Микроневрологична симптоматика при шизофрения // Microneurological symptoms in schizophrenia
Зареждане...
Дата
2024
Автори
Михалев, Калоян Мартин Гевара // Mihalev, Kaloyan Martin Guevara
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ISSN на списанието
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Издател
Медицински университет - София // Medical University - Sofia
Резюме
ЦЕЛ И ЗАДАЧИ
ЦЕЛТА на дисертационния труд е да:
• измери микроневрологични симптоми при пациенти с шизофрения и здрави контроли, чрез Неврологичната оценъчна скала, след което да установи дали тези симптоми са по-изразени в групата на болните.
• установи дали в групата на пациентите с шизофрения микроневрологичните симптоми имат корелация с изследваните демографски показатели, променливите свързани с боледуването, измеримата психопатологична симптоматика, терапията и дефицитите в лицевото разпознаване на емоции, както и дали изследваните величини имат предиктивна стойност спрямо микроневрологичните симптоми.
• установи дали дефицитите в лицевото разпознаване на емоции имат корелация с измеримата психопатологична симптоматика в групата на пациентите с шизофрения.
ЗАДАЧИ:
• Подбор на пациенти с шизофрения и здрави контроли спрямо изискванията за включващи и изключващи критерии.
• Изследване в двете целеви групи и събиране на данни спрямо дизайна на проучването.
• Съпоставяне на данните спрямо целите на изследването, чрез статистически методи и оформяне на резултатите.
• Анализ на резултати и обобщаване на изводите.
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SUMMARY
The microneurological symptoms (MNS) of schizophrenia are expressed through the neurological soft signs. These subtle neurological abnormalities are often found in psychiatric disorders and are indicative of their neurodevelopmental nature. They include deficits in sensory integration, motor coordination, sequencing of complex motor acts and other signs such as Romberg’s test, overflow movements, tremor, memory deficits, eye movements disorders and primitive reflexes. The main objective of the study is to investigate, evaluate, and compare the MNS (assessed with the Neurological Evaluation Scale) in patients with schizophrenia and healthy controls, followed by an analysis of the results. Furthermore, we aimed to examine the association between the MNS and the following variables in the patient sample group:
- sociodemographic variables (age, gender, years of education, parenting, intimate relationships, number of professional positions held, duration of employment);
- variables related to illness in schizophrenia (DUI, DUP, age at onset of first symptoms, age at diagnosis of schizophrenia, total number of hospitalizations, current therapy with dopamine/serotonin antagonists);
- psychopathological symptoms (assessed with the BPRS-E);
- facial emotion recognition deficits (assessed with the AKDEF);
The study involved 60 patients diagnosed with schizophrenia according to the ICD-10, as well as 60 healthy controls. The eligibility criteria specified that only individuals with ages falling between 18 and 65 years were included. The exclusion criteria included individuals with a history of neurological or systemic illness, traumatic head injury, substance abuse and dependence, mental retardation, electroconvulsive therapy within the last 12 months, and acute manifestations of suicidal or violent behavior.
The main findings and conclusions presented in the dissertation were:
• MNS in patients with schizophrenia are significantly more pronounced than in healthy controls. Further research should focus on their role in diagnosis, prognosis, and treatment.
• Schizophrenia patients had less years of education, fewer professional positions, shorter duration of employment, shorter relationships with partners, and were less likely to be parents than healthy controls. This highlights the interconnection between illness and environmental factors, such as social withdrawal and stigmatization.
• Within the group of patients, certain NES subscales and items were found to be correlated with each other. Further research could explore if certain symptoms co-occur together in schizophrenia patients, aiding in differential diagnosis.
• We discovered that there is a significant correlation between the duration of untreated illness (DUI) and the NES total score, while there is no significant correlation between the NES total score and the age at onset of first symptoms, the duration of untreated psychosis (DUP), age at diagnosis of schizophrenia, and the total number of hospitalizations. It is possible that the longer the period of untreated illness, the more substantial neurobiological changes occur, which may contribute to the manifestation of MNS. Delayed initiation of therapy can also result in functional impairments that may worsen MNS. Therefore, future studies that involve genetics and neuroimaging, in conjunction with accessible tools such as NES, would be valuable for early detection and treatment of the disorder.
