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Iftimovici A, Martinez G, Victor J, Bendjemaa N, Jantac C, Danset-Alexandre C, Amado I, Pina-Camacho L, Chaumette B, Fatjó-Vilas M, Fañanás L, Duchesnay E, Krebs MO. Schizophrenia Following Early Adolescence Prodrome: A Neurodevelopmental Subtype With Autism-like Sensorimotor and Social Cognition Deficits. Schizophr Bull 2025:sbae202. [PMID: 39756426 DOI: 10.1093/schbul/sbae202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
Abstract
BACKGROUND AND HYPOTHESIS While age at onset in schizophrenia (SCZ) is usually defined by age at onset of psychosis, the illness actually occurs earlier, with a prodrome often starting in childhood or adolescence. We postulated that SCZ with early-adolescence prodromes (SCZ-eaP) presents with social cognition deficits and sensorimotor impairments more similar to autism spectrum disorders (ASD) than SCZ with late-adolescence prodromes (SCZ-laP). STUDY DESIGN The movie for the assessment of social cognition and neurological soft signs (NSS) were compared between four groups, ASD, SCZ-eaP (<15 years), SCZ-laP (>15 years), and controls (N = 119), while accounting for age, sex, intelligence quotient, education level, and medication effect. Mediation analyses tested the effect of NSS on social cognition, across groups, and local gyrification indices were used to test whether NSS reflected deviations in early neurodevelopmental trajectories. STUDY RESULTS For social cognition and NSS, subjects with ASD were not different from SCZ-eaP, while they differed from SCZ-laP. Age at onset of prodrome correlated with NSS (r = -0.34, P = .018), and social cognition (r = 0.28, P = .048). Neurological soft signs mediated social cognition impairment across diagnoses (β = -1.24, P < 1e-6), and was explained by hypergyrification in the right fusiform gyrus, right frontal pole gyrus, and left postcentral gyrus. CONCLUSIONS Earlier age of prodrome in SCZ is associated with impaired social cognition, mediated by neurodevelopmentally-related sensorimotor impairments along the ASD-SCZ spectrum. It suggests age of prodrome, rather than the age at psychosis onset, should be considered to define more homogeneous subgroups in SCZ.
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Affiliation(s)
- Anton Iftimovici
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
- Université Paris-Saclay, CEA, CNRS, UMR9027 Baobab, NeuroSpin, 91190 Saclay, France
| | - Gilles Martinez
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| | - Julie Victor
- Université Paris-Saclay, CEA, CNRS, UMR9027 Baobab, NeuroSpin, 91190 Saclay, France
| | - Narjès Bendjemaa
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
| | - Célia Jantac
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| | - Charlotte Danset-Alexandre
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| | - Isabelle Amado
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Boris Chaumette
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| | - Mar Fatjó-Vilas
- FIDMAG Germanes Hospitàlaries Research Foundation, 08830 Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
| | - Lourdes Fañanás
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
| | - Edouard Duchesnay
- Université Paris-Saclay, CEA, CNRS, UMR9027 Baobab, NeuroSpin, 91190 Saclay, France
| | - Marie-Odile Krebs
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Pathophysiology of psychiatric disorders", Institut de psychiatrie, CNRS GDR 3557, 75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
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Wang HJ, Chen W, Yan XL, Huang QY, Xu WD. Effect of comprehensive intervention model based on drug-psychology-society-skills on medication compliance and cognitive ability of chronic schizophrenia patients. World J Psychiatry 2024; 14:1947-1955. [PMID: 39704380 PMCID: PMC11622024 DOI: 10.5498/wjp.v14.i12.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/20/2024] [Accepted: 11/05/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND The intervention value of a drug-psycho-social-skill model on medication compliance and cognitive ability in patients with chronic schizophrenia was unknown. AIM To explore the intervention value of a drug-psycho-social-skill model on medication compliance and cognitive ability in patients with chronic schizophrenia. METHODS Overall, 98 out-patients and in-patients with chronic schizophrenia treated in our hospital from February 2022 to January 2023 were included and randomly divided into the study (50 patients) and control groups (48 patients). For 3 months, the control group was treated with conventional drugs, and the research group with a comprehensive intervention model of drug-psychology-society-skills. Data were obtained for the mini mental assessment scale (MMSE), Montreal cognitive assessment scale (MoCA), positive and negative symptom scale, insight and treatment attitude scale, cognitive ability scale and social skills [personal and social function scale (PSP)]. The adverse reactions were observed. RESULTS After the intervention, the MMSE and MoCA scores improved in both groups. MoCA scores in the study group (26.58 ± 3.21) were significantly (P < 0.05) higher than those in the control group (24.68 ± 3.02), MMSE scores were not significantly higher. Post-intervention, positive and negative symptom scores improved in both groups, and the positive and negative symptom scores in the study group [(12.01 ± 2.58) and (32.51 ± 2.11)] were significantly (P < 0.05) different than those in the control group [(14.54 ± 2.33) and (33.74 ± 2.55)]. Post-intervention, insight and treatment attitudes questionnaire scores of both groups were improved and compared with the control group (7.97 ± 3.02), the study group (13.56 ± 6.35) had significantly (P < 0.05) higher scores. Post-intervention, the MATRICS consensus cognitive battery score of both groups was improved and compared with the control group (38.44 ± 6.23), the score of the study group was significantly (P < 0.05) increased (43.51 ± 6.01). Post-intervention, the PSP score of the study group (78.38 ± 6.63) was significantly (P < 0.05) higher than that of the control group (74.52 ± 7.01). During the intervention period, the incidence of adverse reactions in the study group was 6.25%, not significantly different from that in the control group (8.33%). During the intervention, both groups experienced adverse reactions, with no significant difference between groups (P > 0.05). CONCLUSION The comprehensive intervention model based on drug-psychology-society-skills has obvious intervention effects on patients with chronic schizophrenia, which improves their cognitive ability and reduces their positive and negative symptoms. Simultaneously, it improves the self-knowledge of patients, improves their attitude toward treatment, effectively promotes the recovery of patients' social functions, and is safe. Therefore, it is worthy of being vigorously promoted and widely used in clinics.
