Minor physical anomalies in schizophrenic patients and siblings: How effective is the waldropscale?

181

while sensory integration just fell short of significance. Dyskinesa, catatonia, pyramidal and extra-pyramidal signs were not significantly correlated with attention. Individual signs with the strongest correlation with sustained attention included the First-Edge-Palm test, Go-no go test, Ozeretski test and Rhythm tapping. Conelttsions." Involvement of attentional processes is an important feature of the motor soft signs. Sensory integration signs are related to attention through covariation with intellectual function and age. Dyskinesa, catatonia, pyramidal and extra-pyramidal signs are unrelated to attentional performance.

NEUROLOGICAL SIGNS AND PSYCHOMOTOR PERFORMANCE PATIENTS WITH SCHIZOPHRENIA, RELATIVES AND NORMALS

IN THEIR

L. Flyckt, O. Sydow, L. Bjerkenstedt, G. E d m a n , E. Rydin, F.-A. Wiesel

Lena Flyckt MD, Department g['Psyehiat~3'. Dandeo'ds Hospital, S-182 88 Dandel3,d, Sweden Objective: The aim of the study was to describe the occurrence of neurological signs and psychomotor abnormalities in schizophrenic patients and their first-degree relatives in comparison to healthy controls. The influence of genetic factors was studied by dividing parents into carriers and non-carriers of disposition for psychosis. Metho~k Schizophrenic patients (DSM-III-R) were consecutively recruited to a psychiatric clinic in Stockholm and 39 were included. Twenty-one were first-episode and 18 chronic schizophrenic patients. Eight patient were drug-naive, one was off medication and 28 were medicated. Forty-four relatives entered the study of whom 21 were classified as carriers and 8 as non-carriers of psychosis. Fifty-six healthy controls volunteered. Two neurologists investigated all the subjects according to a structured protocol divided into neurological signs and psychomotor performance tests. A psychiatrist also rated symptoms (PANSS), side-effects (ESRS), functioning (GAF, Strauss-carpenter) and made pedigrees of the psychiatric family history. Results: Seventy-eight percent of the patients and 7% of the controls were classified as neurologically aberrant. There were no differences between first episode and chronic schizophrenic patients in neurological signs. The patients and their parents classified as carriers of psychosis exhibited a similar laterality pattern in a fingertapping test significantly different from the fingertapping of non-carriers and normals. Neuroleptic medication did not significantly influence on the occurrence of neurological aberrations. ('onehtsions." These findings support the view that neurological aberrations have a neurodevelopmental origin in schizophrenia and indicate that genetic factors are associated with psychomotor performance.

NEUROLOGICAL SCHIZOPHRENIC SIBLINGS

ABNORMALITY PATIENTS AND

IN

B.T. Ismaill+ E. C a n t o r - G r a a e 2. T.F. McNeil 2

I Department oJP.s:vchiatrv and 2Department q] Community Medicine, University Hospital UMA S, S-205 02 MahnO, Sweden The aim of the study was to investigate the prevalence and type of neurological abnormality (NA) in schizophrenic patients and their non-psychotic siblings. Sixty patients, 21 siblings and 75 normal comparison subjects were given a comprehensive neurological assessment including both 'hard" and +soft' signs. Sixty-seven percent of the patients and 19% of the siblings showed a level of NA not found among the comparison subjects. Both patients and siblings had significantly more abnormality than comparison subjects on the total scores, 'hard" signs, 'soft' signs, primitive reflexes, integrative sensory and motor functions. The abnormalities were most conspicuous in motor coordination and involuntary movements in the patients and in the cranial nerves and mirror movements in their siblings. Degree of NA was positively correlated within patient-sibling pairs. The items which best discriminated patients from comparison subjects were the total battery and thereafter 'hard' signs. The constellation of NA and absence of overt psychopathology in siblings may represent the mildest form of 'disturbance' within the schizophrenia-spectrum, The level of NA covaries positively in patients and siblings within the same family, suggesting common genetic and/or environmental factors in the pathogenesis of these abnormalities in both groups. An extended assessment battery provides optimal discrimination of patients from normal comparison subjects, and 'hard' signs are more differentially associated with schizophrenia than are 'soft" signs. The NA has no consistent localizing profile and nearly all functional domains are involved.

MINOR PHYSICAL ANOMALIES IN SCHIZOPHRENIC PATIENTS AND S I B L I N G S : H O W E F F E C T I V E IS T H E WALDROP SCALE? B.T. Ismail ~, E. C a n t o r - G r a a e 2, T.F. McNeil 2

1Department o[' Psychiatrv and 2Department +~(Community Medicine, University Hospital UMAS. S-205 02 Mahn#. Sweden The aim of the study was to investigate the prevalence and type of minor physical anomalies (MPAs) in schizophrenic patients and their non-psychotic siblings. Sixty patients, 21 siblings and 75 normal comparison subjects were investigated using both the Waldrop scale and 23 'other' MPAs, yielding a total MPA battery of 48 items. With the total battery, the patients had significantly more MPAs than both their siblings and the comparison subjects, while the siblings had significantly more MPAs than the comparison subjects. Patients showed

182

significantly more MPAs than comparison subjects in head, eye, mouth and hand regions, on both the Waldrop scale and the 'other" items by themselves, plus in ears and feet, defined by one of the two sets of items. Increased MPAs in siblings were noted primarily in the eyes (per both MPA techniques) and in the mouth (per the Waldrop scale). While a "rostral' dominance might be suggested by some findings, the increase of MPAs associated with schizophrenia appears to be spread throughout several areas of the body, and is best investigated using an extended battery.

