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Literature review

Neurological soft signs in first episode psychosis
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NSS  minor neuological signs indicating non spesific cerebral disfunction Their presence has been documented extensively in schizofrenia but not during the first psychotic episode

&)MS To review studies that have specifically investigated NSS as the time of the first psychotic episode .

using a clinical examination.M89H61 A review of studies investigating neurological function in the first episode psychosis. .

results The patient with first episode psychosis show an excess of NSS. particularly in the areas of motor coordination and sequencing. urthermore. NSS may be associated with a specific laterality pattern. . sensory integration and in developmental reflexes.

in#er thumb opposition .ist-ed#e-palm movement test .usion "otoric coordination 9andem wal "otor sequencing .t $ test *hythm tappin# 6s2erets i test .1)S37SS)6' Neurological sign in schizophrenia are concentrated in three main domains! Sensory integration &udio-visual inte#ration stereo#nosis 5raphaestesia e:ti$ntion * test #rimitive reflexes 5a2e /almomental Snout 5rasp *apid alternatin# .

1is$ussion There were $ studies from %$&$ to '((( using ) different neurological clinical examination! %. %$&6 .The Scottish Schizophrenia 1esearch 8roup.Neurological examination +adapted from 4uit5in et al. %$67/ ). %$&$/ '.Standard neurological examination 3.uchanan-. %$$( 2.0ondensed Neurological *xamination +1ossi et al.Neurological *valuation Scale +.einrichs.


/revalen$e o. 'SS in healthy $ontrol< . +. • • • .%$6(/ .aving established that an excess of NSS is already present in the early phase of psychosis.'((% / These finding suggest that neurological dysfunction. related to the pathogenesis in the underlying illness.awrie et al. specifically for signs of integration. although first episode patient showed more NSS in higher ris5 sub:ect. 0onsidering that NSSS rates similar to those observe in schizophrenia have been reported in patient with personality disorder +rochfort. compared with healthy control. high ris5 sub:ect had a excess of NSS. 9n another study. • • Neurological sign in patient at their first episode of psychosis are already higher than those of healthy controls.irst episode< hi#h ris .

. especially for frontal.9he temporal stability o.irst psy$hoti$ episode. • "adsen at al %$$$! at the time of the first psychotic episode patient showed a significantly higher total rates neurological abnormalities in healthy controls. 'SS .ollowin# the . • The difference between patient with schizophrenia and healthy control was increased in ) years. corticospinal and temporoparietal function.

• 9t is however difficult to draw a conclusion from a view studies reported.'eurolo#i$al so.t si#n and . .amiliality • The report of no association between possitve family history and neurological dysfunction in this first episode studies is 9n contrast with previous observation of a relationship between the two reported in patient at various illness stages.

Laterality and $erebral dominan$e • Some studies have reported a predominance of neurological abnormalities on the right side of the body. • Although the number of mixed<handed sub:ects was small. but there are conflicting reports of higher scores for NSS on the left sides of the body. this raises the possibility that individuals whose handedness is not lateralised have poorer motor coordination than those with a lateralised hand preference. .

Laterality and $erebral dominan$e • There were no difference between patients for positive or negative family history. . • So there is a possibility for an association between family history and a specific laterality pattern could reflect an in heritage predisposition to this illness.

.orman$e.owever antipsychotic medication might also resulting in side effect such ass NSS.*ole o. antipsy$hoti$ medi$ation in neurolo#i$al per. • "edication consumption of antipsychotics= there is possibility of NSS reduced • No medication at all for those who suffers from any psychological condition will definitely have a NSS • .

"ale patients with NSS might be related to lower education and lower socio<occupational outcome. This might be rated to the maternal obstetricians complication. .owever.t si#n and demo#raphi$ $hara$teristi$ • • • • There were no significant finding regarding NSS and demographics characteristic. there have been isolated reports on NSS being increased in especially schizophrenic male patients Also. >hile male patients with history of ) years history of previous onset are indicating an increase of the NSS. depending on the age and the duration of the illness. This shows on those mixed handed and lateralized patient.'eurolo#i$al so. whom usually have a lower education bac5ground. • .

