Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
Schizophr Res. 2017 Oct;188:144-150. doi: 10.1016/j.schres.2017.01.034. Epub 2017 Jan 24.
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.
神经学软体征（NSS）被认为既代表精神分裂症的状态相关特征，也代表特质相关特征。
我们使用神经学评估量表（NES）评估了 126 例首发精神分裂症、分裂情感性或分裂样精神病患者在标准化治疗 12 个月期间的 NSS 病程，并评估了它们与精神病理学、功能、认知和抗精神病治疗的状态和特质相关关联。我们认为从基线到终点的变化分数与状态相关，而终点分数与特质相关。
所有 NSS 领域均记录到显著的时间效应。对于状态相关的变化分数，感觉整合的改善与工作记忆的改善（p=0.01）；运动序列评分的改善与工作记忆（p=0.005）和功能（p=0.005）的改善有关；而 NES 总分的改善与紊乱症状的改善（p=0.02）有关。特质相关的终点分数之间的关联比状态相关的变化分数更显著。对于终点分数，复合认知评分较低预示着感觉整合较差（p=0.001）；帕金森病评分较高预示着运动协调较差（p=0.0001）；复合认知评分较低（p=0.001）和帕金森病评分较高（p=0.005）预示着运动序列较差；帕金森病评分较高（p=0.0001）和紊乱症状（p=0.04）以及复合认知评分较低（p=0.0007）预示着 NES 总分较高。
NSS 在治疗后得到改善，但与精神病理学的改善相关性较弱。研究将 NSS 作为特质标志物进行研究时，应确保患者在测试时已经得到了最佳治疗，并应考虑到锥体外系症状的可能影响。
