A disturbance in the control of muscle force in neuroleptic-naive schizophrenic patients

doi:10.1016/0006-3223(94)91199-1

Biological Psychiatry

Volume 35, Issue 2, 15 January 1994, Pages 104-111

https://doi.org/10.1016/0006-3223(94)91199-1 Get rights and content

Abstract

The voluntary motor disturbances found among many schizophrenic patients consist of motor incoordination, disturbed pursuit tracking, difficulty following movement sequences, desynchronized tapping, and a myriad of neurologic soft signs. The problem with many of these observations is that it is extremely difficult to distinguish movement disorders related to neuroleptic treatment from those that may have occurred spontaneously. The aim of the present study was to examine potential disturbances in the voluntary control of steady-state force in neuroleptic-naive schizophrenic patients and normal comparison subjects. Twenty-one patients and 21 age- and gender-matched comparison subjects were studied. Spectral analyses of hand force instability revealed a significant difference between patients and comparison subjects. In 52 of the patients, the disturbance in the control of force exceeded the 95th percentile of the comparison mean. Degree of force instability was correlated with positive but not negative symptoms of schizophrenia. These findings suggest that schizophrenic patients may exhibit a disturbance in the control of muscle force that cannot be attributed to the neuroleptic effects of antipsychotic medication. The pattern of disruption, characterized by abnormal spectral energy within the 1.5 to 3.0 Hz range, suggests a motor disturbance that resembles tardive dyskinesia. Implicit within these findings of neuroleptic naive patients is the possibility that disturbances in the control of isometric force may represent spontaneous dyskinesia.

References (46)

R.W. Buchanan et al.
The neurological evaluation scale (NES): A structures instrument for the assessment of neurological signs in schizophrenia
Psychiatry Res
(1989)
M.P. Caligiuri et al.
A potential mechanism underlying the voluntary suppression of tardive dyskinesia
J Psychiatr Res
(1989)
M.P. Caligiuri et al.
Quantitative analyses of voluntary orofacial motor control in tardive dyskinesia and schizophrenia
Biol Psychiatry
(1988)
V.F. Inman et al.
Relation of human electromyogram to muscle tension
Electroencephalogr Clin Neurophysiol
(1952)
T.C. Manschreck et al.
Deficient motor synchrony in schizophrenia disorders: clinical correlates
Biol Psychiatry
(1985)
P.B. Vrtunski et al.
Voluntary movement dysfunction in schizophrenics
Biol Psychiatry
(1989)
P.B. Vrtunski et al.
Isometric force control in schizophrenic patients with tardive dyskinesia
Psychiatry Res
(1991)
J.T. Wegner et al.
Cognitive impairment in tardive dyskinesia
Psychiatry Res
(1985)
M. Alpert et al.
Tremographic studies in tardive dyskinesia
Psychopharmacol Bull
(1976)
N.C. Andreasen
Scale for the Assessment of Negative Symptoms (SANS)
(1981)

T.R.E. Barnes

Tardive dyskinesia: Risk factors, pathophysiology and treatment

T.R.E. Barnes et al.

A comparison of purposeless movements in psychiatric patients treated with antipsychotic drugs and normal individuals

J Neurol Neurosurg Psychiatry

(1983)

L.B. Bigelow et al.

The psychiatric assessment scale

Psychopharmacol Bull

(1989)

B. Bigland et al.

The relation between force, velocity and integrated electrical activity in human muscles

J Physiology

(1954)

D. Bravi et al.

Acute motor response in intravenous levodopa in parkinsonian patients

Movement Disord

(1992)

M.P. Caligiuri et al.

Fine force instability: A quantitative measure of hand dyskinesia

J Neuropsychiatr Clin Neurosci

(1990)

M.P. Caligiuri et al.

Instrumental assessment of lingual motor instability in tardive dyskinesia

Neuropsychopharmacology

(1989)

M.P. Caligiuri et al.

Quantitative evidence that age increases neuroleptic-induced force instability

J Gerontol

(1991)

M.P. Caligiuri et al.

Parkinsonism in neuroleptic-naive schizophrenic patients

Am J Psychiatr

(1993)

D.E. Casey et al.

Spontaneous dyskinesia

T.J. Crow

The two syndrome concept: origins and current status

Schizophr Bull

(1985)

R. DePaul et al.

Differential involvement of hypoglossal, trigeminal, and facial motoneurons in Amyotrophic Lateral Sclerosis

Neurology

(1988)

O. Gureje

Topographic subtypes of tardive dyskinesia in schizophrenic patients aged less than 60 years: relationship to demographic, clinical, treatment, and neuropsychological variables

J Neurol Psychiatry

(1988)

