BUSCADOR RECOLECTA

Executive dysfunction represents a core deficit that is associated with schizophrenia spectrum disorders (SSDs).
However, the longitudinal course of executive deficits in SSDs is still controversial.
The aim of this study was to examine the executive performance of 34 SSD patients in relation to 34 of their
unaffected siblings over a period of 10 years. Both groups completed psychopathological and executive
assessments. Thirteen healthy controls were assessed using the same instruments.
At baseline, the SSD patients differed significantly from siblings and controls in their performance on the Trail
Making Test-B (TMT-B) and the number of categories in which they succeeded in the Wisconsin Card Sorting
Test (WCST). They also differed significantly from the controls in the total number of errors in the WCST. The
siblings did not differ in executive functioning from the controls over the follow-up. Longitudinally, the patients demonstrated significant improvement only for the TMT-B. However, only 14.71% of the patients
showed reliable and clinically significant improvements for the TMT-B, and 8.82% made more errors on the
WCST at the follow-up evaluation. Less than 3% of the patients showed either improved or worse results
on the remaining measures of the WCST. A stabilisation pattern for the WCST was observed in the three
groups.
The patients performed worse than their siblings and controls on both executive tests. Some patients exhibited
significant improvements in the TMT-B over time, but this improvement was reliable and clinically significant for
less than 15% of the sample. Thus, we conclude that the patients exhibited stable impairments over time in the
executive functions assessed., This study was partly funded by the Plan Nacional Sobre Drogas (grant 2008/I/030),
the Department of Health of the Government of Navarra (grant 55/2007) and the
Ministerio de Ciencia e Innovación (grant SAF2008-05674-C03-02)

There is now growing evidence that parkinsonism and other extrapyramidal signs are highly prevalent in patients with first-episode psychosis who have never been exposed to antipsychotic drugs. However, the neurocognitive correlates of parkinsonism in this population remained to be clarified. A sample comprising 100 consecutive drug-naive patients with first-episode psychosis were enrolled on the study and followed up for 6 months. Seventy-seven completed assessments at 3 time points (baseline, 1 mo, and 6 mo), involving clinical and cognitive examinations and a specific assessment of motor abnormalities. The Simpson-Angus Scale (SAS) was used for the assessment of extrapyramidal signs, and each motor domain was evaluated with a standard assessment scale. Linear mixed models were built to explore the longitudinal relationships between parkinsonism scores and cognitive impairment. Parkinsonism scores showed significant strong longitudinal associations with deficits in memory, executive functioning, and attention. Spontaneous parkinsonism (total SAS score and hypokinesia and rigidity subscores at baseline) showed high 6-month predictive values for cognitive impairment. In addition, they also had high predictive values for neurologic soft-sign abnormalities but not for dyskinesia, akathisia, and pure catatonic abnormalities. No predictive value was found for glabella-salivation or tremor subscores on the SAS scale. These results emphasize the relevance of the assessment of parkinsonism signs prior to starting to administer antipsychotic drugs, as core manifestations of psychotic illness with a high predictive value for cognitive impairment., Department of Health of the Government of Navarra
(55/2007, 11/101); Carlos III Health Institute (Fondo Europeo
de Desarrollo Regional Funds) from the Spanish Ministry of
Economy and Competitivity (08/I/1026); Spanish Ministry
of Science and Innovation (SAF2008-05674-C03-02).

Background: Duration of untreated psychosis (DUP) has been significantly associated with poor clinical and
social outcomes in First Episode Psychosis (FEP) patients, but an association with cognitive outcomes has
not been clearly established.
Method: Seventy-seven consecutively admitted, drug-naïve patients with FEP were assessed at baseline and at
1 month and 6 months. Underlying dimensions of DUP (general prodrome and positive, negative and
disorganisation symptoms) were assessed using the Symptom Onset in Schizophrenia (SOS) inventory (Perkins
et al., 2000). To assess the effect of DUP on the neuropsychological status of the patients, a linear mixed-effect
model was fitted to each neuropsychological dimension. These models included a dichotomised version of
DUP (short versus long duration) as a fixed effect, several adjusting variables to account for patient differences,
and a random effect to incorporate the longitudinal structure of the data.
Results: Patients with a short duration of untreated negative symptoms (DUNS) or a short duration of untreated
positive symptoms (DUPS) outperformed patients with a long duration of untreated symptoms on memory
tasks and a pre-attentional visual task but not on measures of verbal fluency, attention, reaction time, visual
processing and executive functions.
Conclusions: This study provides additional support for an early intervention to shorten DUP to facilitate a better
outcome in memory and attentional domains of FEP patients., This work was supported by the Navarra government (grants 946/2005 and 55/2007), the ‘Fondo de Investigaciones Sanitarias’ from the Spanish Ministry of Health (grant PI081026) and the Spanish Ministry of Science and Innovation (grant SAF2008-05674-C03-02).

