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Neurological soft signs in schizophrenia: relationship to thought disorder
SATURDAY, MAY 21
360. NEUROLOGICAL SOFT SIGNS IN SCHIZOPHRENIA: RELATIONSHIP TO THOUGHT DISORDER E. Duncan, M. Sanfilipo, S. Wieland, B. Angrist, & J. Rotrosen New York Department of Veterans Affairs Medical Center and New York University Medical Center, New York, NY 10010 Previous studies have documented a greater incidence of nonlocalizing neurological abnormalities called neurological soft signs (NSS) in schizophrenics than in normal controls. The correlation of NSS with other clinical factors in schizophrenics has been variable across studies. The effects of medication status is unclear, and the presence of tardive dyskinesia may be a confounding factor. Using the scale of Quitkin et al. (1976), we rated NSS, as well as psychopathology (BPRS) and tardive dyskinesia (AIMS) in 30 hospitalized schizophrenics who had been washed out of neuroleptics for a minimum of 35 days. Subjects were treated with a six week prospective trial of haloperidol and rateci again at endpoint. 90% of the subjects had an abnormal score on at least one item from the NSS scale at baseline. Baseline NSS scores were strongly correlated with baseline conceptual disorganization (r - .589), and with baseline AIMS scores (r - .479). Using hierarchical multiple regression, NSS continued to correlate with conceptual disorganization at the p<0.05 level even after the factors of age, AIMS score, and other core items of the BPRS schizophrenia factor were accounted for. Baseline NSS failed to correlate with total BPRS scores or with improvement in BPRS after six weeks of haloperidol treatment. Of those 20 subjects with a baseline NSS score of 4 or greater, 7 improved in NSS by a score of 2 or more by the end of the haloperidoi treatment. This improvement in NSS was not attributable to improvement in AIMS score.
361. NEUROLOGIC SOFT SIGNS IN NEUROLEPTIC NAIVE PATIENTS S. Gupta, L. Flashman, W.C. Hubbard, S. Arndt, M.A. Flaum, & N.C. Andreasen University of Iowa, Department of Psychiatry, Iowa City, IA 52242 Several studies have demonstrated increased frequency of neurological soft signs (NSS) among schizophrenics than normal controls. This may be an epiphenomenon, perhaps related to the effects of psychoactive medications. NSS were examined with a standardized instmmem developed internally, in a group of 140 DSM-IiI-R schizophrenic, 12 schizophreniform patients, and ! 17 age-equivalem controls. The patient group was categorized as i) Neuroleptic Naive (n-26); and 2) Neuroleptic Non-Naive (n-126). Fisher's exact test revealed significant differences (p<.01)between patient groups and controls for NSS. Follow-up tests showed that patient groups differed from controls. Frequency of NSS was significantly less in neuroleptic naive vs. non-naive group. In an effort to assess the contribution of possible confounders, we used logistic regression in the non-naive group, examining age, age of onset, duration of illness, number of hospitalizations, and total exposure to neuroleptics (duration and dose). None of these were found to be significantly predictive of NSS. AIMS scores do not significantly contribute to NSS findings. NSS are more common in schizophrenics than controls, even among never treated patients, early in the course of the illness. These findings suggest that psychoactive medications may play a role in the development of NSS.
BIOL PSYCHIATRY 715
1994;35:615-747
362. NEUROLOGIC DEFICITS, TARDIVE DYSKINESIA, AND MEDICATION STATUS D. Ames, W.C. Wirshing, B. Waters, R. Mohgimi, & M.A. Berisford West Los Angeles VAMC and UCLA Department of Psychiatry, Los Angeles, CA 90073 Neurologic deficits in schizophrenia may be indicative of either a neurodevelopmental or neurodegenerative etiology. This study was designed to examine the role that medication may play in the development of these abnormalities. Neurologic soft signs (NSS) were evaluated in 79 schizophrenics and 60 normal controls using a modified version of Heinrich's and Buchanan's neurologic evaluation scale (NES). The instrument was very sensitive, it detected minor abnormalities in control patients at a rate of 91%. 54% of normals had one rating of 2 or higher, whereas 98% of schizophrenics had a rating of 2 or higher. Schizophrenic subjects had much more severe deficits in terms of overall total score on the NES. There was no relationship between tardive dyskinesia and total NES score ( F-3.28, !)<.085). Nor was there a relationship between medication status and total NES score (F-.297, !)<.587). Medication status and tardive dyskinesia status appear to be unrelated to neurologic abnormalities assessed using the modified NES. This may indicate that these deficits are neurodevelopmental or possibly neurodegenerative in origin and should be studied over time. The data also demonstrate differences between the relative effect of atypical and conventional antipsychotic medication on the presence of neurologic soft signs.
