Héla Slama

University Hospital of Monastir, Al Munastīr, Al Munastīr, Tunisia

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Publications (15)14.58 Total impact

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    ABSTRACT: Minor physical anomalies (MPAs) have been consistently reported to be more frequent in schizophrenia subjects. Limited research has been conducted on these anomalies among biological relatives of patients with schizophrenia. The aims of this study were to investigate the MPAs in a Tunisian population: subjects with schizophrenia, their healthy siblings and control subjects. This study hypothesized that the mean MPAs score would be greater in patients than controls and that siblings would have intermediate scores. Furthermore, it was hypothesized that MPAs scores would be associated with negative and disorganised symptoms of schizophrenia. METHODS: We assessed 93 subjects with schizophrenia, 59 of their healthy siblings and 71 healthy controls, matched on gender and age. MPAs were assessed through use of a standardized scale derived from the Waldrop Scale [D. Gourion, G. Viot, C. Goldberger, M. Cartier, M.C. Bourdel, M.F. Poirier, J.P. Olié, H. Lôo, M.O. Krebs, 2001. French validation of a Minor Morphologic Anomalies Scale in schizophrenic patients and their parents. Encephale 27, 143-147]. The schizophrenia psychopathology was evaluated by the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the Clinical Global Impression-Severity (CGI-S). RESULTS: Subjects with schizophrenia showed significantly higher MPAs score than siblings (4.6±2.8 vs. 3.0±2.1, p<0.0001) and controls groups: 1.9±1.5 (p<0.0001). Siblings had significantly higher score than control subjects (p=0.02). MPAs were correlated negatively with age of onset of the disease, and age of first hospitalisation, and positively with number of hospitalisations. Positive correlations were found between MPAs and PANSS total score, PANSS negative sub-score and CGI-S score. COMMENTS: Results of this study showed that MPAs are more frequent in subjects with schizophrenia and their siblings compared to control subjects. Positive correlations were found between MPAs, age of onset, severity of illness, and negative symptoms of schizophrenia, suggesting that those anomalies are correlated to severe form of schizophrenia.
    Comprehensive psychiatry 01/2013; · 2.08 Impact Factor
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    ABSTRACT: This study aimed to explore the relationship between antioxidant enzyme activities and neurological soft signs (NSS) in a sample of patients with schizophrenia. Sixty clinically stable patients with schizophrenia treated mostly by first-generation antipsychotics and 30 matched healthy controls were recruited. NSS were assessed in two groups by a standardized neurological examination (Krebs et al., 2000). The red blood cell (RBC) antioxidant activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) were measured by spectrophotometry. RBC activities of all enzymes studied: SOD, GSH-Px and CAT, were significantly lower in the patients compared to control group. All NSS scores were significantly higher in the patients compared to healthy controls' scores. In the patients, a negative correlation was found between RBC SOD activity and NSS total score and motor coordination and motor integration sub-scores. The association between low SOD activity as a marker of oxidative stress and NSS in schizophrenic patients suggests a common pathological process of these abnormalities.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 05/2012; 39(1):52-6. · 3.55 Impact Factor
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    ABSTRACT: The objective of this study was to examine the correlations between a history of obstetric complications (OC) and neurological soft signs (NSS) in Tunisian patients with schizophrenia. Forty-six patients were assessed using the Krebs et al. NSS scale. History of OC was obtained from the patients' mothers using the McNeil–Sjöström scale. Although there was no significant difference in NSS between patients with and without OC, there were negative correlations between OC total score and motor coordination and integration sub-scores. These negative correlations suggest that OC could enhance the effects of genetic risk factors for schizophrenia.
    Psychiatry and Clinical Neurosciences 12/2010; 64(6):645-8. · 2.04 Impact Factor
  • Schizophrenia Research - SCHIZOPHR RES. 01/2010; 117:318-319.
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    ABSTRACT: The objectives were to determine the neurological soft signs (NSS) scores in unaffected siblings of patients with schizophrenia compared with healthy controls and to examine their relationships with schizotypal dimensions. Participants comprised 31 unaffected siblings of patients with schizophrenia and 60 healthy controls matched according to age, gender and school level who were assessed by the Schizotypal Personality Questionnaire (SPQ) and the Krebs et al. NSS Scale. Higher NSS total scores and sub-scores were found in the unaffected siblings compared with the controls. The SPQ total score was significantly higher in unaffected siblings compared with control subjects. The NSS total score was positively correlated with the SPQ total score and the SPQ disorganization sub-score in unaffected siblings of patients with schizophrenia. Additionally, in unaffected siblings, motor coordination and integration abnormalities were positively correlated with the SPQ total score and the cognitive-perceptual sub-score. Motor integration abnormalities were also correlated with the SPQ disorganization sub-score. These results reveal that NSS, especially motor signs, are associated with some schizotypal dimensions in siblings of patients with schizophrenia, suggesting the value of using both assessments to study high risk populations.
