ABSTRACT
BACKGROUND: Although neurological soft signs have been consistently described in patients with schizophrenia, their diagnostic specificity is not well clarified. METHODS: To test the hypothesis that neurological soft signs are specifically related to schizophrenia, we examined 305 subjects (patients with schizophrenia-spectrum disorder, n=167; patients with bipolar I disorder, n=88; controls, n=50). Neurological soft signs were assessed using the Neurological Evaluation Scale (NES). Multiple logistic regression analysis was used to compute the diagnostic predictive power of neurological soft signs. RESULTS: Patients in the schizophrenia-spectrum disorder group were found to have significantly greater neurological impairment (NES total score=23.9, standard deviation [SD] 11.2) than those in the bipolar disorder group (NES total score=18.2, SD 7.6; p<0.001). Neurological functioning was closely associated with psychopathology (all p<0.001). The NES total score reliably distinguished patients with schizophrenia spectrum disorders from those with bipolar disorder in 68.7% of the cases (p<0.001). Moreover, a particular set of neurological soft signs showed specificity for the schizophrenia-spectrum disorder diagnostic group. CONCLUSIONS: Our findings suggest that schizophrenia and bipolar disorder can be distinguished in terms of neurological impairment. Furthermore, we recommend the utility of neurological soft signs as a useful, quantifiable, sensitive, and inexpensive tool for the diagnostic work-up of schizophrenia.
Subject(s)
Bipolar Disorder/diagnosis , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Adult , Bipolar Disorder/physiopathology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neurologic Examination , Predictive Value of Tests , Psychotic Disorders/physiopathology , Schizophrenia/physiopathologySubject(s)
Antipsychotic Agents/adverse effects , Arthritis, Juvenile/complications , Benzodiazepines/adverse effects , Exanthema/chemically induced , Psychotic Disorders/complications , Administration, Oral , Adolescent , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/therapeutic use , Benzodiazepines/administration & dosage , Benzodiazepines/therapeutic use , Delayed-Action Preparations/adverse effects , Humans , Male , Olanzapine , Psychotic Disorders/drug therapyABSTRACT
AIMS: Neurological soft signs (NSS) are minor neurological anomalies indicating non-specific cerebral dysfunction, commonly assessed through the Neurological Evaluation Scale (NES). It is generally accepted that NSS are prevalent in schizophrenic patients respect to healthy subjects, but they have been also found in patients with other neurological and psychiatric disorders. We sought to review studies that have specifically investigated NSS in schizophrenia, bipolar disorder and obsessive-compulsive disorder, and we also focused on their relationship with psychopathological features and antipsychotic treatment. METHODS: In this review we selected published studies investigating NSS in psychiatric patients and their relationship with either psychopathological features and antipsychotic treatment. RESULTS: Apart from diagnosis, all patients show more NSS than healthy subjects, but schizophrenic patients perform worse respect to other psychiatric diseases. These signs are already present at the onset of the disease. NSS also show a significant correlation with psychopathological measures and they can be predictive of clinical course and response to medications. On the other hand, NSS can be independent of the pharmacological treatment. CONCLUSIONS: These findings argued the hypothesis that NSS could be a trait characteristic in psychosis. NSS are an objective measure for the assessment of serious psychiatric disorder in the prodromal phase, at onset and along the course of the disease.
Subject(s)
Bipolar Disorder/diagnosis , Neuropsychological Tests , Obsessive-Compulsive Disorder/diagnosis , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Schizophrenic Psychology , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Diagnosis, Differential , Humans , Neurologic Examination , Obsessive-Compulsive Disorder/drug therapy , Obsessive-Compulsive Disorder/psychology , Predictive Value of Tests , Psychiatric Status Rating Scales , Psychotic Disorders/drug therapy , Psychotic Disorders/psychology , Risk Assessment , Schizophrenia/drug therapy , Sensitivity and Specificity , Severity of Illness Index , Treatment OutcomeABSTRACT
A young woman with bipolar I disorder and comorbid catatonia on enteral nutrition from several months, developed a form of near-lethal catatonia with weight loss, pressure sores, muscle atrophy, electrolyte imbalance, and depression of vital signs. A compulsory treatment was necessary, and informed consent was obtained from her mother for electroconvulsive therapy (ECT). After 7 ECT sessions, the patient recovered and resumed feeding. ECT may save the life of a patient with catatonia provided that legal obstacles are overcome. Clinicians should carefully evaluate patients with near-lethal catatonia, taking into account the risk of pulmonary embolism and other fatal events. The medical-legal issues, which vary across state regulations, should be addressed in detail to avoid unnecessary and potentially harmful delay in intervention.
