title: Neurological soft signs in obsessive-compulsive disorder: two empirical studies and meta-analysis.
abstract: BACKGROUND
  Neurological soft signs (NSS) have been inconsistently reported in obsessive-compulsive disorder (OCD) but may make an impact on treatment response. Method The current study examined the presence of NSS in two independent European samples of OCD patients (combined 85 patients and 88 matched healthy controls) using a standardized instrument and conducted a meta-analysis of all published studies identified in the literature with the aim to provide a more definitive answer to the question of whether OCD patients are characterized by increased NSS.
  
  
  RESULTS
  Both empirical studies found elevated NSS scores in patients compared with matched controls. The results of the meta-analysis, which included 15 studies (combined 498 patients and 520 controls) showed large effect sizes (Hedges' g=1.27, 95% confidence interval 0.80-1.75), indicating that OCD patients have significantly higher rates of NSS than matched controls on both sides of the body and in multiple domains (motor coordination, sensory integration and primitive reflexes). The results were robust and remained largely unchanged in our reliability analyses, which controlled for possible outliers. Meta-regression was employed to examine the role of potential variables of interest including sociodemographic variables, symptom severity, medication effects and the use of different instruments, but none of these variables was clearly associated with NSS.
  
  
  CONCLUSIONS
  As a group, OCD patients are characterized by increased rates of NSS, compared with healthy controls. However, their origins and potential clinical importance remain to be clarified. Future directions for research are discussed.
authors.affiliation: King's College London, Institute of Psychiatry, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Jaafari
authors.forename: L
authors.initials: L
authors.lastname: Fernández de la Cruz
authors.forename: M
authors.initials: M
authors.lastname: Grau
authors.forename: E
authors.initials: E
authors.lastname: Knowles
authors.forename: J
authors.initials: J
authors.lastname: Radua
authors.forename: S
authors.initials: S
authors.lastname: Wooderson
authors.forename: C
authors.initials: C
authors.lastname: Segalas
authors.forename: P
authors.initials: P
authors.lastname: Alonso
authors.forename: M L
authors.initials: ML
authors.lastname: Phillips
authors.forename: J M
authors.initials: JM
authors.lastname: Menchón
authors.forename: D
authors.initials: D
authors.lastname: Mataix-Cols
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000453:epidemiology*; D009460:Neurologic Examination; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000453:epidemiology*; D011597:Psychomotor Performance / Q000502:physiology; D012018:Reflex / Q000502:physiology; D012044:Regression Analysis; D015203:Reproducibility of Results; D012677:Sensation / Q000502:physiology; D013030:Spain; D006113:United Kingdom