Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-17T16:26:12.529Z Has data issue: false hasContentIssue false

Neurological soft signs significantly differentiate schizophrenia patients from healthy controls

Published online by Cambridge University Press:  29 November 2017

Konstantinos N. Fountoulakis*
Affiliation:
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Panagiotis Panagiotidis
Affiliation:
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Xenia Gonda
Affiliation:
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
Vasilios Kimiskidis
Affiliation:
Laboratory of Clinical Neurophysiology, School of Medicine, Aristotle University of Thessaloniki Greece
Ioannis Nimatoudis
Affiliation:
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
*
Konstantinos N. Fountoulakis, 6, Odysseos str (1st Parodos Ampelonon street), 55535 Pylaia Thessaloniki, Greece. Tel: +30 2310 435702; Fax: +30 2310 266570; E-mail: kfount@med.auth.gr

Abstract

Objective

Neurological soft signs (NSS) are a group of minor non-localisable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was to test for the effect of gender, age, parental age, age at onset and clinical symptomatology on NSS.

Material and methods

The study sample included 133 patients suffering from schizophrenia according to DSM-IV-TR (77 males and 56 females; aged 33.55±11.22 years old) and 122 normal controls (66 males and 56 females; aged 32.89±9.91 years old). The assessment included the Neurological Evaluation Scale (NES), and a number of scales assessing the clinical symptoms and adverse effects especially extrapyramidal. The statistical analysis included exploratory t-test, simple linear regression analysis, analysis of covariance and the calculation of correlation coefficients.

Results

The results of the current study confirm that NSS are more frequent in patients with schizophrenia in comparison with normal controls (Wilks=0.622, p<0.0001), but do not support an effect of gender, age, age at onset, paternal or maternal age, education, medication status or clinical subtype of schizophrenia on NES scores.

Discussion

Overall these results suggest that NSS constitute an independent (from the rest of symptoms), core (present in the vast majority of patients) and trait (unrelated to age and probably to the stage of schizophrenia) symptom of schizophrenia which could be of value in the clinical assessment and research of schizophrenia. Overall these results are not in full accord with the literature, but they could serve to fill in gaps and inconsistencies observed so far.