    Psychiatry Research 12/2009; 175(1-2):22-6. · 2.68 Impact Factor
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    ABSTRACT: Recent studies have suggested that ethnicity and socioeconomic status may have an impact on the frequency and significance of neurological soft signs (NSS). However, this impact has not been adequately assessed. The objectives were to determine the NSS scores in patients with schizophrenia and their unaffected siblings and to examine the clinical and therapeutic correlates of NSS in two ethnic and socioeconomic distinct populations. Two independent replicate studies were carried out: (1) a French Caucasian sample of 69 patients with schizophrenia, 43 of their unaffected siblings and 108 control subjects; (2) a Tunisian sample of 66 patients with schizophrenia, 31 of their unaffected siblings and 60 control subjects. NSS were assessed with a multidimensional scale, previously validated in drug-naïve and treated samples of patients with schizophrenia. Both patient groups were assessed with the positive and negative syndrome scale (PANSS), the clinical global impressions (CGI) and the global assessment of functioning. NSS total scores were significantly higher in patients with schizophrenia comparatively to siblings and to controls in both studies. The two sibling groups had also higher NSS scores than controls. In addition, NSS total scores were correlated to the PANSS negative and disorganization sub-scores, to the CGI-severity of illness and to a low educational level in both studies. These studies provide a confirmation in two distinct samples of the high prevalence of NSS in patients with schizophrenia, and in their biological relatives, independently of their respective ethnic and socioeconomic origins.
    European Archives of Psychiatry and Clinical Neuroscience 03/2009; 259(4):218-26. · 3.36 Impact Factor
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    ABSTRACT: Neurological soft signs (NSS) are subtle neurological signs indicating non specific cerebral dysfunction. Several studies have found an excess of NSS in schizophrenic patients compared to healthy subjects. Although NSS have been consistently reported in schizophrenic patients, their clinical relevance and their relation to functional impairment and severity of this disease are not well-clarified. In addition, the presence of NSS in schizophrenic patient's relatives suggests that they could be associated with the genetic liability. To determine the prevalence and scores of NSS in schizophrenic patients and their nonaffected siblings and to examine the clinical correlates of NSS in the schizophrenic patients. Sixty-six schizophrenic patients (50 males and 16 females, mean age=31.16+/-7.17 years), were compared to 31 of their nonaffected siblings (22 males and nine females, mean age=32.19+/-5.88 years) and to 60 controls subjects (40 males and 20 females, mean age=30.70+/-6.54 years) without family psychiatric history. NSS were assessed with Krebs et al.'s neurological soft signs scale. It is a comprehensive and standardized scale consisting of 23 items comporting five factors: motor coordination, motor integration, sensory integration, quality of lateralization and involuntary movements or posture. The Simpson and Angus scale for extrapyramidal symptoms was also rated. Clinical assessment of the schizophrenic patients was conducted using the positive and negative syndrome scale (PANSS), clinical global impressions (CGI) and global functioning evaluation (GAF). Psychiatric disorders were ruled out among siblings of schizophrenic patients and control subjects by psychiatric review evaluation, according to the DSM-IV check list. When the total NSS score of 11.5 was considered the cut-off point, the prevalence of NSS was 96.9% in the schizophrenic patients versus 35.5% in the nonaffected siblings (p<0.0001). Schizophrenic patients had also significantly higher NSS total score and subscores than the siblings and control groups. The NSS total score was 19.51+/-5.28 in the schizophrenic patients, 10.77+/-3.38 in their nonaffected siblings and 4.23+/-2.07 in control subjects (p<0.0001). The NSS total score and subscores in the siblings group were intermediate between those of the schizophrenic patients and those of the control subjects. The motor coordination, motor integration and sensory integration subscores were higher in schizophrenic patients and their nonaffected siblings. The NSS total score correlated positively with the negative (p<0.0001) and disorganization symptoms (p=0.001) subscores and total score of PANSS (p=0.004). The PANSS total score and negative and disorganization subscores also correlated positively with the motor integration and quality of laterality subscores of NSS. The NSS total score was significantly correlated with severity of illness (p<0.0001), lower educational level (p=0.002) and poor global functioning (p=0.003). The association between NSS with negative and disorganization dimensions of schizophrenia supports that neurological dysfunction is an intrinsic characteristic of the illness and may distinguish a subgroup of patients with poor illness course and outcome. The NSS could be a trait marker useful in phenotypic characterization of schizophrenic patients and identification of vulnerability in genetically high-risk subjects.
