Soft signs, attention, and startle in schizophrenia

Karper, L.; Grillon, C.; Lysaker, P.; Bell, M.; Charney, D.S.; Krystal, J.H.

Soft signs, attention, and startle in schizophrenia

Laurence Karper

1994, Biological Psychiatry

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the qualitative ratings were more sensitive to the group differences, explaining significantly more between group variance than the quantitative measures. The results suggest that human observers may be sensitive to important features of pathologic anatomy that are not fully revealed through quantitative methods.

71 4 BIOLPSYCHIATRY 1994:35:615-747 the qualitative ratings were more sensitive to the group differences, explaining significantly more between group variance than the quantitative measures. The results suggest that human observers may be sensitive to important features of pathologic anatomy that are not fully revealed through quantitative methods. 356. PREDICTORS OF TARDIVE DYSKINESIA IN FIRST EPISODE SCHIZOPHRENIA M.H. Chakos, J.M. Alvir, R. Bilder, M. Woerner, J. Kane, & J. Lieberman Hillside Hospital, a division of Long Island Jewish Medical Center, an affiliate of the Albert Einstein College of Medicine, Glen Oaks, NY 11004 in order to determine predictors of tardive dyskinesia in schizophrenic patients we analyzed data on 70 patients who have been followed longitudinally in an ongoing prospective cohort study of first episode schizopluenics at Hillside Hospital. Patients received standardized antipsychotic treatment and had MR brain scans early in the course of treatment. They also had neuropsychological testing and regular assessments of psychopathology and side effects. "I'D development was predicted by poorer level of remission from first psychotic episode, longer duration of psychotic symptoms prior to study entry, poorer levels of childhood and early adolescent social adjustment, enlargement of the frontal horns of the lateral ventricles, and global impairment on 6 month neuropsychological testing. Neuroleptic dose was a trend level predictor of TD development. When dose was controlled for as a time dependent covariate, level of remission remained a significant predictor of time to TD development (risk ratio 7.34, 95 % Cl - !.75, 30.87, X: -7.40, d f - I, p - .007) while the effects of dose were eliminated (risk ratio- 1.02, 95% Cl - 0.95, ! .09, X2-0.29, df- I, p-.59). Our findings indicate that TD development is primarily a consequence of a disease related vulnerability to the disorder, rather than a consequence of increased drug exposure. 357. NEUROLOGIC ABNORMALITIES IN SCHIZOPHRENIA D. Ames t, T.C. Manschreck2, & R.W. Buchanan3 tWest Los Angeles VAMC and UCLA Department of Psychiatry, Los Angeles, CA 90073 2New Hampshire Hospital, Concord, NH 03301,~Maryland Psychiatric Research Center, Baltimore, MD 21228 Neurologic abnormalities in schizophrenic disorders may arise from four sources: (i) the disease itself; (2)its treatment; (3) a combination of ! and 2; and (4) factors associated with chrunicity, complications, and individual experience. Their clinical value has usually been associated with differential diagnosis. However, the clinical significance of neurologic abnormalities is likely to have other dimensions, including a role in early detection, relapse prediction, prognosis, response to treatment, and planning of long-term care and rehabilitation, as well as elucidation of pathogenesis and etiology. Research in neurologic features of schizophrenia has increased in recent years and several avenues have produced interesting findings. Among these are attempts to link features to the psychopathology of the disorder, to examine these features experimentally with laboratory measures, and to advance awareness of where these abnormalities originate in the brain. In addition to etiology of neurologic soft signs the presentations in this symposium will address methodologic issues of assessment of neurologic abnormalities. SATURDAI~, MAY 21 358. SOFT SIGNS, ATTENTION, AND STARTLE IN SCHIZOPHRENIA L. Karper, C. Orillon, P. Lysaker, M. Bell, D.S. Charney, & J.H. K r y s t a l Yale University School of Medicine, Depamnent of Psychiatry, West Haven, CT 06516 Schizophrenic patients exhibit abnormalities in attention, startle reflex, and have increased neurological soft signs (NSS) compared to controls. This study correlates startle reflex, vigilance, and distractibility with the Neurological Evaluation Scale (NES). 28 schizophrenic patients participated in tests of acoustic startle response, eyeblink response, and computerized tests of attention. Two components of attention, vigilance and distractibility, were measured by a computerized continuous performance task (CPT). Factor analysis of the NES was derived separately from a study of 100 patients utilizing a modified version of the NES (Heim'icks and Buchanan, 1988). Results: I) Vigilance (r-0.69, !~'0.00005), distractibility (r-0.44, p-0.02), Wisconsin Card Sort Perseverative Errors (WCS-PE) (r-0.67, p~.0002), reaction time (r-0.62, ig0.00$) and habituation of startle amplitude (r-0.38, lg0.05) are significantly correlated with NES Total Score. 2) Factor I, "Memory," correlated significantly with startle amplitude (r-0.38, p~O.O$).3) Factor 2, "Sensorimotor Disinhibition," correlated significantly with vigilance (r-O.$1, pOD.006), WCS-PE (r-0.44, Ig0.03), and reaction time (r-0.53, ig0.004). 4) Factor 3, "Comple~ Motor Tasks" correlated significantly with WCS-PE (r-0.53, ig0.005) and vigilance (r-0.38, lg0.0$). 5) Factor 4, Release Signs" correlated with reaction time (r-0.46, pg0.02). 6) Pie-pulse inhibition was not related to NSS but correlated with distractibility (r-0.44, !><0.02). These findings suggest that neurological deficits are associated with impairments in attention and startle regulation. 359. NEUROLOGIC SOFT SIGNS IN SCHIZOPHRENIA S.C. Clark, D. Malaspina, R. H Dworkin, J. HirkavyFriedman, X.F. Amador, & J.M. Gorman New York State Psychiatric Institute, New York, NY 10034 We report on our ongoing study of neurological soft signs (NSS) and their relationship to medication status and to negative symptoms in schizophrenia. Patients with schizophrenia, other psychiatric disorders, and controls were studied. An eight item instrument derived from the Neurological Evaluation Scale was used. A subgroup of patients were studied after at least two weeks on a fixed dose of haloperidol, then after at least two weeks medication free. Ratings of positive and negative symptoms and affective expression were done in both states. Interrater reliability and NSS prevalence with this shortened scale were comparable to other studies reported, with an excess of signs present in schizophrenics. Preliminary analysis of seven patients studied on and off medications revealed poorer performance in the medication-free patients, with the difference reaching statistical significance for the subgroup of complex motor acts. NSS are more prevalent in schizophrenic patients than controls, and appear to be affected by medication status. Data will be presented on an expanded group of patients, along with the results of clinical symptom and affective expression ratings. The possible relationship between negative symptoms and neurological signs will be discussed.

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Soft signs, attention, and startle in schizophrenia

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