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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: [email protected]
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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.

References

Ammons, RB and Ammons, CH (1962) The quick test (QT): provisional manual. Psychological Reports 11, 111–161.CrossRefGoogle Scholar
Andreasen, NC (1990) Methods for assessing positive and negative symptoms. Modern Problems of Pharmacopsychiatry 24, 73–88.CrossRefGoogle ScholarPubMed
Andreasen, NC, Carpenter, WT, Kane, JM, Lasser, RA, Marder, SR and Weinberger, DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.CrossRefGoogle ScholarPubMed
Bachmann, S and Schröder, J (2018) Neurological soft signs in schizophrenia: an update on the state- versus trait-perspective. Frontiers in Psychiatry 8, 453.CrossRefGoogle ScholarPubMed
Bachmann, S, Bottmer, C and Schröder, J (2005) Neurological soft signs in first-episode schizophrenia: a follow-up study. American Journal of Psychiatry 162, 2337–2343.CrossRefGoogle ScholarPubMed
Bachmann, S, Degen, C, Geider, FJ and Schröder, J (2014) Neurological soft signs in the clinical course of schizophrenia: results of a meta-analysis. Frontiers in Psychiatry 5, 703.CrossRefGoogle ScholarPubMed
Bombin, I (2005) Significance and meaning of neurological signs in schizophrenia: two decades later. Schizophrenia Bulletin 31, 962–977.CrossRefGoogle ScholarPubMed
Buchanan, RW and Heinrichs, DW (1989) The neurological evaluation scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Research 27, 335–350.CrossRefGoogle Scholar
Carbon, M and Correll, CU (2014) Clinical predictors of therapeutic response to antipsychotics in schizophrenia. Dialogues in Clinical Neuroscience 16, 505–524.Google Scholar
Chan, RCK and Gottesman, II (2008) Neurological soft signs as candidate endophenotypes for schizophrenia: a shooting star or a Northern star? Neuroscience and Biobehavioral Reviews 32, 957–971.CrossRefGoogle ScholarPubMed
Chan, RCK, Xu, T, Heinrichs, RW, Yu, Y and Wang, Y (2010) Neurological soft signs in schizophrenia: a meta-analysis. Schizophrenia Bulletin 36, 1089–1104.CrossRefGoogle ScholarPubMed
Chan, RCK, Geng, F-L, Lui, SSY, Wang, Y, Ho, KKY, Hung, KSY, Gur, RE, Gur, RC and Cheung, EFC (2015) Course of neurological soft signs in first-episode schizophrenia: relationship with negative symptoms and cognitive performances. Scientific Reports 5, 11053.CrossRefGoogle ScholarPubMed
Chan, RCK, Xie, W, Geng, F-L, Wang, Y, Lui, SSY, Wang, C-Y, Yu, X, Cheung, EFC and Rosenthal, R (2016) Clinical utility and lifespan profiling of neurological soft signs in schizophrenia spectrum disorders. Schizophrenia Bulletin 42, 560–570.CrossRefGoogle ScholarPubMed
Dazzan, P and Murray, RM (2002) Neurological soft signs in first-episode psychosis: a systematic review. The British Journal of Psychiatry. Supplement 43, s50–s57.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL, Fleiss, JL and Cohen, J (1976) The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766–771.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Williams, JB, Gibbon, M, First (1997). User's guide for the structured clinical inverview for DSM-IV axis I disorders SCID-1: clinician version. American Psychiatric Pub.Google Scholar
Hollingshead, AB (1975). Four factor index of social status. Unpublished manuscript, Yale University, NewHaven, CT.Google Scholar
Honaker, J, King, G and Blackwell, M (2011) Amelia II: a program for missing data. Journal of Statistical Software 45, 1–47.CrossRefGoogle Scholar
Kahn, RS, Sommer, IE, Murray, RM, Meyer-Lindenberg, A, Weinberger, DR, Cannon, TD, O'Donovan, M, Correll, CU, Kane, JM, Van Os, J and Insel, TR (2015) Schizophrenia. Nature Reviews. Disease Primers 1, 15067.CrossRefGoogle ScholarPubMed