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Affiliation(s)
- Hai-Jun Wang
- The Fourth Ward, The Third People’s Hospital of Yongkang, Yongkang 321300, Zhejiang Province, China
| | - Wei Chen
- Department of Psychiatry, Zhejiang University School of Medicine, and the Collaborative Innovation Center for Brain Science, Zhejiang University Affiliated SIR Run Run Shaw Hospital, Hangzhou 311100, Zhejiang Province, China
| | - Xiao-Lin Yan
- Department of Laboratory Medicine, The Third People’s Hospital of Yongkang, Yongkang 321300, Zhejiang Province, China
| | - Qian-Ying Huang
- The Third Ward, The Third People’s Hospital of Yongkang, Yongkang 321300, Zhejiang Province, China
| | - Wei-Dong Xu
- The Fourth Ward, The Third People’s Hospital of Yongkang, Yongkang 321300, Zhejiang Province, China
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Petrescu C, Mihalache OA, Vilciu C, Petrescu DM, Marian G, Ciobanu CA, Ciobanu AM. Clinical and Sociodemographic Correlations with Neurological Soft Signs in Hospitalized Patients with Schizophrenia: A Preliminary Longitudinal Study. Biomedicines 2024; 12:787. [PMID: 38672143 PMCID: PMC11048323 DOI: 10.3390/biomedicines12040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Schizophrenia is a severe, chronic neuropsychiatric disorder characterized by symptoms that profoundly impact behavior, cognition, perception, and emotions, leading to a reduced quality of life and physical impairment. Given the complexity of schizophrenia, there is a pressing need for clinical markers and tools to predict its course, enhance disease staging, facilitate early intervention, improve differential diagnosis, and tailor individualized treatment approaches. Previous studies focused on the relationship between neurological soft signs (NSS) and factors such as age, illness duration, and symptomatology, indicating NSS as state markers improving in parallel with psychotic symptom remission or predicting treatment resistance. However, there is a lack of consensus on NSS assessment tools, hindering routine clinical monitoring despite diagnostic and prognostic potential. The present longitudinal study involved 81 psychiatric inpatients diagnosed with schizophrenia. Patients were assessed at three time points: baseline, 1 month, and 6 months. The examination included the use of scales to evaluate psychotic and neurological symptoms, as well as the identification of adverse extrapyramidal reactions caused by neuroleptic treatment. The progression of NSS was correlated to both the symptomatology and the sociodemographic data of the patients. The main findings from the present investigation revealed a statistical correlation between NSS and psychopathological symptoms, especially with negative symptoms of schizophrenia. However, it is important to note that neuroleptic side effects only had a limited impact on NSS. Therefore, instead of being linked to extrapyramidal symptoms caused by neuroleptics, NSS appears to be more frequently related with symptoms of schizophrenia. Our findings provide further support for their strong association with the course of schizophrenia, independent of treatment side effects, thus emphasizing their potential as reliable assessment tools in both research and clinical settings.
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Affiliation(s)
- Cristian Petrescu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Oana A. Mihalache
- Department of Doctoral Studies, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
| | - Crisanda Vilciu
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
- Neurology Clinic, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
| | - Diana M. Petrescu
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
- Neurology Clinic, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
| | - Gabriela Marian
- Academy of Romanian Scientists, 927180 Bucharest, Romania;
- Department of Psychiatry and Psychology, ‘Titu Maiorescu’ University of Medicine, 040051 Bucharest, Romania
| | - Constantin A. Ciobanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020022 Bucharest, Romania
| | - Adela M. Ciobanu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
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Herold CJ, Duval CZ, Schröder J. Autobiographical memory in chronic schizophrenia: A follow-up study. Neuropsychologia 2023; 191:108707. [PMID: 37890662 DOI: 10.1016/j.neuropsychologia.2023.108707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/31/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
Chronic schizophrenia is a very disabling disease and patient's social integration remains difficult. One important aspect is autobiographical memory (AM) as it is impaired in schizophrenia and highly correlated to patient's outcome, since its closely linked to self and identity. Reduced specificity and lack of details are characteristics of patients' AM, but its longitudinal course in schizophrenia remains unclear. We examined 21 patients who underwent our protocol twice with an interval of 7 years. AM was assessed using a semi-structured interview, covering four periods of life and addressing semantic knowledge and autobiographical episodes as well as their details. The results can be divided into three parts, separating semantic memories, specific autobiographical memories and details describing the latter. While a significant deterioration of semantic AM over time could be revealed, the specificity of the free recalled autobiographical episodes remained rather stable - albeit on a low level. In contrast, unique events were remembered with significantly less details at follow-up than at the first examination. While floor-effects given a relatively small number of unique events have to be considered, semantic AM and episodic details seem to be a valuable target for AM remediation given their further deterioration over time.