• No significant correlation was observed between the NES total score and patients' gender or age. This finding partially discounts the influence of biological differences, socio-cultural factors, traumatic experiences and victimization, as well as socio-economic factors, on the manifestation of the MNS.
• Regarding the correlation between the MNS and psychopathological symptoms, we found the following:
1) a significant positive correlation between the negative symptoms and the total NES score. It is probable that the negative syndrome and the MNS have a shared neurodevelopmental origin and comparable neurobiological mechanisms, including abnormal cortico-subcortical circuits. Further longitudinal studies would provide more insight into this association, with the goal of predicting the progression of the illness early on;
2) BPRS-E total score has a significant positive correlation with NES total score, indicating the close link between general psychopathology and MNS. These two measures can be used as diagnostic and differential diagnostic tools when therapeutic hesitation is present;
3) positive and affective symptoms did not show significant correlations with the NES total score. Positive symptoms are most often the result of dopaminergic dysregulation at the level of the limbic system, affective symptoms, in turn, are explained by serotonergic deficits, while the MNS are a manifestation of a much more complex brain pathology. This result draws a line between the neurodevelopmental underpinnings of the disorder and the non-pathognomonic positive and affective symptoms.
• Facial emotion recognition deficits (FERD) were more pronounced in patients compared to healthy individuals, except for the recognition of happy faces. Within the schizophrenia patients group, FERD were significantly correlated with the NES total score, which is a unique finding not previously reported in scientific literature. These results can be explained by overlapping brain regions, common neurodevelopmental disorders, and similar impairments in the integration and processing of sensory information in a social setting.
• The results of stepwise regression analysis indicated that three models have a predictive value over the MNS. These models are: general psychopathology (BPRSE-E total) and FERD (AKDEF total); deficits in recognition of neutral, sad, and angry faces; negative symptoms, gender, and years of education. The predictors and their associations are likely due to the interplay between complex bio-psycho-social factors. Based on these findings, it can be deduced that early interventions aimed at strengthening protective factors such as education and social competences, and countering risk factors such as physiotherapy, pharmacotherapy, and discrimination, should be the focus of modern preventive strategies aimed at mental health.
• Olanzapine therapy demonstrated a significant negative correlation with NES total, revealing the possible protective effect of this dopamine/serotonin antagonist. Further studies are required in patients with first-episode psychosis to establish the protective effect of drug therapy on the neurobiological basis of the schizophrenia.
• There was a significant correlation between FERD (AKDEF) and general psychopathology (BPRS-E). This association may be related to the severity of symptoms, duration of the illness, overall neurocognitive functioning, and socio-cultural context.
Microneurological symptomatology is significantly more pronounced in patients with schizophrenia compared to healthy individuals. This manifests through a constellation of neurological soft signs and is probably explained by disturbed cerebellar-thalamic-cortical circuits, cognitive dysmetria, disturbed interhemispheric inhibition, reduced cortical thickness, white matter brain pathology, and neurotransmitter dysregulation due to neurodevelopmental disorders. These subtle neurological symptoms are not dependent on gender or age and are strongly associated with negative symptoms and DUI. Our study is the first to establish a relationship between the MNS and deficits in facial emotion recognition among schizophrenic patients. The MNS can be considered an endophenotype and have the potential to serve as a biomarker. Identifying and assessing these symptoms may aid in the early detection, prognostic assessment, and early intervention in schizophrenic patients. Future follow-up studies should focus on environmental influences, gene expression, and underlying brain pathology to achieve a deeper understanding of the sensorimotor disorders we investigated.
Описание
Ключови думи
нервна система - болести; главен мозък - патология; шизофрения; психиатрия; психични разстройства // nervous system diseases; brain - pathology; schizophrenia; psychiatry; mental disorders