Abstract
Minor neurological signs are subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts present in excess in the early stages of psychosis. Still, it remains unclear whether at least some of these signs represent trait or state markers for psychosis and whether they are markers of long-term disease outcome of clinical utility. We examined the relationship between neurological function at illness onset assessed with the Neurological Evaluation Scale and subsequent illness course in 233 patients from AESOP-10 (Aetiology and Ethnicity in Schizophrenia and Other Psychoses), a 10-year follow-up study of a population-based cohort of individuals recruited at the time of their first episode of psychosis in the United Kingdom. In 56 of these patients, we also explored changes in neurological function over time. We included a group of 172 individuals without psychosis as controls. After 10 years, 147 (63%) patients had developed a non-remitting course of illness, and 86 (37%) a remitting course. Already at first presentation, patients who developed a non-remitting course had significantly more primary, motor coordination, and total signs than both remitting patients and healthy controls. While Motor Coordination signs did not change over time, rates of Primary, Sensory Integration, and Total signs increased, independently of illness course type. These findings suggest that motor coordination problems could be a useful early, quick, and easily detectable marker of subsequent clinical outcome. With other motor abnormalities, a measure of motor incoordination could contribute to the identification of the most vulnerable individuals, who could benefit from targeted and more assertive treatment approaches.
Highlights
Minor neurological signs are subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts present in excess in the early stages of affective and nonaffective psychoses, and even in drugnaïve patients.[1]
We examined the relationship between neurological function at illness onset assessed with the Neurological Evaluation Scale and subsequent illness course in 233 patients from AESOP-10 (Aetiology and Ethnicity in Schizophrenia and Other Psychoses), a 10-year follow-up study of a population-based cohort of individuals recruited at the time of their first episode of psychosis in the United Kingdom
To the best of our knowledge, this is the first prospective study that has investigated the relationship between different domains of neurological signs at illness onset and long-term illness course and functional outcome, as well as change over the first 10 years of illness in a large sample of individuals with first-episode psychosis
Summary
Minor neurological signs are subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts present in excess in the early stages of affective and nonaffective psychoses, and even in drugnaïve patients.[1]. Minor neurological signs are already present at illness onset with moderate to large effect sizes of impairment in patients and first-degree relatives with no psychosis[2] and may even precede the onset of psychosis, suggesting that they have a neurodevelopmental origin. As such, they may represent illness traits and endophenotypes.[3,4] This is further supported by evidence that often. Multimodal imaging data have shown that gray matter volume alterations co-occur with aberrant brain activity in cortical and cerebellar systems subserving sensorimotor dynamics and psychomotor organization, pointing to a defined pathophysiological substrate for sensorimotor dysfunctions and contributing to their definition as potential biomarkers for psychosis.[14]
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