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Over the last three decades, movement disorder as well as sensorimotor and psychomotor functioning in schizophrenia (SZ) and other psychoses has gained greater scientific and clinical relevance as an intrinsic component of the disease process of psychotic illness; this extends to early psychosis prediction, early detection of motor side effects of antipsychotic medication, clinical outcome monitoring, treatment of psychomotor syndromes (e.g. catatonia), and identification of new targets for non-invasive brain stimulation. In 2017, a systematic cooperation between working groups interested in movement disorder and sensorimotor/psychomotor functioning in psychoses was initiated across European universities. As a first step, the members of this group would like to introduce and define the theoretical aspects of the sensorimotor domain in SZ and other psychoses. This consensus paper is based on a synthesis of scientific evidence, good clinical practice and expert opinions that were discussed during recent conferences hosted by national and international psychiatric associations. While reviewing and discussing the recent theoretical and experimental work on neural mechanisms and clinical implications of sensorimotor behavior, we here seek to define the key principles and elements of research on movement disorder and sensorimotor/psychomotor functioning in psychotic illness. Finally, the members of this European group anticipate that this consensus paper will stimulate further multimodal and prospective studies on hypo- and hyperkinetic movement disorders and sensorimotor/psychomotor functioning in SZ and other psychotic disorders.
Instrument-based assessment of motor function yields no evidence of dyskinesia in adult first-degree biological relatives of individuals with schizophrenia and schizoaffective disorder
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ANJ during handwriting and force variability during constant application of pressure are both measures of subtle dyskinesia wherein the fluidity of these motor behaviors is disrupted by discoordinated and irregular muscle activity. However, ANJ during handwriting is believed to result from failure to control the timing and contraction of multiple muscle groups within the hand and wrist during movement (Teulings et al., 1997), while maintenance of muscle force steadiness demands controlled contraction of a single agonist-antagonist pair in the absence of proprioceptive feedback (see Caligiuri and Lohr, 1994; Mittal et al., 2011 for discussion). One alternative interpretation of the current findings, then, is that the current study's lack of increased ANJ during handwriting in relatives and the higher incidence of increased force variability during constant pressure exertion in relatives versus controls reported by Koning et al. (2011) could point to the presence of dyskinesia in relatives when subjected to more demanding neuromuscular control tasks.
There is accruing evidence of spontaneous dyskinesia in individuals with schizophrenia that is independent of medication exposure. Dyskinetic motor behavior is also present in individuals who are at high risk of schizophrenia and appears to have prognostic value for the development of psychosis. Nonetheless, it remains unclear whether dyskinesia is present in first-degree relatives of individuals with schizophrenia and thus associated with genetic liability for schizophrenia (i.e., an endophenotype), or whether the motor abnormality is a biomarker specific to the disease state spectrum. There is also limited information about links between dyskinesia and clinically relevant phenomena such as symptoms and cognition. Because dyskinesia marking genetic liability is likely to be subtle, we used sensitive instrument-based measurement of handwriting fluency to quantify dyskinesia in medicated individuals with schizophrenia or schizoaffective disorder, unaffected first-degree biological relatives of individuals with schizophrenia and schizoaffective disorder, and control participants. Results indicated that medicated individuals with schizophrenia or schizoaffective disorder exhibited more dyskinesia than both relatives and controls, with no difference between relatives and controls. Dyskinesia in individuals with schizophrenia or schizoaffective disorder was unrelated to current antipsychotic medication dosage, but associated with worse working memory function and greater positive formal thought disorder. These results provide evidence that dyskinesia is not associated with unexpressed genetic liability for schizophrenia.
Neurological soft signs in bipolar and unipolar disorder: A case-control study
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With regard to the question of whether NSS are medication-dependent phenomena, many studies have previously shown that neurological soft signs are present in schizophrenic patients before the exposure to medication (Browne et al., 2000; Dazzan and Murray, 2002). Most studies aiming at the effect of medication on neurological soft signs have argued against such a relation (Caligiuri and Lohr, 1994; Gupta et al., 1995). For instance, previous studies on schizophrenic patients have shown no significant correlation between medications and NSS score (Schröder et al., 1992; Gupta et al., 1995).
Neuropsychiatric disorders are associated with neurological soft signs (NSS), including motor, sensory, and inhibitory dysfunction. The present study aims at determining the prevalence of NSS and explore the association of sociodemographic characteristics with the occurrence of NSS in patients with bipolar disorder and unipolar depression compared to healthy controls. A case-control study included a sample of 50 bipolar and unipolar patients and 50 healthy controls. NSS subscales of the Neurological Evaluation Scale (NES) were administered to each participant. Significant differences were found in the total NES score, motor coordination, sensory integration, sequence of complex motor act and other subscales among the three groups. Compared with healthy controls, patients with bipolar disorder showed significantly more total NSS signs, motor coordination signs and sensory-integration signs. When compared with patients with unipolar disorder, patients with bipolar disorder showed significantly more sensory integration signs and a trend of difference in the sequencing of complex motor acts and other subscales. Our findings suggest that NSS may be specifically associated with bipolar disorder but not unipolar depression. The specificity of NSS expression has the potential to help the discrimination of bipolar disorder from disorders less likely to have a neurodevelopmental component such as major depression.
Patients with schizophrenia show aberrant patterns of basal ganglia activation: Evidence from ALE meta-analysis
2017, NeuroImage: Clinical
The diverse circuits and functional contributions of the basal ganglia, coupled with known differences in dopaminergic function in patients with schizophrenia, suggest they may be an important contributor to the etiology of the hallmark symptoms and cognitive dysfunction experienced by these patients. Using activation-likelihood-estimation meta-analysis of functional imaging research, we investigated differences in activation patterns in the basal ganglia in patients with schizophrenia, relative to healthy controls across task domains. This analysis included 42 functional neuroimaging studies, representing a variety of behavioral domains that have been linked to basal ganglia function in prior work. We provide important new information about the functional activation patterns and functional topography of the basal ganglia for different task domains in healthy controls. Crucially however, we demonstrate that across task domains, patients with schizophrenia show markedly decreased activation in the basal ganglia relative to healthy controls. Our results provide further support for basal ganglia dysfunction in patients with schizophrenia, and the broad dysfunction across task domains may contribute to the symptoms and cognitive deficits associated with schizophrenia.
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Since all our patients used antipsychotic agents, it is unknown if postural instability was due to schizophrenia only or schizophrenia combined with side effects of neuroleptic medications. However, it has been reported that the problem of muscular power control also exists in drug-free patients with schizophrenia [29], suggesting that postural instability is caused mainly by the disease. Longitudinal data reflecting the influence of medical treatment on psychiatric symptoms are needed to clarify the abnormalities of posture in patients with schizophrenia.
The purpose of this study was to assess postural instability in patients with schizophrenia using a pressure-sensitive platform and to examine the effects of anxiety, psychiatric symptoms, and the use of neuroleptic medications on postural sway. Participants were 23 patients with schizophrenia and 23 healthy controls. We found that the patients showed greater overall postural instability than the controls. Furthermore, they demonstrated greater instability when the test was performed with the eyes closed than with the eyes open. However, removal of visual input had less impact on the indices of postural instability in the patients than in the controls, suggesting that schizophrenia is associated with difficulties in integrating visual information and proprioceptive signals. Furthermore, in contrast to the controls, anxiety exacerbated postural instability in the patients. There were significant associations between postural stability and psychiatric symptoms in the patients without extrapyramidal symptoms, whereas medication dose did not significantly correlate with postural stability.
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The fourth factor encompasses tracts in the brainstem such as the inferior and superior cerebellar peduncles. The anomalies in the cerebellar peduncles may help explain the higher degree of postural instability in patients with schizophrenia, compared with healthy individuals (Caligiuri and Lohr, 1994; Marvel et al., 2004; Kent et al., 2012). Wang et al. (2003) specifically studied the FA of the cerebellar peduncles in patients with schizophrenia and did not find any difference from controls.
Diffusion tensor imaging (DTI) studies in patients with schizophrenia have shown abnormalities in the microstructure of white matter tracts. Specifically, reduced fractional anisotropy (FA) has been described across multiple white matter tracts, in studies that have mainly included patients treated with antipsychotic medications.
To compare FA in antipsychotic-naïve patients experiencing a first episode of psychosis (FEP) to FA in healthy controls to demonstrate that the variance of FA can be grouped, in a coincidental manner, in four predetermined factors in accordance with a theoretical partition of the white matter tracts, using a principal components analysis (PCA).
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Original articleA disturbance in the control of muscle force in neuroleptic-naive schizophrenic patients

