Prospective evaluation of neurological soft signs in first-episode schizophrenia in relation to psychopathology: state versus trait phenomena

Background. Although patients with schizophrenia have increased rates of neurological soft signs, few studies have examined prospectively their trait or state characteristics in relation to psychopathology.Method. In a prospective study of 97 patients with first-episode schizophrenia (DSM-IV criteria) we assessed neurological soft signs and psychopathology at presentation and at 6 month follow-up for 73 cases. To establish whether soft signs were associated with variations in clinical state, neurological soft signs were measured using two validated examinations (Neurological Evaluation Scale and Condensed Neurological Examination); psychopathology was assessed using the Positive and Negative Syndrome Scale.Results. There was significant improvement in overall neurological function, primarily in motor-related and cortical signs, which were associated with improvement in psychopathology. Conversely, ‘harder’ signs were unrelated to improvement in psychopathology.Conclusions. Neurological soft signs in schizophrenia are heterogenous. Motor and cortical signs evidence state-like characteristics and vary with clinical course, while ‘harder’ signs evidence more static, trait-like characteristics in accordance with a neurodevelopmental basis.

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Prevalence and clinical correlates of depression in the acute phase of first episode schizophrenia

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700000860 ◽

2010 ◽

Vol 27 (1) ◽

pp. 15-18 ◽

Cited By ~ 7

Author(s):

Eric Roche ◽

Mary Clarke ◽

Stephen Browne ◽

Niall Turner ◽

Orflaith McTuige ◽

...

Keyword(s):

Negative Symptoms ◽

Depression Scale ◽

First Episode ◽

Syndrome Scale ◽

Prevalence Of Depression ◽

History Of ◽

First Episode Schizophrenia ◽

Negative Syndrome ◽

First Episode Of Schizophrenia

AbstractBackground: Reported rates of depression in schizophrenia vary considerably.Objective: To measure the prevalence of depression in a first episode sample of people with schizophrenia.Methods: All referrals with a first episode of schizophrenia diagnosed using SCID interviews were assessed pre-discharge and again six months later. We used the Calgary Depression Scale for Schizophrenia (CDSS) and Positive and Negative Syndrome Scale (PANSS) to assess the severity of symptoms.Results: Pre-discharge, 10.4% of the sample met CDSS criteria for depression. According to the PANSS depression (PANSS -D) subscale, 3% of patients were depressed, with a mean score of 7.48 (SD = 2.97). Only 3% of patients pre-discharge were found to be depressed on both the CDSS and the PANSS-D. Six months later 6.5% were depressed according to the CDSS. However none reached depression criteria according to the PANSS-D. The CDSS correlated with PANSS-D both pre-discharge and at follow-up. Feelings of depression and self-deprecation were the most common symptoms at baseline and follow-up. The CDSS was unrelated to negative symptoms at both stages. A lifetime history of alcohol abuse increased the risk for depression.Conclusion: Rates of depression in this sample were low. The CDSS appears to discriminate between depression and negative symptoms. Like the general population, alcohol misuse is a risk factor for depression in first episode schizophrenia.

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Neurological soft signs and their relationship to 1-year outcome in first-episode schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2007.03.012 ◽

2007 ◽

Vol 22 (8) ◽

pp. 499-504 ◽

Cited By ~ 32

Author(s):

Radovan Prikryl ◽

Eva Ceskova ◽

Tomas Kasparek ◽

Hana Kucerova

Keyword(s):

