachman, S, Essig, M, Schröder, J (2009). Neurological soft signs and brain morphology in first-episode schizophrenia. Psychological Medicine 39, 371–379.CrossRefGoogle ScholarPubMed
Tosato, S, Dazzan, P (2005). The psychopathology of schizophrenia and the presence of neurological soft signs: a review. Current Opinion in Psychiatry 18, 285–288.CrossRefGoogle ScholarPubMed
Verdoux, H, van Os, J, Sham, P, Jones, P, Gilvarry, K, Murray, RM (1996). Does familiality predispose to both emergence and persistence of psychosis? A follow-up study. British Journal of Psychiatry 168, 620–626.CrossRefGoogle ScholarPubMed
Ward, MF, Wender, PH, Reimherr, FW (1993). The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry 150, 885–890.Google ScholarPubMed
Whitty, P, Clarke, M, Browne, S, McTigue, O, Kamali, M, Feeney, L, Lane, A, Kinsella, A, Waddington, JL, Larkin, C, O'Callaghan, E (2003). Prospective evaluation of neurological soft signs in first-episode schizophrenia in relation to psychopathology: state versus trait phenomena. Psychological Medicine 33, 1479–1484.CrossRefGoogle ScholarPubMed
Whitty, P, Clarke, M, McTigue, O, Browne, S, Gervin, M, Kamali, M, Lane, A, Kinsella, A, Waddington, JL, Larkin, C, O'Callaghan, E (2006). Diagnostic specificity and predictors of neurological soft signs in schizophrenia, bipolar disorder and other psychoses over the first 4 years of illness. Schizophrenia Research 86, 110–117.CrossRefGoogle ScholarPubMed
Whitty, P, Owoeye, O, Waddington, J (2009). Neurological signs and involuntary movements in schizophrenia: intrinsic to and informative on systems pathobiology. Schizophrenia Bulletin 35, 415–424.CrossRefGoogle ScholarPubMed
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