Neurological soft signs in first-episode schizophrenia: State- and trait-related relationships to psychopathology, cognition and antipsychotic medication effects.

Background: Neurological soft signs (NSS) are proposed to represent both state-and trait-related features of schizophrenia. Method: We assessed the course of NSS with the Neurological Evaluation Scale (NES) over 12 months of standardised treatment in 126 patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder, and evaluated their state-and trait-related associations with psychopathology, functionality, cognition and antipsychotic treatment. We considered change scores from baseline to be state-related and endpoint scores to be trait-related. Results: Significant effects for time were recorded for all NSS domains. For state-related change-scores greater improvements in sensory integration were predicted by more improvement in working memory (p = 0.01); greater improvements in motor sequencing scores were predicted by more improvement in working memory (p = 0.005) and functionality (p = 0.005); and greater improvements in NES Total score were predicted by more improvement in disorganised symptoms (p = 0.02). There were more substantial associations between trait-related endpoint scores than for state-related change scores. For endpoint scores lower composite cognitive score predicted poorer sensory integration (p = 0.001); higher Parkinsonism score predicted poorer motor coordination (p = 0.0001); lower composite cognitive score (p = 0.001) and higher Parkinsonism score (p = 0.005) predicted poorermotor sequencing; higher Parkinsonism score (p = 0.0001) and disorganised symptoms (p = 0.04), and lower composite cognitive score (p = 0.0007) predicted higher NES total score. Conclusions: NSS improved with treatment, but were weakly associated with improvements in psychopathology. Studies investigating NSS as trait-markers should ensure that patients have been optimally treated at the time of testing, and should take possible effects of extrapyramidal symptoms into account. (C) 2017 Elsevier B.V. All rights reserved.