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Affiliation(s)
- Christina J Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Voßstr. 4, 69115, Heidelberg, Germany.
| | - Céline Z Duval
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Voßstr. 4, 69115, Heidelberg, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Voßstr. 4, 69115, Heidelberg, Germany
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Nathani YL, Faye A, Kirpekar V, Gawande S, Tadke R, Bhave S, Ingole N, Bandre GR. A Study of Neurological Soft Signs and Cognition in Schizophrenia. Cureus 2023; 15:e50925. [PMID: 38249218 PMCID: PMC10800004 DOI: 10.7759/cureus.50925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Neurological soft signs (NSS) are delicate neurological abnormalities that comprise deficits in motor coordination, problems with the sequencing of complex motor acts, and sensory integration difficulties. These are nonspecific with no specific localization in the brain. NSS are found in many patients with Schizophrenia. Cognitive dysfunctions are also present in more than two-thirds of patients with Schizophrenia. This study aims at assessing the NSS and its association with cognitive impairment in patients with Schizophrenia. METHODS A total of 100 Schizophrenia patients were included in the study. The Heidelberg scale was used for assessing the NSS. The Montreal Cognitive Assessment Scale (MoCA) for cognitive impairment, the Positive and Negative Syndrome Scale (PANSS) for Schizophrenia, and the Brief Psychiatric Rating Scale (BPRS) were used to assess the severity. Statistical analysis was performed by Pearson's Chi-square test, Kruskal-Wallis test, Wilcoxon rank tests and Spearman rank correlation along with mean and standard deviation. RESULTS NSS were present in 68% (N=68) of the patients with motor coordination being maximally affected. Cognitive impairment was found in 73% (N=73) of patients with a MoCA score <26. Patients with predominant negative symptoms had higher NSS scores and lower MoCA scores. A "statistically significant" correlation was observed between cognitive impairment and NSS. Most patients with NSS and impaired cognition were in the "markedly ill" category of BPRS. CONCLUSION A significant association was observed between cognitive deficits, negative symptoms, and NSS in Schizophrenia. NSS and cognitive dysfunctions are integral parts of Schizophrenia symptom domains and need to be assessed as the negative symptoms and severity of illness are associated with NSS, especially problems with motor coordination and cognitive dysfunctions.
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Affiliation(s)
- Yashika L Nathani
- Psychiatry, Gujarat Medical Education and Research Society Medical College, Vadodara, IND
| | - Abhijeet Faye
- Psychiatry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Vivek Kirpekar
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Sushil Gawande
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Rahul Tadke
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Sudhir Bhave
- Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Nishikant Ingole
- Pharmacology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Fares R, Haddad C, Sacre H, Hallit S, Haddad G, Salameh P, Calvet B. Neurological soft signs and cognition among inpatients with schizophrenia. Cogn Neuropsychiatry 2023; 28:406-423. [PMID: 37823861 DOI: 10.1080/13546805.2023.2269647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
Introduction: Evidence has shown that neurological soft signs are strongly associated with neurocognitive dysfunction. Therefore, the primary objective of this study was to assess the association between NSS and cognitive impairments in a sample of inpatients with schizophrenia. The secondary objective was to explore the association between NSS total scores and functioning.Methods: The study enrolled 95 inpatients diagnosed with schizophrenia disorders and 45 healthy controls. The neurological evaluation scale (NES) was used to assess neurological soft sign while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive functioning in patients with schizophrenia.Results: Patients with schizophrenia had significantly higher mean scores on the NES total test and subtests than the control group. Higher cognition was significantly associated with lower NES total and subtest scores. Higher functional independence was significantly associated with a lower NES total score (Beta = -.25), lower motor coordination subtest score (Beta = -.04), and lower others subtest (Beta = -.12). When taking the functional independence scale as the dependent variable, a higher NES total score was significantly associated with lower functioning (Beta = -0.03).Conclusion: NSS were associated to neurocognitive impairments in almost every domain among patients with schizophrenia. Further prospective research is still needed to confirm this role.
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Affiliation(s)
- Rabih Fares
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Chadia Haddad
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Georges Haddad
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Benjamin Calvet
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Pôle Universitaire de Psychiatrie de l'Adulte, de l'Agée et d'Addictologie, centre hospitalier Esquirol, Limoges, France
- Centre mémoire de ressources et de recherche du Limousin, centre hospitalier Esquirol, Limoges, France
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Gray LE, Buchanan RW, Keshavan MS, Torous J. Potential Role of Smartphone Technology in Advancing Work on Neurological Soft Signs with a Focus on Schizophrenia. Harv Rev Psychiatry 2023; 31:226-233. [PMID: 37699066 DOI: 10.1097/hrp.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
LEARNING OBJECTIVE AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO • Outline and Identify potential benefits of using neurological soft signs (NSS) as biomarkers of schizophrenia. ABSTRACT Since the late 1960s, NSS have been a focus of study across psychiatric illnesses, including depression, bipolar disorder, and schizophrenia in particular. Utilizing these subtle neurological impairments as biomarkers of illness has numerous benefits; NSS offer a direct connection between clinical presentation and neurological functioning, and assessments are cost-effective. However, incongruent measurement scales, confounding variables, and rating system subjectivity have hindered the advancement and scalability of NSS research and clinical implementation. This article provides a brief overview of the literature on NSS as related to schizophrenia, and proposes utilizing smartphone sensing technology to create standardized NSS assessments with objective scoring. Incorporating digital phenotyping into NSS assessment offers the potential to make measurement more scalable, accessible, and directly comparable across locations, cultures, and demographics. We conducted a narrative search in PubMed and APA PsycInfo using the following keywords: neurological soft signs, schizophrenia spectrum disorders, and psychotic illnesses. No date limitations were used. There is no other direct work on NSS and new smartphone methods like digital phenotyping; though, there is related work in neurology. Harnessing advances in smartphone technology could provide greater insight into and further our understanding of specific aspects of the NSS field. For instance, it could help us distinguish trait vs. state markers and better understand how distinct groups of signs may reflect different aspects of psychiatric illness and neurological impairment. In addition, such technology can help advance research on the capabilities of NSS as an effective diagnostic tool.
