Jeroen Koning

Dyskinesia and parkinsonism in antipsychotic-naive patients with schizophrenia, first-degree relatives and healthy controls: a meta-analysis.

BACKGROUND Several studies have reported the presence of dyskinesia and parkinsonism in antipsychotic-naive patients with schizophrenia as well as in their first-degree relatives. These movement disorders may therefore form an integral part of the illness and its (genetic) liability. METHOD A systematic search was conducted in the Medline, EMBASE, and PsychINFO databases to identify studies reporting on dyskinesia and parkinsonism assessed in antipsychotic-naive patients with schizophrenia (n = 213) and controls (n = 242) and separately in nonill first-degree relatives (n = 395) and controls (n = 379). Effect sizes were pooled using random-effect models to calculate odds ratios (ORs) to compare the risk of these movement disorders among patients and healthy relatives each with matched controls. RESULTS Antipsychotic-naive schizophrenia was found to be strongly associated with dyskinesia (OR: 3.59, 95% confidence interval [CI]: 1.53-8.41) and parkinsonism (OR: 5.32, 95% CI: 1.75-16.23) compared with controls. Dyskinesia and parkinsonism were also significantly more prevalent in healthy first-degree relatives of patients with schizophrenia as compared with healthy controls (OR: 1.38, 95% CI: 1.06-1.81, and OR: 1.37, 95% CI: 1.05-1.79, respectively). CONCLUSION The results suggest that movement disorders, and by inference abnormalities in the nigrostriatal pathway, are not only associated with schizophrenia itself but may also be related to the (genetic) risk of developing the disease.

Movement disorders in nonpsychotic siblings of patients with nonaffective psychosis

Movement disorders such as dyskinesia and Parkinsonism have frequently been reported in (drug-naïve) patients with nonaffective psychosis. Therefore movement disorders may be related to schizophrenia. Siblings of patients with nonaffective psychosis also appear to have subtle forms of movement disorders. This suggests that motor abnormalities may also be related to the risk of developing the disease. Subtle forms are not always detected with the use of the standard observation-based clinical rating scales, which are less sensitive than mechanical instrument measurement. This study compared the presence and severity of dyskinesia and Parkinsonism in 42 non-psychotic siblings of patients with nonaffective psychosis and in 38 controls as measured by mechanical instruments and clinical rating scales. There were no significant differences in movement disorders between siblings and controls on the basis of clinical assessments. However, mechanical measurements indicated that siblings compared to controls displayed significantly more dyskinesia and Parkinsonism signs. These results suggest that motor signs could be markers of vulnerability for psychosis or schizophrenia. In addition this study shows that mechanical instrument measurement of movement disorders is more sensitive than assessment with clinical rating scales. Therefore, it may be used in screening programs for populations at risk for psychosis.

Movement disorders are associated with schizotypy in unaffected siblings of patients with non-affective psychosis.

BACKGROUND Movement disorders and schizotypy are both prevalent in unaffected siblings of patients with schizophrenia and both are associated with the risk of developing psychosis or schizophrenia. However, to date there has been no research into the association between these two vulnerability factors in persons with an increased genetic risk profile. We hypothesized that unaffected siblings of patients with non-affective psychosis have more movement disorders and schizotypy than healthy controls and that these co-occur. METHOD In a cross-sectional design we assessed the prevalence and inter-relationship of movement disorders and schizotypy in 115 unaffected siblings (mean age 27 years, 44% males) and 100 healthy controls (mean age 26 years, 51% males). Movement disorders were measured with the Abnormal Involuntary Movement Scale (AIMS), the Unified Parkinson Disease Rating Scale (UPDRS), the Barnes Akathisia Rating Scale (BARS), and one separate item for dystonia. Schizotypy was assessed with the Structured Interview for Schizotypy--Revised (SIS-R). RESULTS There were significant differences in the prevalence of movement disorders in unaffected siblings versus healthy controls (10% v. 1%, p<0.01) but not in the prevalence of schizotypy. Unaffected siblings with a movement disorder displayed significantly more positive and total schizotypy (p=0.02 and 0.03 respectively) than those without. In addition, dyskinesia correlated with positive schizotypy (r=0.51, p=0.02). CONCLUSIONS The association between movement disorders (dyskinesia in particular) with positive and total schizotypy in unaffected siblings suggests that certain vulnerability factors for psychosis or schizophrenia cluster in a subgroup of subjects with an increased genetic risk of developing the disease.

