Quantitative Motor Activity Differentiates Schizophrenia Subtypes

University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
Neuropsychobiology (Impact Factor: 2.26). 09/2009; 60(2):80-86. DOI: 10.1159/000236448
Source: PubMed


Background: Motor symptoms are frequent in schizophrenia and relevant to the diagnosis of subtypes. However, the assessment has been limited to observations recorded in scales and experimental designs. The aim of this study was to use wrist actigraphy to obtain motor activity data in 3 schizophrenia subtypes. Methods: In total, 60 patients with schizophrenia (35 paranoid, 12 catatonic, 13 disorganized) were investigated using continuous wrist actigraphy over 24 h in an inpatient setting on average 38 days after admission. Data of the wakeful hours of the day were analyzed. Results: The activity level was predicted by schizophrenia subtype and by the type of antipsychotic medication. The movement index and mean duration of uninterrupted immobility were found to be predicted only by the schizophrenia subtype. Age, gender, duration of illness and chlorpromazine equivalents did not contribute to the variance of the activity data. A MANOVA demonstrated the significant differences in the 3 parameters between schizophrenia subtypes (p = 0.001). Patients with catatonic schizophrenia had lower activity levels, a lower movement index and a longer duration of immobility than those with paranoid schizophrenia. Conclusions: Schizophrenia subtypes can be differentiated using objective measures of quantitative motor activity. The increased duration of immobility appears to be the special feature of catatonic schizophrenia.