Type
Original Article
Copyright
© Scandinavian College of Neuropsychopharmacology 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bombin, I, Arango, C, Buchanan, RW. Significance and meaning of neurological signs in schizophrenia: two decades later. Schizophr Bull 2005;31:962977.CrossRefGoogle ScholarPubMed
2. Heinrichs, DW, Buchanan, RW. Significance and meaning of neurological signs in schizophrenia. Am J Psychiatry 1988;145:1118.Google ScholarPubMed
3. Docx, L, Morrens, M, Bervoets, C et al. Parsing the components of the psychomotor syndrome in schizophrenia. Acta Psychiatr Scand 2012;126:256265.Google Scholar
4. Buchanan, RW, Heinrichs, DW. The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Res 1989;27:335350.Google Scholar
5. Dazzan, P, Morgan, KD, Orr, KG et al. The structural brain correlates of neurological soft signs in AESOP first-episode psychoses study. Brain 2004;127:143153.CrossRefGoogle ScholarPubMed
6. Krebs, MO, Gut-Fayand, A, Bourdel, M, Dischamp, J, Olie, J. Validation and factorial structure of a standardized neurological examination assessing neurological soft signs in schizophrenia. Schizophr Res 2000;45:245260.CrossRefGoogle ScholarPubMed
7. Chen, EY, Hui, CL, Chan, RC et al. A 3-year prospective study of neurological soft signs in first-episode schizophrenia. Schizophr Res 2005;75:4554.Google Scholar
8. Janssen, J, Diaz-Caneja, A, Reig, S et al. Brain morphology and neurological soft signs in adolescents with first-episode psychosis. Br J Psychiatry 2009;195:227233.Google Scholar
9. Mayoral, M, Bombin, I, Zabala, A et al. Neurological soft signs in adolescents with first episode psychosis: two-year followup. Psychiatry Res 2008;161:344348.Google Scholar
10. Zabala, A, Robles, O, Parellada, M et al. Neurological soft signs in adolescents with first episode psychosis. Eur Psychiatry 2006;21:283287.Google Scholar
11. Barkus, E, Stirling, J, Hopkins, R, Lewis, S. The presence of neurological soft signs along the psychosis proneness continuum. Schizophr Bull 2006;32:573577.CrossRefGoogle ScholarPubMed
12. Chan, RC, Wang, Y, Zhao, Q et al. Neurological soft signs in individuals with schizotypal personality features. Aust N Z J Psychiatry 2010;44:800804.CrossRefGoogle ScholarPubMed
13. Chan, RC, Xie, W, Geng, FL et al. Clinical utility and lifespan profiling of neurological soft signs in schizophrenia spectrum disorders. Schizophr Bull 2016;42:560570.CrossRefGoogle ScholarPubMed
14. Chan, RC, Gottesman, II. Neurological soft signs as candidate endophenotypes for schizophrenia: a shooting star or a Northern star? Neurosci Biobehav Rev 2008;32:957971.CrossRefGoogle ScholarPubMed
15. Chan, RC, Xu, T, Heinrichs, RW, Yu, Y, Gong, QY. Neurological soft signs in non-psychotic first-degree relatives of patients with schizophrenia: a systematic review and meta-analysis. Neurosci Biobehav Rev 2010;34:889896.Google Scholar
16. Chan, RC, Xu, T, Heinrichs, RW, Yu, Y, Wang, Y. Neurological soft signs in schizophrenia: a meta-analysis. Schizophr Bull 2010;36:10891104.CrossRefGoogle ScholarPubMed
17. Buchanan, RW, Koeppl, P, Breier, A. Stability of neurological signs with clozapine treatment. Biol Psychiatry 1994;36:198200.Google Scholar
18. Scheffer, RE. Abnormal neurological signs at the onset of psychosis. Schizophr Res 2004;70:1926.Google Scholar
19. Boks, MP, Liddle, PF, Burgerhof, JG, Knegtering, R, Van Den Bosch, RJ. Neurological soft signs discriminating mood disorders from first episode schizophrenia. Acta Psychiatr Scand 2004;110:2935.CrossRefGoogle ScholarPubMed
20. Dazzan, P, Lloyd, T, Morgan, KD et al. Neurological abnormalities and cognitive ability in first-episode psychosis. Br J Psychiatry 2008;193:197202.Google Scholar
21. Prikryl, R, Ceskova, E, Kasparek, T, Kucerova, H. Neurological soft signs and their relationship to 1-year outcome in first-episode schizophrenia. Eur Psychiatry 2007;22:499504.Google Scholar
22. Goswami, U, Sharma, A, Khastigir, U et al. Neuropsychological dysfunction, soft neurological signs and social disability in euthymic patients with bipolar disorder. Br J Psychiatry 2006;188:366373.CrossRefGoogle ScholarPubMed
