Signs In Schizophrenic Patients Research Articles

Comments on "Neurological Soft Signs in Schizophrenic Patients Treated With Conventional and Atypical Antipsychotics"

Carilion Health System, University of Virginia, Roanoke Valley Program, Roanoke, VA [email protected]

Neurologic Soft Signs in Schizophrenic Patients Treated With Conventional and Atypical Antipsychotics

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.

Neurological soft signs in schizophrenic patients with obsessive-compulsive disorder.

The purpose of this study was to examine neurological soft signs (NSS) in schizophrenic patients with obsessive-compulsive disorder (OCD). Neurological soft signs were assessed in 15 schizophrenic patients with OCD (OCD-schizophrenia), 38 schizophrenia patients without OCD (non-OCD-schizophrenia), and 24 healthy controls (HC) by means of the Neurological Evaluation Scale (NES). The OCD-schizophrenia group had significantly higher scores on total and subscales of 'sensory integration' and 'others' of NES than the HC group. Subscale scores of 'sequencing of motor acts' in-non-OCD-schizophrenia patients were significantly higher compared to OCD-schizophrenia patients. Total NES scores of both groups were significantly correlated with Scale for the Assessment of Negative Symptoms (SANS) scores. Only the subscale of 'sequencing of motor acts' was significantly correlated with SANS within the OCD-schizophrenia group. These results suggest that NSS do not significantly differ between schizophrenia patients with and without OCD, contrary to expectations. The NES scores in OCD-schizophrenic patients do not appear to be related to a more severe form of schizophrenia. Neurological signs and negative symptoms in schizophrenia patients with and without OCD may be considered as neurodevelopmental predisposing factors. Further research is required in schizophrenia patients with OCD to investigate the relationships between NSS and several neuroimaging or neuropsychological findings, constituting a subgroup within the schizophrenia spectrum.

Neurological soft signs in schizophrenic patients and their nonpsychotic siblings

Objective: (a) To investigate the prevalence of neurological soft signs (NSS) in schizophrenic patients and their nonpsychotic siblings and (b) to examine the clinical correlates of NSS in the schizophrenic group. Methods: Ninety-nine schizophrenic patients, 80 of their nonpsychotic siblings and 59 healthy controls were included in the study. NSS were assessed with the Neurological Evaluation Scale (NES). Psychiatric assessment of the patients was conducted with the Positive and Negative Syndrome Scale (PANSS). Siblings and the control group were evaluated with Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to determine the presence of any past or current psychotic disorder. Results: Schizophrenic patients had significantly higher scores overall and on each subscale of NES than the sibling and control groups. The sibling group's scores were intermediate between those of the schizophrenic patients and those of the healthy controls. All subscale scores and the total NES scores correlated positively with the negative symptoms subscale scores of PANSS. The general psychopathology subscale scores of PANSS also showed a positive correlation with all subscale scores of NES, except the ‘sequencing of complex motor acts’ subscale. The total NES scores of the patients as well as their scores for the ‘sequencing of complex motor acts’ and ‘others’ subscales were significantly correlated with the respective scores of their own siblings. Conclusions: These results support the findings of previous studies suggesting that there might be common genetic and/or environmental factors in the pathogenesis of neurological impairment in schizophrenic patients and their siblings. They also indicate that neurological soft signs in schizophrenic patients are associated with prominent negative symptoms.

Neurological soft signs in schizophrenic patients: Influence of age, age at onset, sex, and family history of schizophrenia

Neurological soft signs (NSS) are indicators of subtle neurodysfunction which are overrepresented in schizophrenics. The issue of the significance of NSS is still unclear in spite of a considerable amount of literature on the subject. The objective of this study was to investigate the impact on NSS of genetic and environmental factors presumed to be relevant to the etiology and prognosis of schizophrenia. Data on NSS (using a slightly modified version of the Neurological Evaluation Scale) and the age, age at onset, sex and family history of schizophrenia of 50 schizophrenic patients were collected. Extrapyramidal signs were measured with the Extrapyramidal Symptoms Rating Scale. Backward regression analyses with two-factor interactions regression were used to evaluate the influence of the variables on the NSS total score, subscores, and single items. Age at onset and the age-age at onset interaction influenced co-ordination tasks. Sex and the interaction between age and sex influenced sequencing tasks, with males having higher and females lower scores with increasing age. None of the other variables influenced the NSS total score or subscores. Schizophrenics with early onset of disease may perform worse than late-onset patients in motor co-ordination tasks at the onset, but the age-dependent deterioration of motor co-ordination may be more rapid in late-onset patients. Performance in sequencing tasks may be influenced by sex-bound variables.

