Neuromotor abnormalities ‘integral part’ of schizophrenia
MedWire News: Around a third of patients with schizophrenia show neuromotor abnormalities that are independent from the effects of antipsychotic medication, study results show.
Certain neuromotor symptoms were found to correlate with outcome measures suggesting they "need to be considered as both an integral part of the disease process and a severity marker of the psychotic illness," the authors say in the journal Comprehensive Psychiatry.
A broad range of neuromotor abnormalities, including parkinsonian symptoms, catatonic phenomena, dyskinetic movements, and akathisia have been noted in patients with schizophrenia - dating to before the use of neuroleptic drugs.
However, they have been largely overlooked in the literature in recent times, owing to many researchers and clinicians dismissing them as simply adverse effects of medication, according to study authors Victor Peralta and Manuel Cuesta, from the Virgen del Camino Hospital in Pamplona, Spain.
The team therefore recruited 100 non-affective psychotic patients who were consecutively admitted for the first time to the psychiatric ward of the Virgen del Camino Hospital.
Dyskinesia was assessed by Schooler and Kane criteria, parkinsonism according the Simpson and Angus scale, akathisia by Barnes, and catatonia was rated according to the modified Rogers scale. The global rating was used to determine severity.
In all, 34% of the patients presented with at least one neuromotor syndrome, and symptoms co-varied and overlapped among patients. Of the 21 patients with parkinsonism, 19 scored positively for rigidity. Meanwhile, of the nine patients with dyskinesia, six had a predominantly limb-truncal form and three had a predominantly orofacial form.
Higher ratings of parkinsonism, catatonia, and dyskinesia were associated with obstetric complications (based on birth records), poorer premorbid adjustment, more severe negative symptoms, higher prevalence of the deficit syndrome, and poorer response to antipsychotic drugs.
Patients with schizophrenia had higher parkinsonism and dyskinesia ratings than those with other psychotic disorders.
"Our findings underscore the importance of a careful examination of neuromotor abnormalities before administering any antipsychotic medication," Peralta and Cuesta comment.
"This assessment is necessary not only to establish a baseline to avoid misattribution of neurological signs to subsequent medication, but also for using neurological ratings as a putative marker of the severity of the psychotic illness," they add.
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By Andrew Czyzewski