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    • "White matter abnormalities of motor pathways have been reported before it remains difficult to relate those findings to relevant behavioural measures. Actigraphy is a valuable tool for studying motor behaviour in schizophrenia (Farrow et al., 2005; Walther et al., 2009a,b; Wichniak et al., 2011; Bracht et al., 2012). Combined brain imaging and actigraphy studies indicate reduced quantitative motor behaviour and altered associations of motor activity and brain structure and function of regions of the motor system including the ACC, the SMA and the thalamus in schizophrenia (Farrow et al., 2005; Walther et al., 2011a,b). "
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    ABSTRACT: Little is known about the neurobiology of hypokinesia in schizophrenia. Therefore, the aim of this study was to investigate alterations of white matter motor pathways in schizophrenia and to relate our findings to objectively measured motor activity. We examined 21 schizophrenia patients and 21 healthy controls using diffusion tensor imaging and actigraphy. We applied a probabilistic fibre tracking approach to investigate pathways connecting the dorsolateral prefrontal cortex (dlPFC), the rostral anterior cingulate cortex (rACC), the pre-supplementary motor area (pre-SMA), the supplementary motor area proper (SMA-proper), the primary motor cortex (M1), the caudate nucleus, the striatum, the pallidum and the thalamus. Schizophrenia patients had lower activity levels than controls. In schizophrenia we found higher probability indices forming part of a bundle of interest (PIBI) in pathways connecting rACC, pre-SMA and SMA-proper as well as in pathways connecting M1 and pre-SMA with caudate nucleus, putamen, pallidum and thalamus and a reduced spatial extension of motor pathways in schizophrenia. There was a positive correlation between PIBI and activity level in the right pre-SMA-pallidum and the left M1-thalamus connection in healthy controls, and in the left pre-SMA-SMA-proper pathway in schizophrenia. Our results point to reduced volitional motor activity and altered motor pathway organisation in schizophrenia. The identified associations between the amount of movement and structural connectivity of motor pathways suggest dysfunction of cortico-basal ganglia pathways in the pathophysiology of hypokinesia in schizophrenia. Schizophrenia patients may use cortical pathways involving the supplementary motor area to compensate for basal ganglia dysfunction.
    Schizophrenia Research 12/2012; 143(2-3). DOI:10.1016/j.schres.2012.12.004 · 3.92 Impact Factor
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    • "This parameter was shown to have discriminative value and neurobiologic meaning in schizophrenia (Walther et al., 2009a, 2009b, 2011a, 2011b). Furthermore, we calculated the movement index (MI) indicating the proportion of active periods and the mean duration of uninterrupted immobility periods (MIP), which is the average duration of pauses (Middelkoop et al., 1997; Walther et al., 2009a, 2009b). In total, five patients refused to wear an actigraph. "
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    ABSTRACT: INTRODUCTION: Gestures are important for nonverbal communication and were shown to be impaired in schizophrenia. Two categories of gestures can be differentiated: pantomime on verbal command and imitation of seen gestures. There is evidence that the neural basis of these domains may be distinct, pantomime being critically dependent on prefrontal cortex function. The aim of the study was to investigate gestural deficits in schizophrenia and their association with frontal lobe function and motor performance. METHODS: In 30 schizophrenia patients, gesture performance was assessed by the comprehensive Test of Upper Limb Apraxia (TULIA) using previously determined cut-off scores. The ratings of videotaped gesture performance were blinded. In addition, a battery of rating scales on frontal lobe function, parkinsonism, dyskinesia, catatonia and instrumental measures of gross and fine motor performance were assessed. RESULTS: Pantomime deficits were found in 40% and imitation deficits in 23% of the patients. Patients with gestural deficits had poorer frontal cortex function, more catatonic symptoms, and more severe psychopathology. Furthermore, trends indicated an association with a more chronic course of the illness. Pantomime was linked to frontal lobe function whereas imitation was associated with catatonic symptoms and gross motor performance. CONCLUSIONS: Pantomime is frequently impaired in chronic schizophrenia and may critically depend on motor planning, reflecting a further example of brain disconnectivity in schizophrenia.
    Cortex 01/2012; 49(2). DOI:10.1016/j.cortex.2011.12.008 · 5.13 Impact Factor
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    • "We did not find any differences in actigraphic recordings and scores of daytime sleepiness and sleep quality scales between patients treated with olanzapine and risperidone. Also some previous studies have suggested that the kind of medication and medication dose (chlorpromazine equivalents) did not contribute to the variance of activity data in actigraphy (Walther et al., 2009a,b). However, another study involving healthy controls showed that mean 24 h-activity in actigraphy decreased by 41% after a single dose of 10 mg of olanzapine as compared to placebo. "
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    ABSTRACT: Metabolic disturbances are a growing concern for the treatment of schizophrenia. As decreased activity and poor sleep quality are risk factors for metabolic disturbances, we investigated the activity and sleep patterns of schizophrenic patients using actigraphy. Seventy-three patients with schizophrenia spectrum disorder (mean age 29.2 ± 10.2 years, 27 females) treated with olanzapine (n = 54) or risperidone (n = 19) and 36 age- and sex-matched healthy controls were examined. Actigraphic recordings were obtained throughout seven consecutive days. The Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS) were used to assess sleep and daytime sleepiness. Drug side effects were evaluated with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and Barnes Akathisia Rating Scale (BARS). Mental status was rated with the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS). The patients had lower mean 24 h-activity (p < 0.001) and mean 10 h-daytime-activity (p < 0.001), and longer time in bed (p < 0.001). Higher PANSS scores, especially in the negative symptoms scale, were related to lower activity (r(s) = -0.508, p < 0.001). Higher depressive symptoms were related to lower mean 24 h-activity (r(s) = -0.233, p = 0.049), longer time in bed (r(s) = 0.315, p = 0.007) and higher AIS (r(s) = 0.377, p = 0.001) and ESS scores (r(s) = 0.321, p = 0.006). Healthy females presented higher activity than healthy males (p < 0.001). Similar but not significant gender differences were observed in the patients. These findings show that patients with schizophrenia treated with olanzapine or risperidone exhibit low physical activity and altered sleep pattern which may promote metabolic side effects. These changes are linked to negative and depressive symptoms.
    Journal of Psychiatric Research 06/2011; 45(10):1381-6. DOI:10.1016/j.jpsychires.2011.05.009 · 3.96 Impact Factor
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