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Neurological signs at the first psychotic episode as correlates of long-term outcome: results from the AESOP-10 study

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Naika Ferruccio, Sarah Tosato, Julia Lappin, Margaret Heslin, Kim Donoghue, Annalisa Giordano, Ben Lomas, Ulrich Reininghaus, Adanna Onyejiaka, Raymond C. K. Chan, Tim Croudace, Peter B. Jones, Robin Murray, Paul Fearon, Gillian A. Doody, Craig Morgan, Paola Dazzan

Original languageEnglish
JournalSchizophrenia Bulletin
Publication statusAccepted/In press - 2020

King's Authors

Abstract

Minor neurological signs are subtle deficits in sensory integration, motor coordination and sequencing of complex motor acts, present in excess in the early stages of psychosis. Still, it remains unclear whether at least some of these signs represent trait or state markers for psychosis, and whether they are markers of long-term disease outcome of clinical utility.

We examined the relationship between neurological function at illness onset assessed with the Neurological Evaluation Scale, and subsequent illness course in 233 patients from AESOP-10, a 10-year follow up study of a population-based cohort of individuals recruited at the time of their first episode of psychosis in the UK. In 56 of these patients we also explored changes in neurological function over time. We included a group of 172 individuals without psychosis as controls.

After ten years, 147 (63%) patients had developed a Non-Remitting course of illness, and 86 (37%) a Remitting course. Already at first presentation, patients who developed a Non-Remitting course had significantly more Primary, Motor Coordination, and Total signs than both Remitting patients and healthy controls. While Motor Coordination signs did not change over time, rates of Primary, Sensory Integration and Total signs increased, independently of illness course type.

These findings suggest that motor coordination problems could be a useful early, quick and easily detectable marker of subsequent clinical outcome. With other motor abnormalities, a measure of motor incoordination could contribute to the identification of the most vulnerable individuals, who could benefit from targeted and more assertive treatment approaches.

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