23. Negash, A, Kebede, D, Alem, A et al. Neurological soft signs in bipolar I disorder patients. J Affect Disord 2004;80:221230.CrossRefGoogle ScholarPubMed
24. Zhao, Q, Ma, YT, Lui, SS et al. Neurological soft signs discriminate schizophrenia from major depression but not bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2013;43:7278.Google Scholar
25. Chen, EY, Shapleske, J, Luque, R et al. The Cambridge Neurological Inventory: a clinical instrument for assessment of soft neurological signs in psychiatric patients. Psychiatry Res 1995;56:183204.Google Scholar
26. Smith, RC, Kadewari, RP, Rosenberger, JR, Bhattacharyya, A. Nonresponding schizophrenia: differentiation by neurological soft signs and neuropsychological tests. Schizophr Bull 1999;25:813825.Google Scholar
27. Smith, RC, Hussain, MI, Chowdhury, SA, Stearns, A. Stability of neurological soft signs in chronically hospitalized schizophrenic patients. J Neuropsychiatry Clin Neurosci 1999;11:9196.CrossRefGoogle ScholarPubMed
28. Rossi, A, De Cataldo, S, Di Michele, V et al. Neurological soft signs in schizophrenia. Br J Psychiatry 1990;157:735739.CrossRefGoogle ScholarPubMed
29. Schroder, J, Niethammer, R, Geider, FJ et al. Neurological soft signs in schizophrenia. Schizophr Res 1992;6:2530.CrossRefGoogle Scholar
30. Convit, A, Volavka, J, Czobor, P, De Asis, J, Evangelista, C. Effect of subtle neurological dysfunction on response to haloperidol treatment in schizophrenia. Am J Psychiatry 1994;151:4956.Google Scholar
31. Malla, AK, Norman, RM, Aguilar, O, Cortese, L. Relationship between neurological ‘soft signs’ and syndromes of schizophrenia. Acta Psychiatr Scand 1997;96:274280.Google Scholar
32. Keshavan, MS, Sanders, RD, Sweeney, JA et al. Diagnostic specificity and neuroanatomical validity of neurological abnormalities in first-episode psychoses. Am J Psychiatry 2003;160:12981304.Google Scholar
33. Sanders, RD, Allen, DN, Steven, DF, Tarpey, T, Keshavan, MS, Goldstein, G. Confirmatory factor analysis of the Neurological Evaluation Scale in unmedicated schizophrenia. Psychiatry Res 2005;133:6571.CrossRefGoogle ScholarPubMed
34. Sanders, RD, Keshavan, MS, Forman, SD et al. Factor structure of neurologic examination abnormalities in unmedicated schizophrenia. Psychiatry Res 2000;95:237243.CrossRefGoogle ScholarPubMed
35. Compton, MT, Bercu, Z, Bollini, A, Walker, EF. Factor structure of the Neurological Evaluation Scale in a predominantly African American sample of patients with schizophrenia, unaffected relatives, and non-psychiatric controls. Schizophr Res 2006;84:365377.Google Scholar
36. Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261276.Google Scholar
37. Addington, D, Addington, J, Schissel, B. A depression rating scale for schizophrenics. Schizophr Res 1990;3:247251.Google Scholar
38. Addington, D, Addington, J, Maticka-Tyndale, E, Joyce, J. Reliability and validity of a depression rating scale for schizophrenics. Schizophr Res 1992;6:201208.Google Scholar
39. Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382389.Google Scholar
40. Spielberger, CD. Theory and research on anxiety. In: Spielberger CD, editor. Anxiety and behavior. New York: New York Academic Press, 1966. pp. 3–20.Google Scholar
41. Spielberger, CD. Anxiety as an emotional state. In: Spielberger CD, editor. Anxiety: Current trends in theory and research. 1. New York: New York Academic Press, 1972. pp. 23–49.Google Scholar
42. Spielberger, CD. The nature and measurement of anxiety. In: Spielberger CD, Diaz-Guerrero R, editors. Cross-cultural anxiety. Washington, DC: Hemisphere/Wiley, 1976. pp. 3–12.Google Scholar
43. Spielberger, CD. Preliminary manual for the State-Trait Personality Inventory (STPI), Tampa, Florida: University of South Florida; 1979.Google Scholar
44. Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429435.Google Scholar
45. Simpson, GM, Angus, JW. A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 1970;212:1119.Google Scholar
