Movement disorders in nonpsychotic siblings of patients with nonaffective psychosis

Koning, Jeroen; Kahn, René S.; Tenback, Diederik E.; Schelven, Leonard J. van; Harten, Peter N. van

doi:10.1016/j.psychres.2011.01.005

Cited by 31 publications

(36 citation statements)

References 32 publications

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“…The present results linking pre-treatment EPS to symptom severity in first episode psychosis, to cognitive dysfunction, and to abnormalities of brain structure all support the proposal that similar observations in family members of patients with psychosis represent an endophenotype of the illness [5,6]. Findings concerning the course of extrapyramidal symptoms and the relationships to treatment response indicate the possible importance of thorough assessment for EPS at the entry into early psychosis treatment programs.…”

Section: Discussionsupporting

confidence: 80%

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First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment

et al. 2011

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Extrapyramidal movement disorders are common in chronic schizophrenia, and may be an intrinsic feature of the illness as well as related to antipsychotic drug treatment. Similar dysfunctions at illness onset may have implications for outcome, and for understanding the mechanisms of illness. The objectives were to examine the clinical correlates of pre-treatment movement disorders at first episode of psychosis, and determine associations with neuropsychological function and striatal structure. Never medicated subjects were recruited from consecutive admissions to Early Psychosis Programs with defined catchment areas in Hong Kong, China, and Halifax, Canada. Standardized clinical, neuropsychological and brain imaging assessments were carried out at baseline and following acute and long term treatment with typical or atypical antipsychotic drugs. At the Hong Kong site, we studied 84 subjects with first episode psychosis (n = 10 with EPS). At the Halifax site, we studied 40 subjects with first episode psychosis (n = 17 with EPS), and 23 healthy comparison subjects. Subjects with movement disorders prior to treatment (EPS+) had higher total PANSS scores at baseline (mean elevation 19.9% Hong Kong, P = 0.016; 14.7% Halifax, P = 0.049). In subjects treated with atypical antipsychotics (all Halifax), EPS+ status at baseline predicted more movement disorders at long term follow up (P = 0.0005). In both cohorts, EPS+ subjects had poorer acute symptomatic treatment response assessed with the PANSS (Hong Kong P = 0.005; Halifax P = 0.017). Neuropsychological impairment related to executive dysfunction appeared greater in a small sample of EPS+ subjects (Hong Kong, effect size 0.26-0.27, P < 0.05). Caudate volumes were 4.5% larger in EPS+ compared with EPS-subjects (Halifax P = 0.042), and correlations between striatal volumes and age were different in the EPS+ group. In conclusion, pre-treatment EPS is present in a substantial minority of subjects with first episode psychosis, appears to persist at long term follow up, and is associated with poorer response of symptoms to treatment. Selective impairment of executive function and striatal enlargement provides evidence of abnormalities of brain function and structure associated with this aspect of early psychosis. schizophrenia, movement disorder, basal ganglia, antipsychotics, cognitive, psychosis Citation:Honer W G, Lang D J, Kopala L C, et al. First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment.

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Section: Discussionsupporting

confidence: 80%

“…Many of these same signs are described in family members of patients [5,6]. Most endophenotype studies investigate neurological soft signs, that appear to represent signs of developmental deviance [7,8].…”

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confidence: 92%

First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment

et al. 2011

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“…Second, evidence has been gathering over the past two decades to suggest that spontaneous motor abnormalities can occur as a function of pathophysiology in a sizeable subsample of individuals with schizophrenia. 15,16 This has been demonstrated in studies of unaffected relatives, 17 prodromal youth, 18,19 as well as medication naïve groups (for a review see Pappa and Dazzan 20 ). Although it is still difficult to study motor behaviors in patients treated with any medications that affect subcortical dopamine (DA) activity, a more widespread understanding that these behaviors reflect pathogenic processes, research approaches with low dosage inclusion criteria and medication-free or medication-naïve patients, as well as designs focusing on individuals who represent a lower vulnerability loading on the psychosis continuum (ie, populations with elevated schizotypy, schizotypal personality disorder, and nonclinical psychosis exhibit motor abnormalities but are often unmedicated), [21][22][23][24][25][26] will continue to open new avenues.…”