Abstract

Psychiatry Res

J Psychiatr Res

Biol Psychiatry

Electroencephalogr Clin Neurophysiol

Biol Psychiatry

Biol Psychiatry

Psychiatry Res

Psychiatry Res

Tremographic studies in tardive dyskinesia

Psychopharmacol Bull

Scale for the Assessment of Negative Symptoms (SANS)

Tardive dyskinesia: Risk factors, pathophysiology and treatment

A comparison of purposeless movements in psychiatric patients treated with antipsychotic drugs and normal individuals

J Neurol Neurosurg Psychiatry

The psychiatric assessment scale

Psychopharmacol Bull

The relation between force, velocity and integrated electrical activity in human muscles

J Physiology

Acute motor response in intravenous levodopa in parkinsonian patients

Movement Disord

Fine force instability: A quantitative measure of hand dyskinesia

J Neuropsychiatr Clin Neurosci

Instrumental assessment of lingual motor instability in tardive dyskinesia

Neuropsychopharmacology

Quantitative evidence that age increases neuroleptic-induced force instability

J Gerontol

Parkinsonism in neuroleptic-naive schizophrenic patients

Am J Psychiatr

Spontaneous dyskinesia

The two syndrome concept: origins and current status

Schizophr Bull

Differential involvement of hypoglossal, trigeminal, and facial motoneurons in Amyotrophic Lateral Sclerosis

Neurology

Topographic subtypes of tardive dyskinesia in schizophrenic patients aged less than 60 years: relationship to demographic, clinical, treatment, and neuropsychological variables

J Neurol Psychiatry

Original article
A disturbance in the control of muscle force in neuroleptic-naive schizophrenic patients