Temporal Stability ◽

First Episode ◽

Index Hospitalization ◽

Neurological Soft Signs ◽

Course Of Illness ◽

Psychiatric Status ◽

Syndrome Scale ◽

Schizophrenic Patients ◽

First Episode Schizophrenia

AbstractObjectivesTo examine the relationship between the severity of neurological soft signs at onset and at the 1-year follow-up of patients with schizophrenia, and to investigate temporal stability of neurological soft signs within 1 year from the onset of the first episode schizophrenia.MethodsThe study included 92 first-episode male schizophrenic patients. Neurological soft signs were assessed on the Neurological Evaluation Scale (NES) during index hospitalization and at a 1-year follow-up. The patients were divided into remitters and non-remitters according to their psychiatric status assessed at the 1-year follow-up, using the Positive and Negative Syndrome Scale (PANSS).ResultsA trend for a lower score for the NES item “others” in late remitters versus non-remitters at baseline was found during index hospitalization. At the 1-year follow-up, the overall severity of the neurological soft signs was statistically significantly higher in non-remitters than in remitters. Within 1 year after index hospitalization, a significant reduction of neurological soft signs, with the exception of sensory integration, occurred in remitters. Within 1 year after index hospitalization, the non-remitters reported a significant reduction of the overall NES score.ConclusionThese findings in a population of patients with first episode schizophrenia are in accord with the findings of previous studies which found an association between neurological soft signs, treatment response and outcome. This association may characterize a subgroup of patients with a poor course of illness and outcome. Neurological soft signs might be regarded as one of the indicators of treatment outcome in patients suffering from their first episode of schizophrenia.

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Predictors of outcome in first-episode schizophrenia over the first 4 years of illness

Psychological Medicine ◽

10.1017/s003329170800336x ◽

2008 ◽

Vol 38 (8) ◽

pp. 1141-1146 ◽

Cited By ~ 26

Author(s):

P. Whitty ◽

M. Clarke ◽

O. McTigue ◽

S. Browne ◽

M. Kamali ◽

...

Keyword(s):

Negative Symptoms ◽

First Episode ◽

Global Assessment Of Functioning ◽

Methodological Issues ◽

Course Of Illness ◽

Dsm Iv ◽

First Episode Schizophrenia ◽

The Relationship ◽

Positive And Negative Symptoms

BackgroundThe outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.MethodWe conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.ResultsThere were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=−3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=−2.77, p<0.01) significantly predicted a better outcome at follow-up.ConclusionsThe outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.

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Effectiveness of antipsychotic drugs against hostility in patients with schizophrenia in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study

CNS Spectrums ◽

10.1017/s1092852913000849 ◽

2013 ◽

Vol 19 (5) ◽

pp. 374-381 ◽

Cited By ~ 21

Author(s):

Jan Volavka ◽

Pál Czobor ◽

Leslie Citrome ◽

Richard A. Van Dorn

Keyword(s):

Aggressive Behavior ◽

Antipsychotic Drugs ◽

Phase 1 ◽

The Other ◽

First Episode ◽

Intervention Effectiveness ◽

Primary Analysis ◽

Syndrome Scale ◽

First Episode Schizophrenia ◽

Negative Syndrome

IntroductionAggressive behavior can be a dangerous complication of schizophrenia. Hostility is related to aggression. This study aimed to compare the effects of olanzapine, perphenazine, risperidone, quetiapine, and ziprasidone on hostility in schizophrenia.MethodsWe used the data that were acquired in the 18-month Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. We analyzed the scores of the Positive and Negative Syndrome Scale (PANSS) hostility item in a subset of 614 patients who showed at least minimal hostility (a score ≥ 2) at baseline.ResultsThe primary analysis of hostility indicated an effect of difference between treatments (F4,1487 = 7.78, P < 0.0001). Olanzapine was significantly superior to perphenazine and quetiapine at months 1, 3, 6, and 9. It was also significantly superior to ziprasidone at months 1, 3, and 6, and to risperidone at months 3 and 6.DiscussionOur results are consistent with those of a similar post-hoc analysis of hostility in first-episode subjects with schizophrenia enrolled in the European First-Episode Schizophrenia Trial (EUFEST) trial, where olanzapine demonstrated advantages compared with haloperidol, quetiapine, and amisulpride.ConclusionOlanzapine demonstrated advantages in terms of a specific antihostility effect over the other antipsychotics tested in Phase 1 of the CATIE trial.

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The mediating effect of brain-derived neurotrophic factor levels on childhood trauma and psychiatric symptoms in patients with first-episode schizophrenia

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211031478 ◽

2021 ◽

pp. 000486742110314

Author(s):

Leilei Wang ◽

Yi Yin ◽

Yanfang Zhou ◽

Junchao Huang ◽

Ping Zhang ◽

...