Instrument measurement of lingual force variability reflects tardive tongue dyskinesia

Tardive tongue dyskinesia is often under-diagnosed or misdiagnosed. Instrument measurement of lingual force variability may be a valid and reliable method for assessing tardive tongue dyskinesia. Instrument measurement of lingual force variability was compared to the clinical level of tardive tongue dyskinesia and total body dyskinesia as measured by the Abnormal Involuntary Movement Scale (AIMS) in 35 subjects: 23 patients with a psychiatric disorder using antipsychotics, of which 11 were with and 12 were without tardive tongue dyskinesia, and 12 age- and gender-matched healthy controls. Lingual force variability correlated with tardive tongue dyskinesia (Spearman r = 0.56; p < 0.01) and with total dyskinesia (r = 0.47; p = 0.02); there was no association with age, antipsychotic dose, or psychiatric diagnosis. Instrument test-retest reliability corresponded with an ICC of 0.85 p < 0.0001. Instrument measurement of lingual force variability is a valid and reliable method for assessing tardive tongue dyskinesia.

Instrumental measurements of spontaneous dyskinesia and schizotypy in subjects with auditory verbal hallucinations and healthy controls

Spontaneous dyskinesia is associated with non-affective psychosis. Few studies investigated dyskinesia in individuals with subclinical psychotic experiences. We examined dyskinesia using instrumental measurements of force variability in 34 individuals with frequent auditory verbal hallucinations but without a clinical psychotic disorder and 31 matched healthy controls. Schizotypy was assessed using the Schizotypal Personality Questionnaire. We found a positive correlation between dyskinesia and schizotypy in the total group. In addition, when using a cut-off point based on the 95th percentile of force variability in the control group, we found a greater proportion of subjects with dyskinesia in the group with auditory verbal hallucinations than in the control subjects. Current findings are in agreement with the concept of psychosis as a continuous phenomenon and with movement disorders being an integral part of psychosis.

SPONTANEOUS DYSKINESIA AND PARKINSONISMIN SCHIZOPHRENIA AND THEIR SIBLINGS. A SYSTEMATIC REVIEWAND META-ANALYSIS

Introduction: Schizophrenia and first-episode psychosis increase risk for depression, self-harm and suicide. To date, most available reports focus on adult patients with schizophrenia and/or first episode psychosis. Objectives: Our hypothesis was that first episode psychosis, a prodromic event often leading to chronic schizophrenia, is associated with an increased risk for depression and suicidal behavior. Methods: We studied patients admitted to a pediatric inpatient psychiatric unit between 2003-2006. Patients (n=102) were diagnosed with new-onset psychosis using DSM-IV TR criteria for Psychosis NOS, schizophreniform disorder or schizoaffective disorder. Patients were matched for age, race and gender with non-psychotic inpatient controls within the same unit (n=102). Study participants were administered the BPRS-C to assess severity of psychiatric symptoms. The suicidality subscale was analyzed separately. An inventory of 127 variables established patient history, substance abuse, violence, legal history, psychiatric symptoms and medication, among other variables. Results: Thirty two percent of the patients had attempted suicide, 104 total suicide attempts in a group of 102 patients. Individuals with depression were found to be 2.8 times more likely to attempt suicide than those without. Duration of Untreated Psychosis increased the risk of the severity of the suicide attempt in our group. Conclusions: Our results are double of those identified in adult studies. Depression was the second most frequent comorbidity in this patients (n=36), and ADHD the first (n=49). It is imperative to address depressive symptoms in children and adolescents with first episode psychosis or schizophrenia to prevent potential suicidal behavior.