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Affiliation(s)
- Lucy E Gray
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Ms. Gray, and Drs. Keshavan and Torous); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD (Dr. Buchanan); Massachusetts Mental Health Center, Boston, MA (Drs. Keshavan and Torous)
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Petrescu C, Petrescu DM, Marian G, Focseneanu BE, Iliuta FP, Ciobanu CA, Papacocea S, Ciobanu AM. Neurological Soft Signs in Schizophrenia, a Picture of the Knowledge in the Last Decade: A Scoping Review. Healthcare (Basel) 2023; 11:1471. [PMID: 37239757 PMCID: PMC10217815 DOI: 10.3390/healthcare11101471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Neurological Soft Signs (NSS) are subtle neurological abnormalities that are more common in schizophrenia patients than in healthy individuals and have been regularly observed in neuroleptic-naive first-episode patients, supporting the hypothesis that they are an intrinsic component of schizophrenia. (2) Methods: a review of articles published in the last ten years (from January 2013 to January 2023) was carried out on articles published in ScienceDirect and PubMed, by following the PRISMA Statement extension for scoping reviews (PRISMA-ScR), which evaluated the impact of NSS in correlation with the symptomatology, neuroleptic treatment, and the cerebral structural changes of patients with schizophrenia. (3) Results: thirty articles were included, among them twelve included MRI structural evaluation and four studies with a longitudinal design. (4) Conclusions: interest in researching NSS has increased in recent years, but questions remain about their origin and relationship to schizophrenia symptoms, thus this study aims to fill in information gaps in the hope that future research will help provide individualized treatment. It is suggested that NSS in schizophrenia might have an inherited genetic relationship pattern, thus being in line with a trait viewpoint. Most of the research revealed that schizophrenia patients had higher NSS scores than healthy controls, however, they were rather similar to their first-degree relatives, thus, also arguing in favor of a trait perspective. The greatest improvement in scores is seen in those with a remitting course, as shown by declining NSS ratings concurrent with symptomatology.
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Affiliation(s)
- Cristian Petrescu
- Department of Psychiatry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
| | - Diana M. Petrescu
- Neurology Clinic Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Gabriela Marian
- Academy of Romanian Scientists, 050045 Bucharest, Romania;
- Department of Psychiatry and Psychology, Titu Maiorescu University of Medicine, 040441 Bucharest, Romania
| | - Brindusa E. Focseneanu
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
- Department of Psychiatry and Psychology, Titu Maiorescu University of Medicine, 040441 Bucharest, Romania
| | - Floris Petru Iliuta
- Department of Psychiatry and Psychology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | | | - Serban Papacocea
- Department of Neurosurgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Adela M. Ciobanu
- Department of Psychiatry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
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Valerio MP, Lomastro J, Igoa A, Martino DJ. Correlates of neurological soft signs in bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01558-1. [PMID: 36662294 DOI: 10.1007/s00406-023-01558-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023]
Abstract
Recent research has focused on neurological soft signs (NSS) in bipolar disorder (BD), but there is still scarce evidence on their correlates with other relevant variables. The aim of this study was to explore the association between NSS and clinical demographic, neurocognitive, and functional variables. Eighty-eight euthymic BD patients were included in whom NSS were assessed using the Neurological Evaluation Scale. All subjects performed an extensive neurocognitive battery selected to assess premorbid IQ, attention, language, verbal memory, and executive functions. Psychosocial outcomes were assessed by means of the Functioning Assessment Short Test. Among the demographical variables, NSS tended to be negatively associated with years of education and increased with age. Likewise, NSS were higher in BD type I than in BD type II, but independent of age at illness onset and number of previous affective episodes. There was a negative correlation between NSS and premorbid IQ, as well as with performance in attention, language, and executive functions. Results tended to be unchanged when controlled for potential confounders. Although NSS were associated with poor psychosocial functioning in the bivariate analysis, when added to a multiple regression model including neurocognition, these neurological features did not significantly contribute to the variance of the functional outcome. Our findings contribute to a better characterization of NSS in BD; their potential clinical and theoretical implications are discussed in the manuscript.
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Affiliation(s)
- Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Godoy Cruz 2290 (C1425FQB), Buenos Aires, Argentina.,Psychiatric Emergencies Hospital Torcuato de Alvear, Warnes 2630 (C1427DPS), Buenos Aires, Argentina
| | - Julieta Lomastro
- Psychiatric Emergencies Hospital Torcuato de Alvear, Warnes 2630 (C1427DPS), Buenos Aires, Argentina
| | - Ana Igoa
- Psychiatric Emergencies Hospital Torcuato de Alvear, Warnes 2630 (C1427DPS), Buenos Aires, Argentina
| | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET), Godoy Cruz 2290 (C1425FQB), Buenos Aires, Argentina. .,Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1854 (C1126AAB), Buenos Aires, Argentina. .,, Charcas 4189, 1°''C'' (C1425BNG), Buenos Aires, Argentina.
