Sains Malaysiana 42(3)(2013): 381–388

Motor Neurological Soft Signs Among Patients with Schizophrenia: A Clinical Significance

(Petanda tidak Ketara Neurologi Motor Tidak Ketara dalam Kalangan Pesakit

Skizofrenia: Satu Kepentingan Klinikal)

Hazli Zakaria¹*, Nik Ruzyanei Nik Jaafar¹, Azlin Baharuddin¹, Normala Ibrahim² & Marhani Midin¹

¹Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre

Jalan Yaakob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia

²Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

43400 Serdang Selangor D.E. Malaysia

Received: 27 June 2012/Accepted: 10 July 2012

ABSTRACT

Neurological soft signs (NSS) are subtle indicators of brain dysfunction which are present in excess among patients with schizophrenia. Its clinical significance remains unclear despite extensive researches in this area. The objective of this work was to determine the proportion of Schizophrenia patients who have motor NSS and then to compare the clinical features between these two groups; with and without motor NSS. This cross-sectional study which utilized the brief motor scale (BMS) was used to investigate the presence of motor NSS in 80 schizophrenia patients who attended Universiti Kebangsaan Malaysia Medical Centre (UKMCC) Psychiatric clinic. The diagnosis of Schizophrenia was confirmed by mini international neuropsychiatic interview (MINI). Symptomatology and abnormal motor movement were assessed using the brief psychiatric rating scale (BPRS) and abnormal involuntary movement scale (AIMS), respectively. A brief battery of cognitive tests covering aspects of attention, working memory and executive function was administered. The bivariate analyses were applied to look for any relationship between the study factors. Majority of schizophrenia patients (68.8%) in this study have motor NSS. The motor NSS were associated with ethnic group, level of education, age of onset, duration of illness and performance in cognitive assessment; verbal fluency, digit span forward, digit span backward and trail making B (p<0.05) but not with trail making A. The assessment of motor NSS represents a brief, inexpensive and meaningful tool in assessing the cognitive functions in schizophrenia. It has the potential as an illness marker and a link between neurobiological research and clinical practice.

Keywords: Cognitive function; neurological soft signs (NSS); schizophrenia

ABSTRAK

Tanda-tanda neurologi yang tidak ketara (NSS) merupakan petunjuk samar-samar disfungsi otak yang agak sukar dikesan tetapi dialami oleh ramai pesakit skizofrenia. Walaupun telah banyak kajian dijalankan, kepentingan klinikal tanda-tanda ini masih tidak jelas. Objektif kajian adalah untuk menentukan kadar pesakit skizofrenia yang mengalami NSS motor yang tidak ketara dan kemudian membandingkan tahap sosio-demografi, ciri-ciri klinikal dan fungsi kognitif antara dua kumpulan; kumpulan yang mempunyai NSS yang tidak ketara dan kumpulan yang tidak mengalaminya. Ini adalah kajian keratan-lintang yang menggunakan skala motor ringkas (BMS) untuk menentukan kehadiran NSS motor yang tidak ketara ke atas 80 pesakit skizofrenia yang hadir ke klinik pesakit luar psikiatri, PPUKM. Diagnosis pesakit telah disahkan dengan menggunakan temuduga neuropsikiatrik antarabangsa mini (MINI). Gejala penyakit telah diperiksa dengan skala kedudukan psikiatri ringkas (BPRS) dan pergerakan motor yang tidak normal telah diuji dengan skala gerakan luar kawal tak normal (AIMS). Pesakit juga mengambil ujian kognitif ringkas yang meliputi aspek perhatian, ingatan pintas dan fungsi eksekutif. Keputusan yang diperoleh telah dibandingkan antara dua kumpulan ini. Analisis bivariat telah dijalankan untuk mencari sekiranya ada hubungan antara skor BMS, sosio demografi, ciri-ciri klinikal dan fungsi kognitif. Kadar pesakit skizofrenia yang mempunyai NSS motor yang tidak ketara ini adalah tinggi (68.8%). NSS motor yang tidak ketara berhubung kait dengan kumpulan etnik, tahap pendidikan, umur diagnosis, tempoh penyakit dialami dan juga prestasi ujian kognitif (p<0.05). Pemeriksaan NSS motor yang tidak ketara adalah teknik yang ringkas, murah dan berkesan untuk memeriksa fungsi kognitif pesakit skizofrenia. Ia berpotensi digunakan sebagai penanda penyakit dan menjadi penghubung antara kajian neurobiologi dan klinikal.

Kata kunci: Fungsi kognitif; skizofrenia; tanda-tanda neurologi motor (NSS)

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*Corresponding author; email: chermzak@yahoo.com