363. TEMPORAL STABILITY OF NEUROLOGICAL SIGNS IN FIRST-EPISODE PSYCHOTIC PATIENTS R. Scheffer t, E.E. CorrentiI, R.L. Borison 2, & S. Mukherjee2 tDepartment of Psychiatry & Neurology, Dwight D.2Eisenhower Army Medical Center, Fort Gordon, GA 30905; and Department of Psychiatry, Medical College of Georgia, 15 ! 5 Pope Avenue, Augusta, GA 30912 Data will be presented from an ongoing study of patients admitted at an Army Medical Center for a first episode of psychosis. The patients are unique in their very short duration of psychosis (4.474.2.5 days, range 2l0 days) at entry to protocol. To date, 15 patients, with a mean age of 22.534-4.3 years, have completed six months of follow-up. Neurological signs were assessed using the Neurological Evaluation Scale (Buchanan & Heinrichs 1989) at baseline prior to the initiation of neuroleptic treatment and again, blind to initial findings, after six weeks of treatment. On the average, there was no significant difference between baseline and post-treatment measures of sensory integration, motor incoordination, or sequencing of complex motor acts. However, these all showed marked temporal variability across subjects ranging from worsening to improvement. Glabellar sign showed consistent worsening with treatment (pc0.001). Improvement in motor coordination was associated with improvement on both BPRS positive (p=.03) and negative (i).,.008) symptom clusters. There was a trend for improvement in sensory integration to be associated with improvement of negative symptoms (!)-,.06) and improvement in sequencing of complex motor acts to be associated with improvement of positive symptoms (p-.08). Worsening of gtabeUar sign was unrelated to change in clinical state. These findings indicate that, even very early in the course of psychosis, neurological signs may not be temporally stable, but vary as a function of clinical state.
360. NEUROLOGICAL SOFT SIGNS IN SCHIZOPHRENIA: RELATIONSHIP TO THOUGHT DISORDER E. Duncan, M. Sanfilipo, S. Wieland, B. Angrist, & J. Rotrosen New York Department of Veterans Affairs Medical Center and New York University Medical Center, New York, NY 10010 Previous studies have documented a greater incidence of nonlocalizing neurological abnormalities called neurological soft signs (NSS) in schizophrenics than in normal controls. The correlation of NSS with other clinical factors in schizophrenics has been variable across studies. The effects of medication status is unclear, and the presence of tardive dyskinesia may be a confounding factor. Using the scale of Quitkin et al. (1976), we rated NSS, as well as psychopathology (BPRS) and tardive dyskinesia (AIMS) in 30 hospitalized schizophrenics who had been washed out of neuroleptics for a minimum of 35 days. Subjects were treated with a six week prospective trial of haloperidol and rateci again at endpoint. 90% of the subjects had an abnormal score on at least one item from the NSS scale at baseline. Baseline NSS scores were strongly correlated with baseline conceptual disorganization (r - .589), and with baseline AIMS scores (r - .479). Using hierarchical multiple regression, NSS continued to correlate with conceptual disorganization at the p<0.05 level even after the factors of age, AIMS score, and other core items of the BPRS schizophrenia factor were accounted for. Baseline NSS failed to correlate with total BPRS scores or with improvement in BPRS after six weeks of haloperidol treatment. Of those 20 subjects with a baseline NSS score of 4 or greater, 7 improved in NSS by a score of 2 or more by the end of the haloperidoi treatment. This improvement in NSS was not attributable to improvement in AIMS score.