46. Chouinard, G, Margolese, HC. Manual for the Extrapyramidal Symptom Rating Scale (ESRS). Schizophr Res 2005;76:247265.Google Scholar
47. Lingjaerde, O, Ahlfors, UG, Bech, P, Dencker, SJ, Elgen, K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 1987;334:1100.Google Scholar
48. American Psychiatric Association. Diagnostic and statistical manual of mental disorders – 4th edn. Washington, DC: American Psychiatric Press; 2000.Google Scholar
49. Annett, M. A classification of hand preference by association analysis. Br J Psychol 1970;61:303321.Google Scholar
50. Bachmann, S, Degen, C, Geider, FJ, Schroder, J. Neurological soft signs in the clinical course of schizophrenia: results of a meta-analysis. Front Psychiatry 2014;5:185.Google Scholar
51. Gureje, O. Neurological soft signs in Nigerian schizophrenics: a controlled study. Acta Psychiatr Scand 1988;78:505509.Google Scholar
52. Albayrak, Y, Akyol, ES, Beyazyuz, M, Baykal, S, Kuloglu, M. Neurological soft signs might be endophenotype candidates for patients with deficit syndrome schizophrenia. Neuropsychiatr Dis Treat 2015;11:28252831.Google Scholar
53. Cvetic, T, Vukovic, O, Britvic, D, Ivkovic, M, Dukic-Dejanovic, S, Lecic-Tosevski, D. Comparative analysis of soft neurological signs in positive and negative subtype of schizophrenia. Psychiatria Danubina 2009;21:174178.Google Scholar
54. Peralta, V, Moreno-Izco, L, Sanchez-Torres, A et al. Characterization of the deficit syndrome in drug-naive schizophrenia patients: the role of spontaneous movement disorders and neurological soft signs. Schizophr Bull 2014;40:214224.Google Scholar
55. Petruzzelli, MG, Margari, L, Craig, F et al. Markers of neurodevelopmental impairments in early-onset psychosis. Neuropsychiatr Dis Treat 2015;11:17931798.Google Scholar
56. Prikryl, R, Ceskova, E, Tronerova, S et al. Dynamics of neurological soft signs and its relationship to clinical course in patients with first-episode schizophrenia. Psychiatry Res 2012;200:6772.CrossRefGoogle ScholarPubMed
57. Smit, I, Koen, L, Niehaus, DJ, Jordaan, E, Botha, UA. Neurological soft signs as an endophenotype in an African schizophrenia population – a pilot study. Afr J Psychiatry 2012;15:124127.CrossRefGoogle Scholar
58. Ruiz-Veguilla, M, Cervilla, JA, Barrigon, ML et al. Neurodevelopmental markers in different psychopathological dimensions of first episode psychosis: the ESPIGAS study. Eur Psychiatry 2008;23:533540.Google Scholar
59. Nasrallah, HA, Tippin, J, Mccalley-Whitters, M, Kuperman, S. Neurological differences between paranoid and nonparanoid schizophrenia: part III. Neurological soft signs. J Clin Psychiatry 1982;43:310312.Google Scholar
60. Tripathi, R, Soni, A, Tyagi, A, Mehta, S, Gupta, S. Comparative study of neurological soft signs in patients with schizophrenia or obsessive-compulsive disorder, and healthy controls. East Asia Arch Psychiatry 2015;25:6472.Google ScholarPubMed
61. White, C, Stirling, J, Hopkins, R et al. Predictors of 10-year outcome of first-episode psychosis. Psychol Med 2009;39:14471456.Google Scholar
62. Peralta, V, De Jalon, EG, Campos, MS, Basterra, V, Sanchez-Torres, A, Cuesta, MJ. Risk factors, pre-morbid functioning and episode correlates of neurological soft signs in drug-naive patients with schizophrenia-spectrum disorders. Psychol Med 2011;41:12791289.Google Scholar
63. Gunasekaran, V, Venkatesh, VM, Asokan, TV. A study of soft neurological signs and its correlates in drug-naive patients with first episode psychosis. Indian J Psychol Med 2016;38:408413.Google Scholar
64. Mayoral, M, Bombin, I, Castro-Fornieles, J et al. Longitudinal study of neurological soft signs in first-episode early-onset psychosis. J Child Psychol Psychiatry 2012;53:323331.Google Scholar
65. Thomann, PA, Roebel, M, Dos Santos, V, Bachmann, S, Essig, M, Schroder, J. Cerebellar substructures and neurological soft signs in first-episode schizophrenia. Psychiatry Res 2009;173:8387.Google Scholar
66. Thomann, PA, Wustenberg, T, Santos, VD, Bachmann, S, Essig, M, Schroder, J. Neurological soft signs and brain morphology in first-episode schizophrenia. Psychol Med 2009;39:371379.Google Scholar