    L Encéphale 11/2008; 34(5):483-9. · 0.49 Impact Factor
  • Schizophrenia Research - SCHIZOPHR RES. 01/2008; 98:152-152.
  • Schizophrenia Research - SCHIZOPHR RES. 01/2008; 98:35-35.
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    ABSTRACT: Early onset schizophrenia is commonly considered as severe, resistant to treatment, and associated with a poor prognosis. It offers an interesting field of research for the neuro-developmental theory of schizophrenia, which hypothesises a link between some neuro-developmental markers such as physical and neurological anomalies, morphological brain abnormalities, and specific cognitive disturbances, with the existence of a vulnerability to a further occurrence of schizophrenic disorders. These markers, proved to be more common in schizophrenic patients, are considered by some authors as endophenotypes of schizophrenia. The objective of this study was to specify the clinical and endophenotypical features of early-onset schizophrenia. A comparative study was carried out on two groups of patients with schizophrenia according to DSM-IV criteria, who were systematically recruited from the outpatient clinic of psychiatry of the University Hospital of Monastir during the second semester of 2003. Patients who did not meet exclusion criteria (age over 50 years at study time, age of onset between 15 and 20, medical history of cranial trauma, evidence of cerebral disorders or mental retardation, addiction to alcohol or to psychoactive substances) were divided into 2 groups: Group I: onset before the age of 14 (N = 15). With a mean age at the time of the study of 20.8 ± 8.1 years and a gender distribution of 8 male vs 7 female patients; and Group II: onset after the age of 20 (N = 35), with a mean age at the time of the study of 34.6 ± 6.2 years and a predominance of male patients (80 %). The following tests were administered to both groups: Positive and Negative Syndrome Scale (PANSS), Evaluation of Global Functioning (EGF), Clinical Global Impressions (CGI), Minor Physical Anomalies Scale (MPAS) and Neurological Soft Signs (NSS). In the early-onset schizophrenia group, the disorganised subtype was predominant (60 %), in the second group the paranoid subtype was the most frequent (43 %) (P = 0.2). The severity of the disorder and of psychotic symptoms were more important in the early-onset schizophrenia group. Negative symptoms were predominant in group I (PANSS negative score = 30.6 ± 10.1 vs 24.9 ± 8.4 in group II) (P = 0.04). The physical and the neurological anomalies were more frequent in the early-onset group, with a total score of MPAS of 5.8 ± 2.8 vs 4.2 ± 2.4 (P = 0.04), and a score of NSS at 24.5 ± 6.1 vs 19.6 ± 5.4 (P = 0.006) respectively. These results show neurodevelopmental anomalies to be more common in early-onset schizophrenia, which could be interpreted as an association between early damages to the brain and occurrence of severe and early forms of schizophrenia. These findings highlight the probability of neurodevelopmental determinism in schizophrenia.
    Annales Médico-psychologiques, revue psychiatrique. 01/2008;
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    ABSTRACT: BackgroundNeurological soft signs (NSS) are subtle neurological signs indicating non specific cerebral dysfunction. Several studies have found an excess of NSS in schizophrenic patients compared to healthy subjects. Although NSS have been consistently reported in schizophrenic patients, their clinical relevance and their relation to functional impairment and severity of this disease are not well-clarified. In addition, the presence of NSS in schizophrenic patient's relatives suggests that they could be associated with the genetic liability.ObjectivesTo determine the prevalence and scores of NSS in schizophrenic patients and their nonaffected siblings and to examine the clinical correlates of NSS in the schizophrenic patients.MethodSixty-six schizophrenic patients (50 males and 16 females, mean age = 31.16 ± 7.17 years), were compared to 31 of their nonaffected siblings (22 males and nine females, mean age = 32.19 ± 5.88 years) and to 60 controls subjects (40 males and 20 females, mean age = 30.70 ± 6.54 years) without family psychiatric history.NSS were assessed with Krebs et al.'s neurological soft signs scale. It is a comprehensive and standardized scale consisting of 23 items comporting five factors: motor coordination, motor integration, sensory integration, quality of lateralization and involuntary movements or posture. The Simpson and Angus scale for extrapyramidal symptoms was also rated. Clinical assessment of the schizophrenic patients was conducted using the positive and negative syndrome scale (PANSS), clinical global impressions (CGI) and global functioning evaluation (GAF). Psychiatric disorders were ruled out among siblings of schizophrenic patients and control subjects by psychiatric review evaluation, according to the DSM-IV check list.ResultsWhen the total NSS score of 11.5 was considered the cut-off point, the prevalence of NSS was 96.9% in the schizophrenic patients versus 35.5% in the nonaffected siblings (p < 0.0001). Schizophrenic patients had also significantly higher NSS total score and subscores than the siblings and control groups. The NSS total score was 19.51 ± 5.28 in the schizophrenic patients, 10.77 ± 3.38 in their nonaffected siblings and 4.23 ± 2.07 in control subjects (p < 0.0001). The NSS total score and subscores in the siblings group were intermediate between those of the schizophrenic patients and those of the control subjects. The motor coordination, motor integration and sensory integration subscores were higher in schizophrenic patients and their nonaffected siblings. The NSS total score correlated positively with the negative (p < 0.0001) and disorganization symptoms (p = 0.001) subscores and total score of PANSS (p = 0.004). The PANSS total score and negative and disorganization subscores also correlated positively with the motor integration and quality of laterality subscores of NSS. The NSS total score was significantly correlated with severity of illness (p < 0.0001), lower educational level (p = 0.002) and poor global functioning (p = 0.003).ConclusionsThe association between NSS with negative and disorganization dimensions of schizophrenia supports that neurological dysfunction is an intrinsic characteristic of the illness and may distinguish a subgroup of patients with poor illness course and outcome. The NSS could be a trait marker useful in phenotypic characterization of schizophrenic patients and identification of vulnerability in genetically highy-risk subjects.
