Neurological Soft Signs: A Further Step in the Diagnosis of Bipolar-I Disorder?
Abstract
Objectives: To study the prevalence and demographic characteristics of Neurological Soft Signs (NSS) among the patients with Bipolar Mood Disorder-I (BID).
Method: In a cross- sectional descriptive-analytic study we studied 20 patients with BID with BID with 20 healthy individuals. We used DSM-IV and Young Mania Rating Scale (MRS) for diagnosing and rating the patients with BID, Neurological Evaluation Scale along for assessment of NSS. Control subjects who were matched on age and sex were selected; other confounding factors such as age at the onset, severity and duration of the disease were also considered and analyzed to find any possible correlation with NSS.
Results: Total NSS scores were significantly higher in the patients' group (PV<0.0001). The most significant difference in NSS subscales was detected in the Sequencing of Complex Motor Acts (PV<0.0001). No significant correlation was found between NSS scores and age at the onset of the disease, severity and duration of the disease and medication.
Conclusion: This study may emphasize the role of NSS as a sign of organic brain disorder which may be present independent of medication effects in the patients with BID; however, further studies may be able to extend our findings to explore the etiology and pathogenesis of BID.
Kaplan HI,Sadock BJ. Synopsis of Psychiatry. Baltimore: Lippincott Williams and Wilkins; 1998.
Boks MP, Liddle PF, Burgerhof JG, Knegtering R,van den Bosch RJ. Neurological soft signs discriminating mood disorders from first episode schizophrenia. Acta Psychiatr Scand 2004; 110: 29-35.
Venkatasubramanian G, Latha V, Gangadhar BN, Janakiramaiah N, Subbakrishna DK, Jayakumar PN, et al. Neurological soft signs in never-treated schizophrenia. Acta Psychiatr Scand 2003; 108: 144-146.
Praharaj SK, Ram D,Arora M. Neurological Abnormalities in Drug-free and Drug-treated Patients with Bipolar Affective Disorder. Hong Kong Journal of Psychiatry 2005; 15: 82.
Buchanan RW,Heinrichs DW. The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Res 1989; 27: 335-350.
Cox SM,Ludwig AM. Neurological soft signs and psychopathology: incidence in diagnostic groups. Can J Psychiatry 1979; 24: 668-673.
Nasrallah HA, Tippin J,McCalley-Whitters M. Neurological soft signs in manic patients. A comparison with Schizophrenic and control groups. J Affect Disord 1983; 5: 45-50.
King DJ, Wilson A, Cooper SJ,Waddington JL. The clinical correlates of neurological soft signs in chronic schizophrenia. Br J Psychiatry 1991; 158: 770-775.
Shaffer D, Schonfeld I, O'Connor PA, Stokman C, Trautman P, Shafer S, et al. Neurological soft signs. Their relationship to psychiatric disorder and intelligence in childhood and adolescence. Arch Gen Psychiatry 1985; 42: 342-351.
Smith RC, Hussain MI, Chowdhury SA,Stearns A. Stability of neurological soft signs in chronically hospitalized schizophrenic patients. J Neuropsychiatry Clin Neurosci 1999; 11: 91- 96.
Tasman A, Kay J,Lieberman JA. Psychiatry. New York: WB Saunders Company; 1997.
Soares JC,Innis RB. Brain imaging findings in bipolar disorder. In: Soares JC,Gershon S, eds. Bipolar disorders. New York: Marcel Dekker; 2000. p. 252-227.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association ; 1994.
Young RC, Biggs JT, Ziegler VE,Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978; 133: 429-435.
Mukherjee S, Shukla S,Rosen A. Neurological abnormalities in patients with bipolar disorder. Biol Psychiatry 1984; 19: 337-345.
Negash A, Kebede D, Alem A, Melaku Z, Deyessa N, Shibire T, et al. Neurological soft signs in bipolar I disorder patients. J Affect Disord 2004; 80: 221-230.
Goswami U, Sharma A, Khastigir U, Ferrier IN, Young AH, Gallagher P, et al. Neuropsychological dysfunction, soft neurological signs and social disability in euthymic patients with bipolar disorder. Br J Psychiatry 2006; 188: 366-373.
Basu S, Ram D, Das SC,Gupta SC. A case controlled study of neurological soft signs in childhood and adolescent mania. Hong Kong Journal of Psychiatry 2002; 12: 6-10.
Whitty P, Clarke M, McTigue O, Browne S, Gervin M, Kamali M, et al. Diagnostic specificity and predictors of neurological soft signs in schizophrenia, bipolar disorder and other psychoses over the first 4 years of illness. Schizophr Res 2006; 86: 110-117.
Starkstein SE, Boston JD,Robinson RG. Mechanisms of mania after brain injury. 12 case reports and review of the literature. J Nerv Ment Dis 1988; 176: 87-100.
Coffman JA, Bornstein RA, Olson SC, Schwarzkopf SB,Nasrallah HA. Cognitive impairment and cerebral structure by MRI in bipolar disorder. Biol Psychiatry 1990; 27: 1188-1196.
Bjo◌rck RV, Sjalin M,Nordin C. Neurological soft signs in schizophrenic patients: Influence of age, age at onset, sex, and family history of schizophrenia. Nord J Psychiatry 2000; 54: 437-440.
Darijani N, Mir Sepasi GR, Sanati M,Norouzian M. [Soft neurological signs in Paranoid and other subtypes of Schizophrenia]. Quarterly Journal of Andeesheh Va Raftar 2000; 2-3: 9- 15.
Gupta S, Andreasen NC, Arndt S, Flaum M, Schultz SK, Hubbard WC, et al. Neurological soft signs in neuroleptic-naive and neuroleptic- treated schizophrenic patients and in normal comparison subjects. Am J Psychiatry 1995; 152: 191-196.
Heinrichs DW,Buchanan RW. Significance and meaning of neurological signs in schizophrenia. Am J Psychiatry 1988; 145: 11- 18.
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Issue | Vol 4 No 1 (2009) | |
Section | Articles | |
Keywords | ||
Bipolar- I Disorder Neurological Soft Signs Neurological examination |
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