Background. Although it is well recognized that individuals with schizophrenia display evidence of
subtle neurological impairment, its aetiopathological and clinical significance continues to be
Methods. Patients presenting with a first episode of schizophrenia or schizophreniform psychosis
(DSM-IV criteria) were examined using two previously validated neurological examinations. The
majority (N = 35) were examined prior to their ‘first ever’ dose of neuroleptic while the remaining
patients (N = 21) had been medicated for less than one month. The manner in which neurological
functioning is influenced by symptomatology and handedness was ascertained.
Results. The majority of patients who were examined neuroleptic-naive displayed evidence of
neurodysfunction. A combination of relative hand preference and symptomatology explained a
significant proportion of the variance in neurological functioning. Mixed handedness among adults
at the time of first presentation with schizophrenia was associated with more severe neurological
impairment and a history of poorer scholastic attainment and pre-morbid social adjustment.
Conclusions. Neurological soft signs are an intrinsic part of schizophrenia rather than a direct
consequence of treatment. Early developmental processes are associated with the level of
subsequent neurological impairment in first episode schizophrenia. However, symptomatology
appears to have an influence on the apparent severity of neurological impairment.