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10
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The Impact of Antipsychotic Treatment on Neurological Soft Signs in Patients with Predominantly Negative Symptoms of Schizophrenia. Biomedicines 2022; 10:biomedicines10112939. [PMID: 36428507 PMCID: PMC9687986 DOI: 10.3390/biomedicines10112939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia is a complex and incompletely elucidated pathology that affects sensorimotor function and also produces numerous therapeutic challenges. The aims of this cross-sectional study were to identify the profile of neurological soft signs (NSS) in patients with predominantly negative symptoms of schizophrenia (PNS) compared with patients with schizophrenia who do not present a predominance of negative symptoms (NPNS) and also to objectify the impact of treatment on the neurological function of these patients. Ninety-nine (n = 99; 56 females and 43 males) patients diagnosed with schizophrenia according to DSM-V were included; these patients were undergoing antipsychotic (4 typical antipsychotics, 86 atypical antipsychotics, and 9 combinations of two atypical antipsychotics) or anticholinergic treatment (24 out of 99) at the time of evaluation, and the PANSS was used to identify the patients with predominantly negative symptoms (n = 39), the Neurological Evaluation Scale (NES) was used for the evaluation of neurological soft signs (NSS), and the SAS was used for the objectification of the extrapyramidal side effects induced by the neuroleptic treatment, which was converted to chlorpromazine equivalents (CPZE). The study's main finding was that, although the daily dose of CPZE did not represent a statistically significant variable, in terms of neurological soft signs, patients with PNS had higher rates of NSS.
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11
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Herold CJ, Kong L, Ceballos ME, Schröder J, Toro P. Neurological soft signs and brain morphology in people living with HIV. J Neurovirol 2022; 28:236-247. [PMID: 35352314 PMCID: PMC9187556 DOI: 10.1007/s13365-022-01071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Neurological soft signs (NSS) are a common feature of severe psychiatric disorders such as schizophrenia but are also prevalent in organic brain diseases like HIV-associated neurocognitive disorder (HAND) or Alzheimer’s disease. While distinct associations between NSS, neurocognition, and cerebral regions were demonstrated in schizophrenia, these associations still have to be elucidated in HIV. Therefore, we investigated 36 persons with HIV of whom 16 were neurocognitively healthy and 20 were diagnosed with HAND. NSS were assessed using the Heidelberg scale. NSS scores were correlated with gray matter (GM) using whole brain voxel-based morphometry. Results showed significantly elevated NSS in the HAND group when compared to the neurocognitively healthy with respect to NSS total score and the subscores “orientation” and “complex motor tasks”. While the two groups showed only minor, non-significant GM differences, higher NSS scores (subscales “motor coordination”, “orientation”) were significantly correlated with GM reduction in the right insula and cerebellum (FWE-corrected). Our results corroborate elevated NSS in HIV+ patients with HAND in contrast to cognitively unimpaired patients. In addition, cerebral correlates of NSS with GM reductions in insula and cerebellum were revealed. Taken together, NSS in this patient group could be considered a marker of cerebral damage and neurocognitive deficits.
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Affiliation(s)
- Christina J Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
| | - Li Kong
- Department of Psychology, Shanghai Normal University, Shanghai, China.
| | - María Elena Ceballos
- Department of Infectious Diseases, Medicine School, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Pablo Toro
- Department of Psychiatry, Medicine School, Pontificia Universidad Católica de Chile, Santiago, Chile
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12
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Zaki HM, Sliem H, Ibrahim HR, Yassine IA. Neurological Soft Signs in Non-diabetic End Stage Renal Disease Patients: Evaluation and Prediction. Neurol Res 2022; 44:645-650. [PMID: 35048798 DOI: 10.1080/01616412.2022.2028958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients on hemodialysis suffer from several serious complex neurological complications resulting in significant disability. Early detection of these complications during the asymptomatic phase may consent to early intervention to prevent or minimize the disability. To assess and predict neurological soft signs (NSS) in non-diabetic end-stage renal disease (ESRD) patients on hemodialysis (HD) who do not suffer any apparent neurological symptoms. An analytical, cross-sectional study was done in Hemodialysis units in the Suez Canal University Hospitals. 96 ESRD adult patients on hemodialysis are exposed to: Medical history was taken via personal interview, laboratory tests, and clinical assessment of NSS using Heidelberg scale, and brain CT was done for 50 high-risk patients (hypertensive or those on dialysis for more than 5 years) to detect the presence of any probable neuro-radiological brain abnormalities. 79.2% of our studied ESRD patients on HD had positive NSS with a mean value of total score 8.5 ± 5.9. Strong positive correlations were present between NSS and Hb levels, duration of hemodialysis, and hypertension. CT had revealed no abnormality. NSS represent a reliable, affordable tool for regular bedside assessment of ESRD patients with HD who do not suffer any neurological symptoms for early detection of asymptomatic neurological lesions, especially since the CT brain scan did not show such changes early. The duration of hemodialysis, Hb level, and hypertension were independent predictors for the occurrence of silent neurological lesions in ESRD patients.
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Affiliation(s)
- Heba M Zaki
- Department of Internal Medicine- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hamdy Sliem
- Department of Internal Medicine- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Heba R Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Imane A Yassine
- Department of Neurology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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13
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Kobayashi S, Iwama Y, Nishimaru H, Matsumoto J, Setogawa T, Ono T, Nishijo H. Examination of the Prefrontal Cortex Hemodynamic Responses to the Fist-Edge-Palm Task in Naïve Subjects Using Functional Near-Infrared Spectroscopy. Front Hum Neurosci 2021; 15:617626. [PMID: 33633554 PMCID: PMC7901956 DOI: 10.3389/fnhum.2021.617626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/15/2021] [Indexed: 01/12/2023] Open
Abstract
The Fist-Edge-Palm (FEP) task, a manual hand task, has been used to detect frontal dysfunctions in clinical situations: its performance failures are observed in various prefrontal cortex (PFC)-related disorders, including schizophrenia. However, previous imaging studies reported that the performance of the FEP task activated motor-related areas, but not the PFC. Here, we aimed to investigate the relationships between the performance of the FEP task and PFC functions. Hemodynamic activity in the PFC, including the dorsolateral PFC (area 46) and frontal pole (area 10), was recorded. Healthy young subjects performed the FEP task as well as a palm tapping (PT) task (control task) three times. The subjects also completed a Wisconsin Card Sorting Test (WCST) and Schizotypal Personality Scale (STA) questionnaire. We found that hemodynamic activity (Oxy-Hb) in the PFC increased in the first trial of the FEP task but decreased considerably in the second and third trials compared to the PT task. The number of performance errors in the FEP task also decreased in the second and third trials. Error reduction (i.e., learning) in the FEP task between the first and second trials was negatively correlated with schizotypal trait and the number of perseveration errors in the WCST. Furthermore, changes in the PFC hemodynamic activity between the first and second trials were positively correlated with error reduction in the FEP task between the first and second trials, and negatively correlated with the number of perseveration errors in the WCST. These results suggest that learning in the FEP task requires PFC activation, which is negatively associated with perseveration errors in the WCST. The results further suggest that the FEP task, in conjunction with near-infrared spectroscopy, may be useful as a diagnostic method for various disorders with PFC dysfunction.
