Risk Model Assessment in Early-Onset and Adult-Onset Schizophrenia Using Neurological Soft Signs

Abstract

Age at onset is one of the most important clinical features of schizophrenia that could indicate greater genetic loadings. Neurological soft signs (NSS) are considered as a potential endophenotype for schizophrenia. However, the association between NSS and different age-onset schizophrenia still remains unclear. We aimed to compare risk model in patients with early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS) with NSS. This study included 262 schizophrenia patients, 177 unaffected first-degree relatives and 243 healthy controls. We estimated the discriminant abilities of NSS models for early-onset schizophrenia (onset age < 20) and adult-onset schizophrenia (onset age ≥ 20) using three data mining methods: artificial neural networks (ANN), decision trees (DT) and logistic regression (LR). We then assessed the magnitude of NSS performance in EOS and AOS families. For the four NSS subscales, the NSS performance were greater in EOS and AOS families compared with healthy individuals. More interestingly, there were significant differences found between patients’ families and control group in the four subscales of NSS. These findings support the potential for neurodevelopmental markers to be used as schizophrenia vulnerability indicators. The NSS models had higher discriminant abilities for EOS than for AOS. NSS were more accurate in distinguishing EOS patients from healthy controls compared to AOS patients. Our results support the neurodevelopmental hypothesis that EOS has poorer performance of NSS than AOS. Hence, poorer NSS performance may be imply trait-related NSS feature in EOS.

The Importance of Family Support in Successful Treatment Adherence of Schizophrenic Patient

“…Here, we describe a case of paranoid schizophrenia with non-adherence to treatment. Most schizophrenia typically manifests in late adolescence or young adulthood [10]. In this case, the patient had been suffering from paranoid schizophrenia since patient was 17 years old.…”

Motor function in early onset schizophrenia—A 2‐year follow‐up study

“…Examining motor function in EOS, a subgroup with greater genetic loading (Asarnow, 1999) and possibly less affected by environmental alterations (Vyas et al, 2011), gives us a unique opportunity to understand the underlying neurodevelopmental aspect of schizophrenia. The fact that NSS is able to differentiate EOS from AOS not only in prevalence (Biswas et al, 2007), but also in specificity of NSS (Chen et al, 2019), indicates that not only could motor function be a potential marker of subtypes of schizophrenia (EOS vs. AOS), but possibly also subtypes within these groups. Examining motor function systematically using motor tests in larger populations of EOS could thus provide important insight.…”

“…However, to what degree these impairments are stable in the years following schizophrenia onset in EOS is unknown. To the best of our knowledge, no study has assessed the longitudinal course of general motor function compared to controls, and only two studies have assessed the longitudinal course of NSS in EOS revealing significant decrease in NSS in a 2‐year follow‐up (Chen et al, 2019; Mayoral et al, 2012). Notably, studies suggest that NSS are more frequent in children and adolescents, which may be related to increased neurological load but possibly also because children and adolescents in general have more NSS due to the neurological brain maturation that takes place from childhood until the 20s (Biswas et al, 2007; Thompson et al, 2001).…”

Neurological soft signs and schizophrenia

“…Data showed significant heritability and familiarity of NSS. In another study 52 which included 262 patients with schizophrenia, 243 healthy controls and 177 healthy first-degree relatives, NSS were more prominent in first-degree relatives than controls and also in patients with early onset schizophrenia than in those with age of onset after 20 years. Chan and colleagues 42 investigated the effect size of NSS in 738 schizophrenia patients,155 unaffected first-degree relatives of schizophrenia patients, 256 individuals with schizotypal personality disorder (n = 256), 379 patients with other psychiatric disorders, and 1577 healthy individuals.…”