Keyword(s):

Childhood Trauma ◽

Neurotrophic Factor ◽

Brain Derived Neurotrophic Factor ◽

First Episode ◽

Emotional Neglect ◽

Childhood Trauma Questionnaire ◽

Syndrome Scale ◽

First Episode Schizophrenia ◽

Negative Syndrome ◽

The Relationship

Background: Previous studies have implicated childhood trauma and abnormal brain-derived neurotrophic factor in the pathogenesis of schizophrenia. Here, we explored whether brain-derived neurotrophic factor levels mediated the relationship between childhood trauma and psychopathological symptoms in patients with first-episode schizophrenia. Methods: Patients with first-episode schizophrenia ( n = 192) and healthy controls ( n = 136) were enrolled. Childhood traumatic experiences and psychopathology were assessed by Childhood Trauma Questionnaire and Positive and Negative Syndrome Scale, respectively. Enzyme-linked immunosorbent assay was used to quantify brain-derived neurotrophic factor levels. Results: The patients with first-episode schizophrenia experienced more severe childhood trauma and had lower serum brain-derived neurotrophic factor levels than healthy controls. Emotional abuse and Childhood Trauma Questionnaire total score showed positive correlation with Positive and Negative Syndrome Scale positive, general psychopathological subscore and total score. Emotional neglect showed positive correlation with Positive and Negative Syndrome Scale positive subscore. Physical neglect was positively associated with Positive and Negative Syndrome Scale negative subscore. Emotional neglect and Childhood Trauma Questionnaire total score were negatively correlated with serum brain-derived neurotrophic factor levels. The serum brain-derived neurotrophic factor levels mediated the relationship between both Childhood Trauma Questionnaire total score and Positive and Negative Syndrome Scale total score and negative symptoms in the patients. The brain-derived neurotrophic factor levels also mediated the relationship between emotional neglect and Positive and Negative Syndrome Scale total score in the patients. Conclusion: Childhood trauma might contribute to the clinical symptoms of schizophrenia by affecting brain-derived neurotrophic factor levels. Perhaps we can prevent schizophrenia by reducing childhood traumatic experiences.

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Five year follow-up of outcome in a prospective study of first-episode schizophrenia at Hillside hospital

Schizophrenia Research ◽

10.1016/0920-9964(95)95581-s ◽

1995 ◽

Vol 15 (1-2) ◽

pp. 189

Author(s):

J. Becker ◽

A. Koreen ◽

M. Chakos ◽

S. Geisler ◽

J. Alvir ◽

...

Keyword(s):

Prospective Study ◽

First Episode ◽

A Prospective Study ◽

First Episode Schizophrenia

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An early improvement threshold to predict response and remission in first-episode schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.069328 ◽

2010 ◽

Vol 196 (6) ◽

pp. 460-466 ◽

Cited By ~ 30

Author(s):

R. Schennach-Wolff ◽

F. H. Seemüller ◽

A. Mayr ◽

W. Maier ◽

S. Klingberg ◽

...

Keyword(s):

Predictive Validity ◽

Area Under The Curve ◽

First Episode ◽

Early Improvement ◽

Score Improvement ◽

Syndrome Scale ◽

Definition Of ◽

First Episode Schizophrenia ◽

Negative Syndrome ◽

First Episode Of Schizophrenia

BackgroundEarly improvement with treatment is thought to be important in patients with first-episode schizophrenia, yet a valid definition is still outstanding.AimsTo develop a valid definition of early improvement and test its predictive validity regarding response and remission.MethodWe examined 188 in-patients with first-episode schizophrenia. Early improvement was defined as improvement in Positive and Negative Syndrome Scale (PANSS) total score at week 2, response as a 40% PANSS total score improvement at end-point, and remission according to consensus criteria.ResultsReasonable predictive validity of early improvement was found for a 46% PANSS total score improvement at week 2 and a 50% improvement for remission (area under the curve: response 0.707, remission 0.692). Estimated confidence intervals ranged from 26 to 62% PANSS reduction for response and remission.ConclusionsPatients with a first episode of schizophrenia should improve by at least 30% in PANSS total score at week 2 to achieve response and remission.

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