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Affiliation(s)
- Satoshi Kobayashi
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan.,Japan Suicide Countermeasures Promotion Center, Tokyo, Japan
| | - Yudai Iwama
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Nishimaru
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Jumpei Matsumoto
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Tsuyoshi Setogawa
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Taketoshi Ono
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Hisao Nishijo
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
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14
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Cai XL, Wang YM, Wang Y, Zhou HY, Huang J, Wang Y, Lui SSY, Møller A, Hung KSY, Mak HKF, Sham PC, Cheung EFC, Chan RCK. Neurological Soft Signs Are Associated With Altered Cerebellar-Cerebral Functional Connectivity in Schizophrenia. Schizophr Bull 2021; 47:1452-1462. [PMID: 33479738 PMCID: PMC8379549 DOI: 10.1093/schbul/sbaa200] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cerebellar dysfunction is associated with neurological soft signs (NSS), which is a promising endophenotype for schizophrenia spectrum disorders. However, the relationship between cerebellar-cerebral resting-state functional connectivity (rsFC) and NSS is largely unexplored. Moreover, both NSS and cerebellar-cerebral rsFC have been found to be correlated with negative symptoms of schizophrenia. Here, we investigated the correlations between NSS and cerebellar-cerebral rsFC, explored their relationship with negative symptoms in a main dataset, and validated the significant findings in a replication dataset. Both datasets comprised schizophrenia patients and healthy controls. In schizophrenia patients, we found positive correlations between NSS and rsFC of the cerebellum with the inferior frontal gyrus and the precuneus, and negative correlations between NSS and rsFC of the cerebellum with the inferior temporal gyrus. In healthy controls, NSS scores were positively correlated with rsFC of the cerebellum with the superior frontal gyrus and negatively correlated with rsFC between the cerebellum and the middle occipital gyrus. Cerebellar-prefrontal rsFC was also positively correlated with negative symptoms in schizophrenia patients. These findings were validated in the replication dataset. Our results suggest that the uncoupling of rsFC between the cerebellum and the cerebral cortex may underlie the expression of NSS in schizophrenia. NSS-related cerebellar-prefrontal rsFC may be a potential neural pathway for possible neural modulation to alleviate negative symptoms.
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Affiliation(s)
- Xin-Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
| | - Yong-Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Han-Yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jia Huang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Simon S Y Lui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Arne Møller
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Henry K F Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pak C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Center for PanorOmic Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Centre for Education and Research, Beijing, China
- To whom correspondence should be addressed; 16 Lincui Road, Beijing 100101, China; tel: +86(0)10-64836274, fax: 86(0)10-64836274, e-mail:
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15
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Khoweiled AA, Gaafar Y, El Makawi SM, Kamel RM, Ayoub DR. Neurological soft signs correlation with symptom severity in borderline personality disorder. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-020-00078-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Abstract
Background
Borderline personality disorder (BPD) is a severe psychiatric disorder with multiple psychopathological domains; so studying the correlation of clinical or behavioral data with underlying structural and functional neurological findings in BPD is the focus of interest in recent years.
The aim of our study was to compare the presence of neurological soft signs (NSS) in patients with borderline personality disorder with their presence in normal controls, and to correlate the severity of different symptoms of BPD with the presence of NSS through a case-control study which was conducted on 30 patients and 30 matching controls recruited from Al Kasr Al Ainy Hospital, Cairo University, Egypt. All subjects were assessed by the Borderline Personality Questionnaire, the Barratt Impulsivity Scale-11, the Brief Non-Suicidal Self-Injury Assessment tool, and the Cambridge Neurological Inventory.
Results
The BPD group had significantly higher total NSS scores, primitive reflexes subscale score, and sensory integration subscale scores. There was also a positive correlation between NSS and overall severity of borderline symptoms.
Conclusions
The increased rates of NSS were associated with specific clinical symptoms in BPD including suicidality, self-harm, emptiness, and quasi-psychosis. Impulsivity was found to have the highest correlation with NSS.