361. NEUROLOGIC SOFT SIGNS IN NEUROLEPTIC NAIVE PATIENTS S. Gupta, L. Flashman, W.C. Hubbard, S. Arndt, M.A. Flaum, & N.C. Andreasen University of Iowa, Department of Psychiatry, Iowa City, IA 52242 Several studies have demonstrated increased frequency of neurological soft signs (NSS) among schizophrenics than normal controls. This may be an epiphenomenon, perhaps related to the effects of psychoactive medications. NSS were examined with a standardized instmmem developed internally, in a group of 140 DSM-IiI-R schizophrenic, 12 schizophreniform patients, and ! 17 age-equivalem controls. The patient group was categorized as i) Neuroleptic Naive (n-26); and 2) Neuroleptic Non-Naive (n-126). Fisher's exact test revealed significant differences (p<.01)between patient groups and controls for NSS. Follow-up tests showed that patient groups differed from controls. Frequency of NSS was significantly less in neuroleptic naive vs. non-naive group. In an effort to assess the contribution of possible confounders, we used logistic regression in the non-naive group, examining age, age of onset, duration of illness, number of hospitalizations, and total exposure to neuroleptics (duration and dose). None of these were found to be significantly predictive of NSS. AIMS scores do not significantly contribute to NSS findings. NSS are more common in schizophrenics than controls, even among never treated patients, early in the course of the illness. These findings suggest that psychoactive medications may play a role in the development of NSS.
BIOL PSYCHIATRY 715
1994;35:615-747
362. NEUROLOGIC DEFICITS, TARDIVE DYSKINESIA, AND MEDICATION STATUS D. Ames, W.C. Wirshing, B. Waters, R. Mohgimi, & M.A. Berisford West Los Angeles VAMC and UCLA Department of Psychiatry, Los Angeles, CA 90073 Neurologic deficits in schizophrenia may be indicative of either a neurodevelopmental or neurodegenerative etiology. This study was designed to examine the role that medication may play in the development of these abnormalities. Neurologic soft signs (NSS) were evaluated in 79 schizophrenics and 60 normal controls using a modified version of Heinrich's and Buchanan's neurologic evaluation scale (NES). The instrument was very sensitive, it detected minor abnormalities in control patients at a rate of 91%. 54% of normals had one rating of 2 or higher, whereas 98% of schizophrenics had a rating of 2 or higher. Schizophrenic subjects had much more severe deficits in terms of overall total score on the NES. There was no relationship between tardive dyskinesia and total NES score ( F-3.28, !)<.085). Nor was there a relationship between medication status and total NES score (F-.297, !)<.587). Medication status and tardive dyskinesia status appear to be unrelated to neurologic abnormalities assessed using the modified NES. This may indicate that these deficits are neurodevelopmental or possibly neurodegenerative in origin and should be studied over time. The data also demonstrate differences between the relative effect of atypical and conventional antipsychotic medication on the presence of neurologic soft signs.
363. TEMPORAL STABILITY OF NEUROLOGICAL SIGNS IN FIRST-EPISODE PSYCHOTIC PATIENTS R. Scheffer t, E.E. CorrentiI, R.L. Borison 2, & S. Mukherjee2 tDepartment of Psychiatry & Neurology, Dwight D.2Eisenhower Army Medical Center, Fort Gordon, GA 30905; and Department of Psychiatry, Medical College of Georgia, 15 ! 5 Pope Avenue, Augusta, GA 30912 Data will be presented from an ongoing study of patients admitted at an Army Medical Center for a first episode of psychosis. The patients are unique in their very short duration of psychosis (4.474.2.5 days, range 2l0 days) at entry to protocol. To date, 15 patients, with a mean age of 22.534-4.3 years, have completed six months of follow-up. Neurological signs were assessed using the Neurological Evaluation Scale (Buchanan & Heinrichs 1989) at baseline prior to the initiation of neuroleptic treatment and again, blind to initial findings, after six weeks of treatment. On the average, there was no significant difference between baseline and post-treatment measures of sensory integration, motor incoordination, or sequencing of complex motor acts. However, these all showed marked temporal variability across subjects ranging from worsening to improvement. Glabellar sign showed consistent worsening with treatment (pc0.001). Improvement in motor coordination was associated with improvement on both BPRS positive (p=.03) and negative (i).,.008) symptom clusters. There was a trend for improvement in sensory integration to be associated with improvement of negative symptoms (!)-,.06) and improvement in sequencing of complex motor acts to be associated with improvement of positive symptoms (p-.08). Worsening of gtabeUar sign was unrelated to change in clinical state. These findings indicate that, even very early in the course of psychosis, neurological signs may not be temporally stable, but vary as a function of clinical state.