Neurological soft signs in first-episode schizophrenia: State- and trait-related relationships to psychopathology, cognition and antipsychotic medication effects

Schizophr Res. 2017 Oct:188:144-150. doi: 10.1016/j.schres.2017.01.034. Epub 2017 Jan 24.

Abstract

Background: Neurological soft signs (NSS) are proposed to represent both state- and trait-related features of schizophrenia.

Method: We assessed the course of NSS with the Neurological Evaluation Scale (NES) over 12months of standardised treatment in 126 patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder, and evaluated their state- and trait-related associations with psychopathology, functionality, cognition and antipsychotic treatment. We considered change scores from baseline to be state-related and endpoint scores to be trait-related.

Results: Significant effects for time were recorded for all NSS domains. For state-related change-scores greater improvements in sensory integration were predicted by more improvement in working memory (p=0.01); greater improvements in motor sequencing scores were predicted by more improvement in working memory (p=0.005) and functionality (p=0.005); and greater improvements in NES Total score were predicted by more improvement in disorganised symptoms (p=0.02). There were more substantial associations between trait-related endpoint scores than for state-related change scores. For endpoint scores lower composite cognitive score predicted poorer sensory integration (p=0.001); higher Parkinsonism score predicted poorer motor co-ordination (p=0.0001); lower composite cognitive score (p=0.001) and higher Parkinsonism score (p=0.005) predicted poorer motor sequencing; higher Parkinsonism score (p=0.0001) and disorganised symptoms (p=0.04), and lower composite cognitive score (p=0.0007) predicted higher NES total score.

Conclusions: NSS improved with treatment, but were weakly associated with improvements in psychopathology. Studies investigating NSS as trait-markers should ensure that patients have been optimally treated at the time of testing, and should take possible effects of extrapyramidal symptoms into account.

Keywords: Depot; Flupenthixol; Neurological; Outcome; Psychosis; Schizophrenia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antipsychotic Agents / administration & dosage*
  • Cognition / drug effects*
  • Female
  • Flupenthixol / administration & dosage
  • Flupenthixol / analogs & derivatives
  • Humans
  • Interview, Psychological
  • Linear Models
  • Longitudinal Studies
  • Male
  • Memory, Short-Term / drug effects
  • Motor Activity / drug effects
  • Neurologic Examination
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / physiopathology*
  • Psychotic Disorders / psychology
  • Schizophrenia / drug therapy*
  • Schizophrenia / physiopathology*
  • Schizophrenic Psychology
  • Severity of Illness Index
  • Treatment Outcome
  • Young Adult

Substances

  • Antipsychotic Agents
  • flupenthixol decanoate
  • Flupenthixol