Publications (6)37.71 Total impact
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Article: Phenomenological Differences Between Spontaneous and Drug-Related Extrapyramidal Syndromes in Patients With Schizophrenia-Spectrum Disorders.
Journal of clinical psychopharmacology 04/2013; · 5.09 Impact Factor -
Article: Characterization of the Deficit Syndrome in Drug-Naive Schizophrenia Patients: The Role of Spontaneous Movement Disorders and Neurological Soft Signs.
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ABSTRACT: 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.Schizophrenia Bulletin 12/2012; · 8.80 Impact Factor -
Article: Duration of untreated negative and positive symptoms of psychosis and cognitive impairment in first episode psychosis.
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ABSTRACT: 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. Seventy-seven consecutively admitted, drug-naïve patients with FEP were assessed at baseline and at 1month and 6months. 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. 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. 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.Biological Psychiatry 09/2012; 141(2-3):222-7. · 8.28 Impact Factor -
Article: Characterization of spontaneous Parkinsonism in drug-naive patients with nonaffective psychotic disorders.
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ABSTRACT: Spontaneous Parkinsonism (SP) in schizophrenia-related disorders is poorly characterized. The objective of this study was to examine the concordance and clinical validity of alternative definitions of SP in patients with nonaffective psychotic disorders. Two-hundred drug-naive patients with nonaffective psychotic disorders were examined for core parkinsonian signs, including bradykinesia, rigidity, and tremor, and diagnosed of SP according to the Simpson-Angus Scale (SAS) cutoff criterion, the UK Parkinson's disease brain bank (UKPDBB) criteria, the National Institute of Neurological Disorders and Stroke (NINDS) criteria, and criteria requiring the presence of all three core features (full syndrome criteria). Parkinsonian signs and criteria were examined in relation to a number of relevant clinical variables. The most frequent sign was rigidity (33.5%) followed by bradykinesia (16%) and tremor (12%). The prevalence rate of SP according to the SAS cutoff criterion, the UKPDBB criteria, the NINDS criteria for possible and probable SP, and the full syndrome criteria were 20.5, 13, 25.5, 18.5, and 4%, respectively. Bradykinesia was specifically related to negative symptoms, rigidity to neurological soft signs, and tremor to dyskinetic movements. The set of criteria showing more associations with clinical variables were the NINDS criteria for probable SP. Patients fulfilling these criteria had higher ratings for poor premorbid adjustment, negative symptoms, dyskinesia, neurological soft signs, and poor global treatment response than those without that diagnosis. The NINDS criteria for probable SP, i.e., presence of any two of the three core parkinsonian signs, seem to be the most suitable for clinical and research purposes.Archiv f ur Psychiatrie und Nervenkrankheiten 05/2011; 262(2):131-8. · 2.75 Impact Factor -
Article: The meaning of childhood attention-deficit hyperactivity symptoms in patients with a first-episode of schizophrenia-spectrum psychosis.
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ABSTRACT: To examine childhood ADHD symptoms in regard to their association with a number of illness-related variables including risk factors, early neurodevelopment, premorbid functioning and clinical characteristics in patients with schizophrenia-spectrum psychoses. One-hundred and twenty-two first-episode patients with DSM-IV schizophrenia-spectrum disorders were retrospectively assessed by means of their biological mothers for childhood ADHD symptoms. Using correlational analyses and hierarchical regression models, the severity of ADHD symptoms was examined in relation to familial liability to schizophrenia, obstetric complications, milestones attainment delay, premorbid functioning during childhood and adolescence, age at illness onset, episode psychopathology and response to treatment after one-month trial with antipsychotic medication. Twenty-one patients (17%) met DSM-IV criteria for childhood ADHD. Univariate analyses showed that severity of childhood ADHD symptoms was related to male gender, obstetric complications, delayed milestones attainment, poor school functioning and an earlier age of onset of psychotic symptoms. Hierarchical regression analyses showed that severity of childhood ADHD symptoms was independently predicted by obstetric complications and neurodevelopmental delay, with no further variables entering in the regression models. Path analyses showed that obstetric complications had both direct and indirect effects, through neurodevelopmental delay, on ADHD symptoms. These findings are consistent with a neurodevelopmental model of schizophrenia and with the hypothesis of shared environmental risk factors between ADHD and schizophrenia-spectrum disorders. Childhood ADHD symptoms in schizophrenia-spectrum disorders appear to be an epiphenomenon of obstetric complications and early neurodevelopment delay with no further influence on the clinical expression of the illness.Biological Psychiatry 10/2010; 126(1-3):28-35. · 8.28 Impact Factor -
Article: Motor behavior abnormalities in drug-naïve patients with schizophrenia spectrum disorders.
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ABSTRACT: Prevalence and correlates of primary motor abnormalities in schizophrenia are presently ill defined. This study was aimed at examining the prevalence, syndromic structure, external correlates, and response to antipsychotic medication of a broad array of primary motor abnormalities. Two-hundred antipsychotic-naive patients with schizophrenia spectrum disorders were examined for motor abnormalities using the Modified Rogers Scale. Thirty-one motor signs were subjected to factor analysis, and the resulting factors examined for association with a number of risk factors, clinical and psychopathological variables. One-hundred and eighty-nine patients were reassessed for motor abnormalities after completing a 4-week trial with antipsychotic medication. Prevalence rates for at least one motor sign and syndrome at baseline were 66% and 40%, respectively. Motor signs clustered together into seven clinically interpretable factors: abnormal involuntary movements, hypokinesia, retarded catatonia, echo-phenomena, excited catatonia, catalepsy, and parkinsonism. All motor domains but parkinsonism were inter-related. Abnormal involuntary movements were associated with variables indicating both neurodevelopmental dysfunction and illness severity, and most motor domains were closely related to negative or disorganization symptoms. Change scores in motor domains after treatment with antipsychotic medication indicated improvement for abnormal involuntary movements, hypokinesia, retarded catatonia, excited catatonia and echophenomena, and worsening for parkinsonism. It is concluded that primary motor dysfunction is a prevalent and heterogeneous condition of schizophrenia. Motor abnormalities segregate into various syndromes, which have different clinical correlates and a differential response pattern to antipsychotic medication. It is hypothesized that the existence of a differential dopaminergic dysfunction in the nigroestriatal circuitry is responsible for the generation of those motor domains that improve and worsen with antipsychotic drugs.Movement Disorders 03/2010; 25(8):1068-76. · 4.51 Impact Factor
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2010–2013
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Complejo Hospitalario de Navarra
Pamplona, Navarre, Spain
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