    L'Encéphale. 01/2008;
  • Schizophrenia Research - SCHIZOPHR RES. 01/2008; 98:151-152.
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    ABSTRACT: To appreciate the impact of the neuroleptic treatment on the neurological soft signs (NSS) in schizophrenic patients and to examine their relation with the treatment response based on the level of CGI-improvement. A cross-sectional study bearing on 66 schizophrenic patients: untreated patients (N = 13) and treated patients (N = 53). All patients were assessed by the Krebs et al. Neurological Soft Signs Scale and the Clinical Global Impressions (CGI). No difference has been noted concerning the NSS total score between treated and untreated schizophrenic patients. Concerning the NSS sub-scores, we have noted a significantly difference in the sensory integration sub-score. In treated patients, no correlation was found between NSS and daily dosage or duration of exposure of neuroleptic treatment, extrapyramidal symptoms and level of CGI-improvement. The excess of NSS in schizophrenic patients is independent of the neuroleptic treatment, suggesting that NSS represent a neurodevelopmental risk factor for schizophrenia.
    Thérapie 01/2007; 62(5):449-53. · 0.37 Impact Factor
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    ABSTRACT: Objectives: To appreciate the impact of the neuroleptic treatment on the neurological soft signs (NSS) in schizophrenic patients and to examine their relation with the treatment response based on the level of CGI-improvement. Methods: A cross-sectional study bearing on 66 schizophrenic patients: untreated patients (N = 13) and treated patients (N = 53). All patients were assessed by the Krebs et al. Neurological Soft Signs Scale and the Clinical Global Impressions (CGI). Results: No difference has been noted concerning the NSS total score between treated and untreated schizophrenic patients. Concerning the NSS sub-scores, we have noted a significantly difference in the sensory integration sub-score. In treated patients, no correlation was found between NSS and daily dosage or duration of exposure of neuroleptic treatment, extrapyramidal symptoms and level of CGI-improvement. Conclusion: The excess of NSS in schizophrenic patients is independent of the neuroleptic treatment, suggesting that NSS represent a neurodevelopmental risk factor for schizophrenia. Objectifs : Évaluer l'impact du traitement neuroleptique sur les signes neurologiques mineurs (SNM) chez des patients schizophrènes et examiner leur relation avec l'amélioration sous traitement. Méthodes : Il s'agit d'une étude transversale comparative, portant sur 66 patients schizophrènes, dont la majorité (78,8 %) était sous traitement neuroleptique. Treize patients n'étaient jamais traités ou en arrêt du traitement. Les SNM ont été évalués par l'échelle de Krebs et al. L'amélioration sous traitement a été appréciée par les impressions cliniques globales. Résultats : Il n'y avait pas de différence entre les patients traités et ceux non traités concernant les scores des SNM, à l'exception de celui de l'intégration sensorielle. Chez les patients traités, aucune corrélation n'a été trouvée entre SNM et posologie journalière ou durée du traitement neuroleptique, symptomatologie extrapyramidale et niveau d'amélioration sous traitement. Conclusion : Les SNM seraient un marqueur intrinsèque de la schizophrénie, plutôt stable et peu influencé par le traitement.
    http://dx.doi.org/10.2515/therapie:2007066. 01/2007;
  • Neuropsychiatrie de l Enfance et de l Adolescence 01/2006; 16.