Determinants of neurological dysfunction in first episode schizophrenia

Background. Although it is well recognized that individuals with schizophre nia display evidence of subtle neurological impairment, its aetiopathologic al and clinical significance continues to be unclear. Methods. Patients presenting with a first episode of schizophrenia or schiz ophreniform psychosis (DSM-IV criteria) were examined using two previously validated neurological examinations. The majority (N = 35) were examined pr ior to their 'first ever' dose of neuroleptic while the remaining patients (N = 21) had been medicated for less than one month. The manner in which ne urological functioning is influenced by symptomatology and handedness was a scertained. Results. The majority of patients who were examined neuroleptic-naive displ ayed evidence of neurodysfunction. A combination of relative hand preferenc e and symptomatology explained a significant proportion of the variance in neurological functioning. Mixed handedness among adults at the time of firs t presentation with schizophrenia was associated with more severe neurologi cal impairment and a history of poorer scholastic attainment and pre-morbid social adjustment. Conclusions. Neurological soft signs are an intrinsic part of schizophrenia rather than a direct consequence of treatment. Early developmental process es are associated with the level of subsequent neurological impairment in f irst episode schizophrenia. However, symptomatology appears to have an infl uence on the apparent severity of neurological impairment.