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16
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Neurological soft signs and cognition in the late course of chronic schizophrenia: a longitudinal study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1465-1473. [PMID: 32417958 PMCID: PMC8563630 DOI: 10.1007/s00406-020-01138-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
Neurological soft signs (NSS) are minor ('soft') neurological abnormalities in sensory and motor performances, which are frequently reported in patients with schizophrenia at any stage of their illness. It has been demonstrated that NSS vary in the clinical course of the disorder: longitudinally NSS decrease in parallel with remission of psychopathological symptoms, an effect which mainly applies to patients with a remitting course. These findings are primarily based on patients with a first episode of the disorder, while the course of NSS in patients with chronic schizophrenia and persisting symptoms is rather unknown. Therefore, we investigated NSS twice in 21 patients with chronic schizophrenia (initial mean duration of illness: 23 ± 11 years) with a mean follow-up interval of 7 years. NSS were evaluated by the Heidelberg Scale, established instruments were used to rate neuropsychological performance and psychopathological symptoms. NSS showed significant increases on the subscales "motor coordination" and "integrative functions", while positive and negative symptoms, including apathy, showed only minor, non-significant changes. Verbal memory, verbal fluency, and cognitive flexibility along with severity of global cognitive deficits demonstrated a significant deterioration. Regression analyses identified executive dysfunction (cognitive flexibility and verbal fluency) at baseline as significant predictors of NSS increase at follow-up. Our findings indicate that NSS deteriorate in the long-term course of chronic schizophrenia. This effect may be accounted for by a decrease of executive functions and logical memory, which can be attributed to premature brain aging.
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17
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Herold CJ, Essig M, Schröder J. Neurological soft signs (NSS) and brain morphology in patients with chronic schizophrenia and healthy controls. PLoS One 2020; 15:e0231669. [PMID: 32320431 PMCID: PMC7176089 DOI: 10.1371/journal.pone.0231669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/28/2020] [Indexed: 01/06/2023] Open
Abstract
Subtle abnormalities in sensory integration, motor coordination and sequencing of complex motor acts or neurological soft signs (NSS) are characteristic phenomena in patients with schizophrenia at any stage of the illness. Previous MRI studies in schizophrenia found NSS to be associated with cortical, thalamic and cerebellar changes. Since these studies mainly focused on first-episode or recent onset schizophrenia, the cerebral correlates of NSS in chronic schizophrenia remained rather unclear. 49 middle-aged patients with chronic schizophrenia with a mean duration of illness of 20.3 ± 14.0 years and 29 healthy subjects matched for age and sex were included. NSS were examined on the Heidelberg Scale and correlated to grey matter (GM) by using whole brain high resolution magnetic resonance imaging (3 Tesla) with SPM12/CAT12 analyses. As expected, NSS in patients were significantly (p≤0.001) elevated in contrast to healthy controls, a finding, which not only applied to NSS total score, but also to the respective subscales "motor coordination", "sensory integration", "complex motor tasks", "right/left and spatial orientation" and "hard signs". Within the patient group NSS total scores were significantly correlated to reduced GM in right lingual gyrus, left parahippocampal gyrus, left superior temporal gyrus, left thalamus (medial dorsal nucleus) and left posterior lobe of the cerebellum (declive). Respective negative associations could also be revealed for the subscales "motor coordination", "complex motor tasks" and "right/left and spatial orientation". These findings remained significant after FWE-correction for multiple comparisons and were confirmed when years of education, chlorpromazine-equivalents or variables indicating the severity of psychopathology were introduced as additional covariates. According to our results lingual, parahippocampal, superior temporal, inferior and middle frontal gyri, thalamus and cerebellum have to be considered as important sites of NSS in chronic schizophrenia. That these findings only applied for patients but not healthy controls may indicate a different pathogenesis of NSS.
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Affiliation(s)
- Christina J. Herold
- Department of General Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marco Essig
- Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - Johannes Schröder
- Department of General Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
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18
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Belrose C, Duffaud A, Rakotoarison E, Faget C, Raynaud P, Dutheil F, Boyer L, Billaud JB, Trousselard M. Neurological Soft Signs and Post-Traumatic Stress Disorder: A Biomarker of Severity? Front Psychiatry 2020; 11:533662. [PMID: 33192652 PMCID: PMC7606651 DOI: 10.3389/fpsyt.2020.533662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 09/03/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The psychophysiological changes for individual suffering from chronic post-traumatic stress disorder (PTSD) raise to the questions of how facilitate recovery and return to work. Negative alterations in neuro-cognition remain a complaint for patients and participate to long-term functional impairments. Neurological soft signs (NSSs) appear as a candidate for better understanding these complaints. They have been reported in several mental disorders. They are found in several behavioral and/or neurocognitive disorders and are taken into account by psychiatric rehabilitation programs to support recovery. As few studies evaluate NSSs in PTSD, our exploratory study aims to assess NSSs in chronic PTSD and their relationships with PTSD severity. METHOD Twenty-two patients with a clinical diagnosis of chronic PTSD were evaluated in terms of PTSD severity (post-traumatic checklist scale, PCL5), NSSs (NSSs psychomotor skills scale, PASS), and well-being upon arrival to the hospital and compared with 15 healthy subjects. Statistical non-parametric analyses assessed the relationships between these variables. RESULTS PTSD subjects exhibited higher NSSs compared with healthy subjects. NSSs were positively associated with PTSD severity, with negative alterations in cognition and mood, and with impairment in well-being. They were higher in women compared with men. No impact of age was found. Three groups were identified based on the severity of the PTSD. Severe PTSD exhibited NSSs characterized by motor integration alterations. CONCLUSIONS This pilot study suggests that NSSs might be a biomarker of PTSD severity. This proof of concept highlights the need for further research for better evaluating the clinical neuro-functional impairment. This will be helping for defining neurological remediation for promoting PTSD recovery.