Keshavan, MS, Haas, G, Miewald, J, Montrose, DM, Reddy, R, Schooler, NR and Sweeney, JA (2003 a) Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychoses. Schizophrenia Bulletin 29, 757–769.CrossRefGoogle ScholarPubMed
Keshavan, MS, Sanders, RD, Sweeney, JA, Diwadkar, VA, Goldstein, G, Pettegrew, JW and Schooler, NR (2003 b) Diagnostic specificity and neuroanatomical validity of neurological abnormalities in first-episode psychoses. American Journal of Psychiatry 160, 1298–1304.CrossRefGoogle ScholarPubMed
Li, Z, Huang, J, Xu, T, Wang, Y, Li, K, Zeng, Y-W, Lui, SSY, Cheung, EFC, Jin, Z, Dazzan, P, Glahn, DC and Chan, RCK (2018) Neural mechanism and heritability of complex motor sequence and audiovisual integration: a healthy twin study. Human Brain Mapping 39, 1438–1448.CrossRefGoogle ScholarPubMed
Loebel, AD, Lieberman, JA, Alvir, JM, Mayerhoff, DI, Geisler, SH and Szymanski, SR (1992) Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry 149, 1183–1188.Google ScholarPubMed
Martins, I, Lauterbach, M, Slade, P, Luís, H, DeRouen, T, Martin, M, Caldas, A, Leitão, J, Rosenbaum, G and Townes, B (2008) A longitudinal study of neurological soft signs from late childhood into early adulthood. Developmental Medicine & Child Neurology 50, 602–607.CrossRefGoogle ScholarPubMed
McEvoy, JP, Hogarty, GE and Steingard, S (1991) Optimal dose of neuroleptic in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose. Archives of General Psychiatry 48, 739–745.CrossRefGoogle ScholarPubMed
Prasad, KM, Sanders, R, Sweeney, J, Montrose, D, Diwadkar, V, Dworakowski, D, Miewald, J and Keshavan, M (2009) Neurological abnormalities among offspring of persons with schizophrenia: relation to premorbid psychopathology. Schizophrenia Research 108, 163–169.CrossRefGoogle ScholarPubMed
Prikryl, R, Ceskova, E, Tronerova, S, Kasparek, T, Kucerova, HP, Ustohal, L, Venclikova, S and Vrzalova, M (2012) Dynamics of neurological soft signs and its relationship to clinical course in patients with first-episode schizophrenia. Psychiatry Research 200, 67–72.CrossRefGoogle ScholarPubMed
Reichenberg, A, Feo, C, Prestia, D, Bowie, CR, Patterson, TL and Harvey, PD (2014) The course and correlates of everyday functioning in schizophrenia. Schizophrenia Research. Cognition 1, e47–e52.CrossRefGoogle Scholar
Sanders, RD and Keshavan, MS (1998) The neurologic examination in adult psychiatry: from soft signs to hard science. The Journal of Neuropsychiatry and Clinical Neurosciences 10, 395–404.CrossRefGoogle ScholarPubMed
Sanders, RD, Keshavan, MS and Schooler, NR (1994) Neurological examination abnormalities in neuroleptic-naive patients with first-break schizophrenia: preliminary results. American Journal of Psychiatry 151, 1231–1233.Google ScholarPubMed
Sanders, RD, Forman, SD, Pierri, JN, Baker, RW, Kelley, ME, Van Kammen, DP and Keshavan, MS (1998) Inter-rater reliability of the neurological examination in schizophrenia. Schizophrenia Research 29, 287–292.CrossRefGoogle Scholar
Simon, GE, Coleman, KJ, Yarborough, BJ, Operskalski, B, Stewart, C, Hunkeler, E, Lynch, FL, Carrell, D and Beck, A (2017) Incidence and presentation of first-episode psychosis in a population-based sample. Psychiatric Services 68, 456–461.CrossRefGoogle Scholar
Torrey, EF, Taylor, EH, Bracha, HS, Bowler, AE, McNeil, TF, Rawlings, RR, Quinn, PO, Bigelow, LB, Rickler, K and Sjostrom, K (1994) Prenatal origin of schizophrenia in a subgroup of discordant monozygotic twins. Schizophrenia Bulletin 20, 423–432.CrossRefGoogle Scholar
Zhao, Q, Li, Z, Huang, J, Yan, C, Dazzan, P, Pantelis, C, Cheung, EFC, Lui, SSY and Chan, RCK (2014) Neurological soft signs are not ‘soft’ in brain structure and functional networks: evidence from ALE meta-analysis. Schizophrenia Bulletin 40, 626–641.CrossRefGoogle Scholar
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