PREVALENCE
Early studies estimated the prevalence of NSS in patients with schizophrenia to be between 50% and 65%, compared with 5% in control groups.[14,15] However, many of these studies were limited by possible confounds of prior neuroleptic medications and illness chronicity. Early studies divided neurological dysfunction into “hard” and “soft” signs. The hard signs included pathological reflexes, cranial nerve abnormalities, motor weakness, unilateral sensory impairment and movement disorders, whereas the soft signs included agraphaesthesia, stimulus extinction and right left confusion.[16] Studies also compared neurological signs between patients with schizophrenia, bipolar disorder, alcohol and drug abuse, and healthy controls where the raters were blind to the diagnosis. It was found that patients with schizophrenia had more of these signs than the other patients as well as controls.[17]
A 2009 meta-analysis of NSS in schizophrenia which reviewed 33 studies in this area found that on average, 73% of patients with schizophrenia perform outside the range of healthy subjects on aggregate NSS measures.[18]
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Relatives of patients with schizophrenia have been found to have significantly greater neurological signs than healthy controls although lesser than patients, suggesting familial basis for these abnormalities.[19] A systematic review and meta-analysis published in 2009 used the Comprehensive Meta-Analysis software package to quantify group differences between schizophrenia patients, non-psychotic relatives of patients, and healthy controls. Quantification of NSS differences yielded a mean effect size of 0.81 for schizophrenia patients and their non-psychotic relatives, and 0.97 for non-psychotic relatives of schizophrenia patients and healthy controls. This study confirmed large group differences in NSS prevalence between patients with schizophrenia, non-psychotic relatives, and healthy controls.[20]
A major problem had been the inconsistent composition of neurological scales and subscales.[10,14] However, most recent studies have used the standardized version of the Neurological Evaluation Scale (NES),[21] the Cambridge Neurological Inventory (CNI),[22] or the Heidelberg Scale.[23] The NES, which has been used by the maximum number of studies, is a 30-item scale with ratings from 0 to 2 for each item, including Annett’s handedness questionnaire. The Brief Motor Scale (BMS) is a recently developed scale which offers faster assessment with good sensitivity and specificity.[24] The recent upsurge of interest in the cerebellum has led to the use of separate scales for cerebellar signs, like the International Cooperative Ataxia Rating Scale (ICARS).[25]
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