Section: At Issuementioning

confidence: 87%

Cross-Cutting Advancements Usher in a New Era for Motor Research in Psychosis

Mittal

2016

SCHBUL

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As gesture serves as an interaction point between motor, language, and sensory-integration processes, an intersection also implicated in psychosis, schizophrenia researchers have recently turned toward this area as well. 1 The findings of Walther et al 2 move our understanding of this nascent field significantly ahead, with results indicating that deficits in gesture performance and perception are closely tied with clinical and functional outcome in individuals with schizophrenia over a 6-month period. More broadly, this article suggests that a test of hand gesture may provide a viable method for predicting clinical course and potentially highlighting a novel vulnerability subtype in schizophrenia patients. Given the importance of these findings, and the relative ease of such assessments, the questions remain-why are we not seeing more studies like this, and where are the translational applications? Further, in addition to aberrant gesture, schizophrenia has been linked with a range of motor signs including delays in developmental milestones, clumsiness, poor coordination, abnormalities in gait, posture and neuromusculature, diffuse neurological soft signs, catatonia, psychomotor slowing, and both medication-induced and spontaneous hyper/hypo dyskinesias spanning muscle groups throughout the body. Despite the broad array of affected behaviors and characteristics, and the long history of movement and motor research in this area, 3 the question remains, why is this such a neglected area in our field?There are several factors that have been impeding more widespread use of motor variables in cuttingedge research. First, rigid intradisciplinary boundaries between neurology and psychiatry have historically kept abnormalities in movement and socio-emotional behavior distinct. In a related issue, until recently, key relevant target structures such as the basal ganglia and cerebellum have been viewed primarily as a motor centers and related movement behaviors have not been linked into the sophisticated comprehensive models or etiological theories that are often necessary generate enthusiasm about a domain or target. Second, the advent of first-generation antipsychotic medications, which produce characteristic movement disorders in some patients, contributed to further confusion about etiology of movement signs. More broadly, both generations of neuroleptics have also continued to serve as a tricky barrier for definitive research in this area. 4 Third, empirical studies have relied almost entirely on drug-induced motor abnormality assessments, 5 or scales designed to follow diffuse markers (eg, neurological soft signs). 6 While these instruments can be reliable at a particular site, they require highly specialized training, miss more subtle movements, and can press investigators to impose subjective categories on continuous phenotypes. Fourth, although it has been clear for some time that there are motor abnormalities present in psychosis, the translational relevance of these markers is uncertain. Finally, motor behaviors...

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“…This would require follow-up evidence through the period of risk for developing the illness. The quantifiable nature (Koning et al, 2011) of the line-drawing task was useful to unravel the lateralized features of the motor deficits in FHR group. However, another possible limitation could be that line-drawing task performance was not timed.…”

Section: Limitationsmentioning

confidence: 99%

“…Subjective awareness of motor impairment occurs frequently among the early features of SZ (Schneider, 1959;Chapman, 1966;Mellor, 1970). More recently, Koning et al (2011) examined dyskinesia and extrapyramidal system (EPS) signs in FHR subjects with both instrumentbased and clinical measures. They found that the clinical measures detected no motor differences between the groups; on the other hand, the instrument-based measures revealed that FHR subjects had significantly more dyskinesia and EPS symptoms than controls.…”

Section: Introductionmentioning

confidence: 99%

Impaired motor performance in adolescents at familial high-risk for schizophrenia

Manschreck

Chun

Merrill

et al. 2015

Schizophrenia Research

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Movement disorders in nonpsychotic siblings of patients with nonaffective psychosis

Cited by 31 publications

References 32 publications

First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment

First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment

Cross-Cutting Advancements Usher in a New Era for Motor Research in Psychosis

Impaired motor performance in adolescents at familial high-risk for schizophrenia

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