To evaluate Rubyn used a 0omputer topography to study an association between NSS and shorter brain length and wider left Sylvian fissure. This shows the tendency of patients with more neurological abnormalities to have a smaller brain volume. more 0S in the sulci and cisterna on the barin surface.'SS and brain stru$tural abnormalities • • The presence of NSS has been associated with an enlargement of the cerebral ventricles and smaller brain areas. The finding suggest that neurological abnormalities could be associated with cortical rather than subcortical. thus increased the width of the right Sylvian fissure and smaller temporal horn volume. There were no indication that NSS wee associated with the greater volume of lateral ventricles?. • • .

s$hi2ophrenia • The potential association between the presence of neurological signs and a more chronic and severe form of the illness has also been investigated by studies on patients at different stages of the illness. longer under hospitalization and impaired premorbid functioning. The ma:ority of first<episode studies report no correlation between NSS and age at onset. • • . This has been supported by the association of NSS with young age at onset.relationship between 'SS and psy$hopatholo#y and $ourse o. a more chronic course.

irst episode o..3on$lusion • /atients su.erin# their . motor $oordination and se>uen$in# < in sensory inte#ration and in developmental re. . • 'eurolo#i$al per. s$hi2ophrenia or psy$hosis and indeed in hi#h ris sub=e$ts without psy$hosis.le:es • 9hese anomalies are .ound parti$ularly in males and in sub=e$ts with lower edu$ation< and possibly in those with a more severe $lini$al pi$ture.orman$e appears to be worse in the areas o.

neurolepti$ use< althou#h hi#her 'SS s$ores are observed in those .$on$lusion • 9he presen$e o.amily psy$hosis .< whi$h usually a$$ompanied by a positive . the body. laterality< as su##ested by their parti$ular e:$ess in mi:ed handed sub=e$ts and by some preliminary reports o. neurolo#i$al abnormalities $annot be e:plained away as $onse>uen$es o.i$ pattern o. • &sso$iation between neurolo#i$al si#n and a spe$i.irst-episode sub=e$ts on neurolepti$ treatment. their laterali2ation to one side o.

3riti$al appraisal • Title! @Neurological soft signs in first<episode psychosis! a systematic reviewA >hat the question did the systematic review addressB – 9he title $onsistin# 11 words o. the =ournal. =ournal. the theme o.< and strai#ht to the point o. a =ournal title< and strai#ht to the point o. Stated in a simple relation o. 9he title $onsistin# 11 words o. Stated in a simple relation o. • Abstract and introduction! – 9he abstra$t had been providin# with si#ni. the theme o.i$ant point that understandable. – – . )ntrodu$tion provided by the resour$es with minimal in.ormation =ust to eep the reader in the main loop. the =ournal. 3onsistin# with all the ne$essary points. a =ournal title. =ournal.

3riti$al appraisal • "ethod ! A review of studies investigating neurological function in first<episode psychosis. relevant studies were missedB >ere the criteria used to select articles for inclusion appropriateB rom the methods that has been used there were possibility some important and relevant studies were missed. using a clinical examination. 9s it unli5ely that important. The method was not well presented as this :ournal has no criteria to be compared to other :ournal. – .

<The result however was not presented very well as it mostly written in words and not presented in table to be easily read. urthermore. particularly in the areas of motor coordination and sequencing. sensory integration and in developmental reflexes. NSS may be associated with a specific laterality pattern. >ere the results similar from study to studyB .ow are the results presentedB <The results that has been compared to the other :ournal has been resulting similarly.3riti$al &ppraisal • 1esult! #atients with first<episode psychosis show an excess of NSS. .

Than5 you .