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Affiliation(s)
- Célia Belrose
- Département de Neurosciences et Sciences Cognitives, Unité de Neurophysiologie du Stress, Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.,Réseau ABC des Psychotraumas, Montpellier, France.,APEMAC, EA 4360, Université de Lorraine, Nancy, France
| | - Anais Duffaud
- Département de Neurosciences et Sciences Cognitives, Unité de Neurophysiologie du Stress, Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.,Réseau ABC des Psychotraumas, Montpellier, France
| | | | | | - Philippe Raynaud
- APEMAC, EA 4360, Université de Lorraine, Nancy, France.,Centre Hospitalier Léon Jean Grégory, Thuir, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia
| | - Léa Boyer
- Département de Neurosciences et Sciences Cognitives, Unité de Neurophysiologie du Stress, Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
| | - Jean-Baptiste Billaud
- Département de Neurosciences et Sciences Cognitives, Unité de Neurophysiologie du Stress, Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
| | - Marion Trousselard
- Département de Neurosciences et Sciences Cognitives, Unité de Neurophysiologie du Stress, Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.,Réseau ABC des Psychotraumas, Montpellier, France.,APEMAC, EA 4360, Université de Lorraine, Nancy, France
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19
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Fountoulakis KN, Panagiotidis P, Kimiskidis V, Nimatoudis I. 12-Month stability of neurological soft signs in stabilized patients with schizophrenia. Nord J Psychiatry 2019; 73:451-461. [PMID: 31393751 DOI: 10.1080/08039488.2019.1649724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: Neurological soft signs (NSS) are a group of minor non-localizable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was to investigate their temporal stability and relationship to the overall outcome over a 12-month period. Material and methods: The study sample included 133 stabilized patients suffering from schizophrenia (77 males and 56 females; aged 33.55 ± 11.22 years old). The assessment included the application at baseline and after 12 months of the Neurological Evaluation Scale (NES), and a number of scales assessing the clinical symptoms and adverse effects. The statistical analysis included ANOVA, exploratory t-test and Pearson correlation coefficients with Bonferroni correction. Results: In stabilized patients, NSS are stable over a 12-month period with only the subscale of NES-sensory integration manifesting a significant worsening, while, in contrast, most of the clinical variables improved significantly. There was no relationship of NES scores with the magnitude of improvement. The only significant negative correlation was between NES-motor coordination and Positive and Negative Syndrome Scale-GP change at 1 year. Discussion: The results of the current study suggest that after stabilization of patients with schizophrenia, there are probably two separate components, a 'trait' which is stable over a 12-month period, and a 'degenerative' component with a tendency to worsen probably in parallel with the progression of the illness and in correlation with the worsening of negative symptoms. However, the statistical support of the 'degenerative' component is weak. Significant outcomes Neurological softs signs are stable over a 12-month period, with the exception of 'sensory integration' which manifests significant improvement irrespective of treatment response. They do not respond to treatment with antipsychotics. They do not constitute a prognostic factor to predict improvement over a period of 1 year. Neurological soft signs constitute a trait symptom of schizophrenia which is stable though time. Limitations All the subjects have been previously hospitalized which may represent a more severe form of schizophrenia. Also, all patients were under antipsychotic and some also under benzodiazepine medications. Patients with comorbid somatic disorders were excluded which may decrease generalizability of results.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Panagiotis Panagiotidis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Ioannis Nimatoudis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Toro P, Schröder J. Editorial: Neurological Soft Signs in Neuropsychiatric Conditions. Front Psychiatry 2019; 9:736. [PMID: 30692941 PMCID: PMC6339934 DOI: 10.3389/fpsyt.2018.00736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pablo Toro
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Disease, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Johannes Schröder
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Section of Geriatric Psychiatry, Heidelberg University, Heidelberg, Germany
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Allé MC, Giersch A, Potheegadoo J, Meyer N, Danion JM, Berna F. From a Lived Event to Its Autobiographical Memory: An Ecological Study Using Wearable Camera in Schizophrenia. Front Psychiatry 2019; 10:699. [PMID: 31636574 PMCID: PMC6787264 DOI: 10.3389/fpsyt.2019.00699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022] Open
Abstract
Cognitive disorders are considered as a core symptom of schizophrenia. Importantly, episodic autobiographical memory deficits are strongly related to patients' social dysfunction. Although the cognitive mechanisms underlying autobiographical memory deficit are highly important to open the door for specific cognitive remediation, they are yet to be understood. The present study focused on event segmentation to check to which extent possible impairments in temporal ordering and segmenting in patients hinder memories construction. Twenty-seven patients with schizophrenia and 27 matched controls took part in an outdoor circuit while wearing a wearable camera. A week later, their memory and the temporal organization of this event have been assessed. Results showed that patients, compared with control participants, reported a reduced amount of details, especially less actions with interaction related to the event. Contrary to our initial hypotheses, event segmentation abilities in patients were not affected. The relationship between event segmentation and memory is discussed.
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Affiliation(s)
- Mélissa C Allé
- Inserm U1114 - Cognitive Neuropsychology and Pathophysiology of Schizophrenia, Strasbourg, France.,FMTS: Fédération de Médcine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Anne Giersch
- Inserm U1114 - Cognitive Neuropsychology and Pathophysiology of Schizophrenia, Strasbourg, France.,FMTS: Fédération de Médcine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Jevita Potheegadoo
- Inserm U1114 - Cognitive Neuropsychology and Pathophysiology of Schizophrenia, Strasbourg, France.,FMTS: Fédération de Médcine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France.,University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- FMTS: Fédération de Médcine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France.,University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Marie Danion
- Inserm U1114 - Cognitive Neuropsychology and Pathophysiology of Schizophrenia, Strasbourg, France.,FMTS: Fédération de Médcine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France.,University Hospital of Strasbourg, Strasbourg, France
| | - Fabrice Berna
- Inserm U1114 - Cognitive Neuropsychology and Pathophysiology of Schizophrenia, Strasbourg, France.,FMTS: Fédération de Médcine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France.,University Hospital of Strasbourg, Strasbourg, France
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