Background: Neurological soft signs (NSS) are intrinsic features of psychosis that appear years before beginning a
drug treatment. However, whether NSS respond to antipsychotics and whether these changes are clinically
reliable and significant remains to be seen.
Objective: We sought to determine the effect of antipsychotics on NSS in a first-episode psychosis (FEP) sample
who had never exposed to antipsychotics.
Methods: We included 100 antipsychotic-naïve patients with FEP in this study. 77 patients completed the
study assessments at baseline, 1 month and 6 months. The Neurological Evaluation Scale (NES) evaluated
NSS. Patients were alternatively selected to receive risperidone or olanzapine treatments and continued participation in their mental health setting during follow-up with one of four treatment groups: risperidone,
olanzapine, mixed antipsychotics or no medication. We also included a control group of 28 healthy volunteers.
Results: Treatment groups showed a statistically significant improvement on total NES scores and most NES
subscales except for ‘frontal signs’, regardless of antipsychotic allocation. NSS changes were reliable; however,
there was great variation in the total NES scores between treatment groups, ranging from 4% to 24%. Clinically
meaningful changes (CMCs) on total NES scores ranged from 25% to 50%. Six patients (7.8%) demonstrated a
reliable change (RC) and CMC on total NES scores.
Conclusions: NSS improved significantly over follow up regardless of the treatment regimen assigned to
antipsychotic-naïve patients with a FEP. However, only 6 (7.8%) achieved a reliable and clinically meaningful
improvement. The pattern of response of NSS to antipsychotic drugs evidenced both state and trait
characteristics., This work was supported by The Government of Navarra— grants 946/2005 and 55/2007; the “National Plan of Drugs” of the Ministry of Health of Spain— grant 2008/030 and the Ministry of Science and Innovation of Spain— grant SAF2008-05674-C03-02.

Motor abnormalities (MAs) may be already evidenced long before the beginning of illness and are highly prevalent in psychosis. However, the extent to which the whole range of MAs are related to cognitive impairment in
psychosis remains understudied.
This study aimed to examine comparatively the relationships between the whole range of motor abnormalities
and cognitive impairments in the first-episode of psychosis (FEP), their unaffected siblings and healthy control
subjects.
Fifty FEP patients, 21 of their healthy siblings and 24 age- and sex matched healthy controls were included. Motor
assessment included catatonic, extrapyramidal and neurological soft signs (NSS) by means of standardized instruments. An exhaustive neuropsychological battery was also performed to extract the 7 cognitive dimensions
of MATRICS initiative.
Higher scores on NSS but not on extrapyramidal and catatonic signs showed significant associations with worse
cognitive performance in the three study groups. However, the pattern of associations regarding specific cognitive functions was different among the three groups. Moreover, extrapyramidal signs showed significant associations with cognitive impairment only in FEP patients but not in their unaffected siblings and healthy controls.
Catatonic signs did not show any significant association with cognitive functioning in the three study groups.
These findings add evidence to the associations between motor abnormalities, particularly NSS and extrapyramidal signs, and cognitive impairment in first-episode psychosis patients. In addition, our results suggest that the
specific pattern of associations between MAs and cognitive functioning is different in FEP patients from those
of the unaffected siblings and healthy subjects., This work was supported by the Department of Health of the Government of Navarra (grants 55/2007, 11/101 and 87/2014), the Carlos III Health Institute (FEDER Funds) from the Spanish Ministry of Economy and Competitivity (grant 11/02831) and the Spanish Ministry of Science and Innovation (grant SAF2008–05674-C03–02).

This study aimed to characterize the deficit syndrome in drug-naive schizophrenia patients and to examine the relationship between deficit features and primary neurological abnormalities. Drug-naive schizophrenia patients (n = 102) were examined at baseline for demographics, premorbid functioning, duration of untreated illness (DUI), psychopathology, neurological signs, and deficit symptoms, and reassessed at 1-year follow-up. Neurological abnormalities were examined before inception of antipsychotic medication and included four domains of spontaneous movement disorders (SMD) and four domains of neurological soft signs (NSS). Patients fulfilling the deficit syndrome criteria at the two assessments (n = 20) were compared with nondeficit patients (n = 82) across demographic, clinical, and neurological variables. Deficit and nondeficit groups showed similar demographic characteristics and levels of psychotic, disorganization, and depressive symptoms. Compared with nondeficit patients, deficit patients showed poorer premorbid adjustment, higher premorbid deterioration, a lengthier DUI, and much poorer functional outcome. Relative to the nondeficit patients, those with the deficit syndrome showed higher levels of SMD—excepting akathisia—and NSS. This association pattern was also evident for deficit and neurological ratings in the whole sample of schizophrenia patients. Parkinsonism, motor sequencing, and release signs were all independently related to the deficit syndrome. These findings confirm that the deficit/nondeficit categorization is replicable and reliable in first-admission patients and raise the possibility that premorbid deterioration, deficit symptoms, and neurological abnormalities represent a triad of manifestations that share common underlying neurobiological mechanisms. More specifically, the data are consistent with a neurodevelopmental model of deficit symptoms involving basal ganglia dysfunction., Ministerio de Educación y Ciencia (SAF2008-05674-C03-02); Departamento de Salud del Gobierno de Navarra (946-2005, 55-2007); Comissionat per a Universitats i Recerca del DIUE (2009SGR827).