DIFFERENTIAL

PRESENTATION

NEUROLOGICAL

SIGNS AND

SCHIZOPHRENIC

SYMPTOMS

RELATION

OF SOFT

IN

TO SEX AND AGE OF ONSET

*~L.C.W. Lam, bE.Y.H. Chen, ~D.G.H. Nguyen, bR.Y.L. Chen

~D~Tartment o/ PsTehiatrv. The Chinese UniversiO' ~)[Hong Kong; bDepartment q/' Ps3'ehiatrv. University q['Hong Kong: ~Kwai Chung Hoapita/, Hong Kong *O~rrespondence." Prince 0[' Wales"Hospital, Shathl, Hong Kong Introduction: Anecdotal evidence suggested a differential pattern in schizophrenic psychopathology among different clinical subgroups. We examined the soft neurological signs and psychiatric symptoms in well defined demographic subgroups of schizophrenic patients. Methods. Symptom profiles and soft neurological signs of 204 patients with DSM-III-R diagnosis of schizophrenia were assessed using the Cambridge Neurological Inventory and Brief Psychiatric Rating Scale. The association of soft neurological signs and psychiatric symptoms with age of onset (<24 years, 25 44 years and >45 years) and sex was analyzed. Results: No significant sex difference was found in major groups of soft neurological signs (sensory integration, motor coordination, catatonia and disinhibition). Female patients showed significantly higher ratings in positive symptoms: unusual thought content (t = 3.75,p <0.001 ): suspiciousness ( t 2.35, p<0.05); and disorganization ( t - 2.17, p<0.05). Male patients showed significantly more negative symptoms: retardation (:=3.47, p<0.001): and blunted affect (t-3.(I3. p <0.005). Patients with earlier age of onset had significantly lower ratings in blunted affect (one way ANOVA, F=3.3(L p < 0.053, disorganization (one way A NOVA, F= 4.60, p < 0.05 ) and grandiosity (one way ANOVA, F-4.95, p<0.01). Dyskinesia was more common in patient group with onset older than 45 years. Conclusions. Sex difference in schizophrenic symptom dimension was shown. Difference in soft neurological signs in terms of sex and age of onset was less prominent.

ARE NEUROLOGICAL RELATED

SOFT SIGNS

TO NEUROLEPTIC

SIDE

EFFECTS? J. SchrOder, T. Jahn, W. H u b m a n n , R. Niethammer, M. Karr, F. Mohr, R. Cohen

Dept. ~f Psyehiutrv. University of Heidelberg, Voflstr. 4, D-69115 Heidelberg, Germany Recent studies indicate that neurological soft signs (NSS) are associated with psychopathological symptoms, neuropsychological deficits, and genetic disposition. Since these findings also apply for drug-na~ve patients it is suggested that neuroleptic side effects do not account for NSS. However, the relation between NSS and neuroleptic side effects was not particularly addressed. NSS, psychopathological symptoms, and neuroleptic side effects were investigated in 82 patients with DSM-1II-R schizophrenia. Only patients with a subchronic or chronic course were included since these patients are particularly vulnerable to neuroleptic side effects and NSS. To address potential fluctuations of the respective variables in the clinical course, patients were examined twice at an interval of between 14 21 days. NSS were significantly (p<0.053 correlated with severity of illness, lower social functioning, negative symptoms, and a poor performance in the Wisconsin Card Sorting Test. Modest, also significant correlations (r=0.34; p<0.05) were found between NSS and extrapyramidal side-effects as assessed on the Simpson and Angus Scale. Neither the neuroleptic dose prescribed to the patients nor scores for tardive dyskinesia and akathisia were significantly correlated with NSS. NSS scores did not significantly differ between patients receiving clozapine and conventional neuroleptics. Patients in whom psychopathological symptoms remained stable or improved in the clinical course showed a significant reduction of NSS scores. Our findings demonstrate that NSS in schizophrenia are relatively independent of neuroleptic side effects but refer to symptoms and course of the disease.

NEUROLOGICAL PRODROMAL

SOFT SIGNS IN

PATIENTS

D. Velakoulis 1'2, A. Yung, W. Brewer, P. McGorry, C. Pantelis

tApplied Schizophrenia Division, Mental Health Research Institute, Locked Bag 11, Parkville, 3052, Australia. 2Royal Melbourne Hospital, Parkville. 3052, Victoria. Australia Neurological soft signs are considered to represent subtle brain pathology and their presence in patients with schizophrenia has been cited as evidence for the neurodevelopmental hypothesis of schizophrenia. This hypothesis predicts that neurological soft signs will be present prior to the onset of illness. Neurological soft signs have been described in patients with chronic schizophrenia and in first episode psychosis patients but there have been few studies examining patients prior to the onset of illness. We administered a neurological