Literature review

Neurological soft signs in first episode psychosis

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"&345*67'1
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

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

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

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 *i#ht-le;t $on;usion

"otoric coordination 9andem wal

"otor sequencing .ist-rin# test

#rimitive reflexes 5a2e /almomental Snout 5rasp

*apid alternatin# .ist-ed#e-palm movement test .in#er thumb opposition .in#er-nose test *hythm tappin# 6s2erets i test

1is$ussion
There were $ studies from %$&$ to '((( using ) different neurological clinical examination! %.Neurological *valuation Scale +,uchanan-.einrichs, %$&$/ '.0ondensed Neurological *xamination +1ossi et al, %$$( 2.Standard neurological examination 3.Neurological examination +adapted from 4uit5in et al, %$67/ ).The Scottish Schizophrenia 1esearch 8roup, %$&6

/revalen$e o; 'SS in healthy $ontrol< ;irst episode< hi#h ris ,

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

9he temporal stability o; 'SS ;ollowin# the ;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. The difference between patient with schizophrenia and healthy control was increased in ) years, especially for frontal, corticospinal and temporoparietal function.

'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. 9t is however difficult to draw a conclusion from a view studies reported.

Laterality and $erebral dominan$e

Some studies have reported a predominance of neurological abnormalities on the right side of the body, but there are conflicting reports of higher scores for NSS on the left sides of the body. Although the number of mixed<handed sub:ects was small, 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.

*ole o; antipsy$hoti$ medi$ation in neurolo#i$al per;orman$e,

"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

.owever antipsychotic medication might also resulting in side effect such ass NSS.

'eurolo#i$al so;t si#n and demo#raphi$ $hara$teristi$

There were no significant finding regarding NSS and demographics characteristic. .owever, there have been isolated reports on NSS being increased in especially schizophrenic male patients Also, depending on the age and the duration of the illness. "ale patients with NSS might be related to lower education and lower socio<occupational outcome. This shows on those mixed handed and lateralized patient, whom usually have a lower education bac5ground. >hile male patients with history of ) years history of previous onset are indicating an increase of the NSS. This might be rated to the maternal obstetricians complication.

'SS and brain stru$tural abnormalities

The presence of NSS has been associated with an enlargement of the cerebral ventricles and smaller brain areas. 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, 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?. The finding suggest that neurological abnormalities could be associated with cortical rather than subcortical.

relationship between 'SS and psy$hopatholo#y and $ourse o; s$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. This has been supported by the association of NSS with young age at onset, a more chronic course, longer under hospitalization and impaired premorbid functioning. The ma:ority of first<episode studies report no correlation between NSS and age at onset.

3on$lusion
/atients su;;erin# their ;irst episode o; s$hi2ophrenia or psy$hosis and indeed in hi#h ris sub=e$ts without psy$hosis, 'eurolo#i$al per;orman$e appears to be worse in the areas o; motor $oordination and se>uen$in# < in sensory inte#ration and in developmental re;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,

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

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; a =ournal title,< and strai#ht to the point o; the theme o; the =ournal, Stated in a simple relation o; =ournal,

Abstract and introduction!

9he abstra$t had been providin# with si#ni;i$ant point that understandable, 3onsistin# with all the ne$essary points, )ntrodu$tion provided by the resour$es with minimal in;ormation =ust to eep the reader in the main loop, 9he title $onsistin# 11 words o; a =ournal title< and strai#ht to the point o; the theme o; the =ournal, Stated in a simple relation o; =ournal,

3riti$al appraisal
"ethod ! A review of studies investigating neurological function in first<episode psychosis, using a clinical examination. 9s it unli5ely that important, 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. The method was not well presented as this :ournal has no criteria to be compared to other :ournal.

3riti$al &ppraisal
1esult! #atients with first<episode psychosis show an excess of NSS, particularly in the areas of motor coordination and sequencing, sensory integration and in developmental reflexes. urthermore, 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. <The result however was not presented very well as it mostly written in words and not presented in table to be easily read.

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