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Trajectory of neurological examination abnormalities in antipsychotic-naïve first-episode psychosis population: a 1 year follow-up study

Published online by Cambridge University Press:  27 August 2019

Paulo Lizano Open the ORCID record for Paulo Lizano [Opens in a new window] ,
Kiranpreet Dhaliwal ,
Olivia Lutz ,
Suraj Sarvode Mothi ,
Jean Miewald ,
Debra Montrose  and
Matcheri Keshavan
Paulo Lizano*
Affiliation:
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
Kiranpreet Dhaliwal
Affiliation:
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
Olivia Lutz
Affiliation:
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
Suraj Sarvode Mothi
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Jean Miewald
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
Debra Montrose
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
Matcheri Keshavan
Affiliation:
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Paulo Lizano, E-mail: lizanopl@gmail.com
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Abstract

Background

Neurological Examination Abnormalities (NES) are quantified by measuring subtle, partially localizable (cerebello-thalamo-prefrontal cortical circuit) and heritable neurological signs comprising sensory integration, motor coordination and complex motor sequencing that are associated with first-episode psychosis (FEP). A few studies have evaluated NES longitudinally and as a predictor for diagnostic and response classification, but these studies have been confounded, underpowered and divergent. We examined (1) baseline and longitudinal NES differences between diagnostic and year 1 response groups; (2) if NES predicts diagnostic and response groups and (3) relationships between clinical variables and NES measures in antipsychotic-naïve FEP.

Methods

NES and clinical measures were obtained for FEP-schizophrenia (FEP-SZ, n = 232), FEP non-schizophrenia (FEP-NSZ, n = 117) and healthy controls (HC, n = 204). Response groups with >25% improvement in average year 1 positive and negative symptomatology scores were classified as responsive (n = 97) and <25% improvement as non-responsive (n = 95). Analysis of covariance, NES trajectory analysis and logistic regression models assessed diagnostic and response group differences. Baseline and longitudinal NES relationships with clinical variables were performed with Spearman correlations. Data were adjusted for age, sex, race, socioeconomic status and handedness.

Results

Cognitive perceptual (COGPER) score was better than repetitive motor (REPMOT) at differentiating FEP-SZ from FEP-NSZ and distinguishing responders from non-responders. We identified significant group-specific associations between COGPER and worse GAF, positive and negative symptomatology and some of these findings persisted at 1-year assessment.

Conclusion

NES are an easy to administer, bedside-elicited, endophenotypic measure and could be a cost-effective clinical tool in antipsychotic-naïve FEP.

Keywords

First-episode psychosisglobal functioningresponsesoft neurological signsschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 12 , September 2020 , pp. 2057 - 2065
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

Co-first authors.

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