title: Neurological soft signs in first-episode schizophrenia: State- and trait-related relationships to psychopathology, cognition and antipsychotic medication effects.
abstract: Neurological soft signs (NSS) are proposed to represent both state- and trait-related features of schizophrenia.
  
  
  
  We assessed the course of NSS with the Neurological Evaluation Scale (NES) over 12months of standardised treatment in 126 patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder, and evaluated their state- and trait-related associations with psychopathology, functionality, cognition and antipsychotic treatment. We considered change scores from baseline to be state-related and endpoint scores to be trait-related.
  
  
  
  Significant effects for time were recorded for all NSS domains. For state-related change-scores greater improvements in sensory integration were predicted by more improvement in working memory (p=0.01); greater improvements in motor sequencing scores were predicted by more improvement in working memory (p=0.005) and functionality (p=0.005); and greater improvements in NES Total score were predicted by more improvement in disorganised symptoms (p=0.02). There were more substantial associations between trait-related endpoint scores than for state-related change scores. For endpoint scores lower composite cognitive score predicted poorer sensory integration (p=0.001); higher Parkinsonism score predicted poorer motor co-ordination (p=0.0001); lower composite cognitive score (p=0.001) and higher Parkinsonism score (p=0.005) predicted poorer motor sequencing; higher Parkinsonism score (p=0.0001) and disorganised symptoms (p=0.04), and lower composite cognitive score (p=0.0007) predicted higher NES total score.
  
  
  
  NSS improved with treatment, but were weakly associated with improvements in psychopathology. Studies investigating NSS as trait-markers should ensure that patients have been optimally treated at the time of testing, and should take possible effects of extrapyramidal symptoms into account.
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa. Electronic address: rae@sun.ac.za.
authors.forename: Robin
authors.initials: R
authors.lastname: Emsley
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
authors.forename: Bonginkosi
authors.initials: B
authors.lastname: Chiliza
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
authors.forename: Laila
authors.initials: L
authors.lastname: Asmal
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
authors.forename: Sanja
authors.initials: S
authors.lastname: Kilian
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Riaan Olivier
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
authors.forename: Lebogang
authors.initials: L
authors.lastname: Phahladira
authors.affiliation: Department of Psychiatry, University of Ibadan, Nigeria.
authors.forename: Akinsola
authors.initials: A
authors.lastname: Ojagbemi
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
authors.forename: Freda
authors.initials: F
authors.lastname: Scheffler
authors.affiliation: Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carr
authors.affiliation: Centre for Statistical Consultation, Stellenbosch University, South Africa.
authors.forename: Martin
authors.initials: M
authors.lastname: Kidd
authors.affiliation: Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D005475:Flupenthixol / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007406:Interview, Psychological; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D009043:Motor Activity / Q000187:drug effects; D009460:Neurologic Examination; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy* / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; C007761:flupenthixol decanoate; D005475:Flupenthixol
keywords: Depot; Flupenthixol; Neurological; Outcome; Psychosis; Schizophrenia