Neurological Soft Signs in First -Episode Schizophrenia

Neurological soft signs (NSS) refer to subtle neurological abnormalities comprising deficits in sensory integration, motor coordination, or sequencing of complex motor acts. It is generally accepted that NSS are more prevalent in schizophrenia patients, including first -episode cases, than in healthy subjects. Moreover, NSS have been consistently demonstrated in neuroleptic naïve firstepisode patients; thus, they are thought to be an intrinsic feature of schizophrenia. This notion is underlined by the increased NSS scores in highrisk subjects, such as relatives of schizophrenic patients, and in the unaffected cotwins of monozygotic twin pairs discordant for schizophrenia. However, recent studies clearly demonstrate that NSS are not a static feature of the disease, but rather vary in the clinical course of the disorder. This variation with psychopathological symptoms was first established in the shortterm course with the remission of acute symptoms under neuroleptic treatment, but also applied to the longterm course over a followup period of up to 5 years. In conclusion, NSS correspond to both genetic liability and the activity of the disease process; future studies in this field may not only enhance our understanding of schizophrenia, but may also establish NSS as one of the clinical predictors of outcome. Publication Date: November 2008 243 Volume 28 • Lesson 19 Directions in Psychiatry