Neurocognitive deficits and neurological signs in schizophrenia

Objective This is a comprehensive study designed to examine the association between specific clusters of neurological abnormalities and several clinically relevant aspects of schizophrenia such as positive and negative symptoms, neurocognitive deficits and psychosocial performance. Methods Thirty-seven clinically stable schizophrenic (DSM-III-R) patients maintained on antipsychotic medication were comprehensively examined and Convit's Quantified Neurologic Scale (QNS) was completed. In addition, patients' psychopathology was rated on the Positive and Negative Syndromes Scale (PANSS); psychosocial performance was rated on the Global Scale of Adaptive Functioning (GAF) and the Social Performance Schedule (SPS); and neurocognitive deficits were measured with a computer-assisted neurocognitive test battery, COGLAB. The association between these factors was determined using Pearson's correlation coefficients. Results Frontal and soft neurological scores on the QNS correlated significantly with negative syndrome scores ( r=0.45–0.51, p<0.05) and general psychopathology scores ( r=0.46–0.49, p<0.02) on PANSS; poor psychosocial performance on GAF ( r=0.43–0.56, p<0.02) and SPS ( r=0.37–0.54, p<0.007); and performance on the span of apprehension ( r=0.48–0.74, p<0.0001), backward masking ( r=0.34–0.54, p<0.01) and Wisconsin card sorting ( r=0.48–0.67, p<0.001) tasks. Conclusion Frontal and soft neurological signs in schizophrenic patients are associated with prominent negative symptoms, relatively poor psychosocial performance and significantly more cognitive impairment. Past research has associated soft neurological signs, cognitive impairment and structural brain abnormalities with poor outcome and prognosis in patients with schizophrenia.

Neurological soft signs in neuroleptic-naive and neuroleptic-treated schizophrenic patients and in normal comparison subjects

The goal of this study was to assess neurological soft signs and developmental reflexes in schizophrenic patients who had never received neuroleptic medication and those who were receiving neuroleptic medication. Neurological soft signs and developmental reflexes were examined in 26 schizophrenic patients who had never received a neuroleptic, 126 schizophrenic patients who were currently receiving neuroleptics, and 117 normal subjects. Soft signs were present in 23% of the neuroleptic-naive and 46% of the medicated schizophrenic patients. Developmental reflexes were present in 19% of the neuroleptic-naive and 12% of the medicated patients. Both soft signs and developmental reflexes were absent in the normal subjects. There were significant differences between patients and normal subjects in neurological soft signs and developmental reflexes. The possibly confounding variables of age, age at onset, duration of illness, number of hospitalizations, Abnormal Involuntary Movement Scale (AIMS) scores, and Simpson-Angus Scale extrapyramidal symptom scores were assessed by using logistic regression in the patients who were receiving neuroleptics. AIMS scores and Simpson-Angus Scale scores correlated with soft signs in these patients. The presence of neurological soft signs in schizophrenic patients who had never received neuroleptics indicates that these signs are present independent of medication effects, but it is possible that neuroleptics contribute to the prevalence of these abnormalities, as demonstrated by the patients who were receiving neuroleptics.

Neurological soft signs in schizophrenic patients

Neurological soft signs in schizophrenic patients

Significance and meaning of neurological signs in schizophrenia.

The authors review studies of abnormal signs on clinical neurological examination of schizophrenic patients. In spite of a number of methodologic limitations, the cumulative evidence strongly argues that there are more neurological signs in schizophrenic patients than in nonpsychiatric control subjects. Although less consistent, there is considerable evidence of more neurological signs in schizophrenic patients than in patients with affective disorders or with mixed, nonpsychotic disorders. The existing literature suggests several preliminary hypotheses with respect to neuroanatomical localization of neurological signs, subtyping of schizophrenia, and utility of studies of relatives at high risk and family history studies. Directions for future research in these areas are described.

Negative symptoms in schizophrenia: their longitudinal course and prognostic importance.

Negative and positive symptoms were investigated longitudinally in 39 young schizophrenic patients at two followup assessments approximately 2.5 and 5 years after hospital discharge. Negative symptoms, such as flat affect and poverty of speech, which were assessed at the first followup, were found to be effective prognostic signs in schizophrenic patients for predicting later poor role functioning at the second followup. The prognostic importance of negative symptoms was predominantly due to their tendency to occur in patients who were already functioning poorly in social and instrumental areas at the first followup, and who tended to continue doing poorly at the second followup. Contrary to some current hypotheses, positive symptoms, such as delusions and hallucinations, were also found to be prognostic of later deficits in role functioning at the second followup. Negative symptoms appeared to be generally persistent over time, although there was some tendency toward remission. Potential models of the etiology of negative symptoms and their role in schizophrenia are proposed.

SCHIZOPHRENIA AND THE LIMBIC SYSTEM

There is accumulating evidence that Summary the brain's limbic system is pathologically involved in at least some cases of schizophrenia. The evidence comes from schizophrenia-like symptoms observed in cases of known limbic-system neuropathology, and from signs of limbic-system dysfunction in some patients diagnosed with schizophrenia. Prominent in the first group are cases of temporallobe epilepsy, encephalitis, and brain tumours. Suggestions of limbic-system dysfunction are found in studies of the earliest changes observed by schizophrenic patients themselves, studies of the site of action of psychedelic drugs, and studies of electro-encephalographic abnormalities in schizophrenics. Whereas the results of scalp-electrode studies of schizophrenics remain equivocal, at least four separate studies using implanted electrodes have recorded electrical abnormalities specifically from limbic-system structures. Recent findings of " soft " neurological signs in schizophrenic patients, including autonomic dysfunction, proprioception, vestibular dysfunction, and eye-tracking, also point towards disturbances in the subcortical area of the brain which includes the limbic system. Although pathological changes in the limbic system have been described in some patients with schizophrenia, failure to follow up and/or replicate such findings leaves these studies in doubt. The evidence linking the limbic system to schizophrenia, although admittedly circumstantial, is sufficient to warrant a serious look for further clues. The limbic system appears to be the part of the brain of first choice for elucidating the biology and pathomorphology of this disease.