Motor Deficits in Schizophrenia Quantified by Nonlinear Analysis of Postural Sway

Motor dysfunction is a consistently reported but understudied aspect of schizophrenia. Postural sway area was examined in individuals with schizophrenia under four conditions with different amounts of visual and proprioceptive feedback: eyes open or closed and feet together or shoulder width apart. The nonlinear complexity of postural sway was assessed by detrended fluctuation analysis (DFA). The schizophrenia group (n = 27) exhibited greater sway area compared to controls (n = 37). Participants with schizophrenia showed increased sway area following the removal of visual input, while this pattern was absent in controls. Examination of DFA revealed decreased complexity of postural sway and abnormal changes in complexity upon removal of visual input in individuals with schizophrenia. Additionally, less complex postural sway was associated with increased symptom severity in participants with schizophrenia. Given the critical involvement of the cerebellum and related circuits in postural stability and sensorimotor integration, these results are consistent with growing evidence of motor, cerebellar, and sensory integration dysfunction in the disorder, and with theoretical models that implicate cerebellar deficits and more general disconnection of function in schizophrenia.

[1]  E. Walker,et al.  Longitudinal progression of movement abnormalities in relation to psychotic symptoms in adolescents at high risk of schizophrenia. , 2008, Archives of general psychiatry.

[2]  J. Nadal,et al.  Calculation of area of stabilometric signals using principal component analysis , 1996, Physiological measurement.

[3]  Robin M. Murray,et al.  Neurological soft signs in first-episode psychosis: A systematic review , 2002, British Journal of Psychiatry.

[4]  Karl J. Friston.  The disconnection hypothesis , 1998, Schizophrenia Research.

[5]  F. Horak,et al.  Postural strategies associated with somatosensory and vestibular loss , 1990, Experimental Brain Research.

[6]  S. Crowe,et al.  The relationship between alcoholic cerebellar degeneration and cognitive and emotional functioning , 2008, Neuroscience & Biobehavioral Reviews.

[7]  H. Stanley,et al.  Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series. , 1995, Chaos.

[8]  Godfrey D. Pearlson,et al.  Endophenotypes in schizophrenia: A selective review , 2009, Schizophrenia Research.

[9]  Jerillyn S. Kent,et al.  Postural Control in Bipolar Disorder: Increased Sway Area and Decreased Dynamical Complexity , 2011, PloS one.

[10]  Carola Wicher,et al.  Influence of pathologic and simulated visual dysfunctions on the postural system , 2008, Experimental Brain Research.

[11]  P. Odenrick,et al.  Development of postural sway in the normal child. , 1984, Human neurobiology.

[12]  S. Kay,et al.  The positive and negative syndrome scale (PANSS) for schizophrenia. , 1987, Schizophrenia bulletin.

[13]  R.J. Robbins.  Challenges in the human genome project , 1992, IEEE Engineering in Medicine and Biology Magazine.

[14]  C. Tamminga,et al.  Effects of ketamine on leading saccades during smooth-pursuit eye movements may implicate cerebellar dysfunction in schizophrenia. , 2002, The American journal of psychiatry.

[15]  N. Andreasen.  A unitary model of schizophrenia: Bleuler's "fragmented phrene" as schizencephaly. , 1999, Archives of general psychiatry.

[16]  Tyrone D. Cannon,et al.  Striatal volumes and dyskinetic movements in youth at high-risk for psychosis , 2010, Schizophrenia Research.

[17]  William J. Marks,et al.  Deep Brain Stimulation Management: Abnormal Involuntary Movement Scale , 2010 .

[18]  P. Dazzan,et al.  Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review , 2008, Psychological Medicine.

[19]  Adolf Pfefferbaum,et al.  Balance and gait deficits in schizophrenia compounded by the comorbidity of alcoholism. , 2004, The American journal of psychiatry.

[20]  Fractal Fluctuations in Breath Number, Period, and Amplitude are Independently Controlled in Awake, Healthy Humans , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[21]  F. L. Mak,et al.  Soft neurological signs in schizophrenic patients and their nonpsychotic siblings. , 2000, The Journal of nervous and mental disease.

[22]  D. Manzoni,et al.  The cerebellum may implement the appropriate coupling of sensory inputs and motor responses: Evidence from vestibular physiology , 2008, The Cerebellum.

[23]  G. Venkatasubramanian,et al.  Cerebellar and other neurological soft signs in antipsychotic‐naïve schizophrenia , 2006, Acta psychiatrica Scandinavica.

[24]  A. Goldberger.  Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside , 1996, The Lancet.

[25]  Nancy C. Andreasen,et al.  Cerebellar dysfunction in neuroleptic naive schizophrenia patients: clinical, cognitive, and neuroanatomic correlates of cerebellar neurologic signs , 2004, Biological Psychiatry.

[26]  Karl J. Friston,et al.  Schizophrenia: a disconnection syndrome? , 1995, Clinical neuroscience.

[27]  F. Horak,et al.  Proprioception and Motor Control in Parkinson's Disease , 2009, Journal of motor behavior.

[28]  K. Mizukoshi,et al.  The contribution of proprioception to posture control in normal subjects. , 1993, Acta oto-laryngologica. Supplementum.

[29]  A. Burgess,et al.  Chlorpromazine equivalents: a consensus of opinion for both clinical and research applications , 1997 .

[30]  S. Paradiso,et al.  "Cognitive dysmetria" as an integrative theory of schizophrenia: a dysfunction in cortical-subcortical-cerebellar circuitry? , 1998, Schizophrenia bulletin.

[31]  T.E. Prieto,et al.  Postural steadiness and ankle joint compliance in the elderly , 1992, IEEE Engineering in Medicine and Biology Magazine.

[32]  Celso Arango,et al.  Significance and meaning of neurological signs in schizophrenia: two decades later. , 2005, Schizophrenia bulletin.

[33]  L. Schad,et al.  Reduced cerebellar volume and neurological soft signs in first-episode schizophrenia , 2005, Psychiatry Research: Neuroimaging.

[34]  E. Walker,et al.  Motor dysfunction and risk for schizophrenia , 1999, Development and Psychopathology.

[35]  N. Andreasen,et al.  Cerebellar functional abnormalities inSchizophrenia are suggested by classical eyeblink conditioning , 2000, Biological Psychiatry.

[36]  B. B. Andersen.  Reduction of Purkinje cell volume in cerebellum of alcoholics , 2004, Brain Research.

[37]  Paul M. Thompson,et al.  Cerebellar grey matter deficits in first-episode schizophrenia mapped using cortical pattern matching , 2010, NeuroImage.

[38]  B. O’Donnell,et al.  Eye-blink conditioning deficits indicate temporal processing abnormalities in schizophrenia , 2009, Schizophrenia Research.

[39]  C. Marvel,et al.  A quantitative measure of postural sway deficits in schizophrenia , 2004, Schizophrenia Research.

[40]  Göran Hajak,et al.  Gait disturbances in patients with schizophrenia and adaptation to treadmill walking , 2005, Psychiatry and clinical neurosciences.

[41]  K. M. Yazıcı,et al.  Neurological soft signs in schizophrenic patients and their nonpsychotic siblings , 2002, Schizophrenia Research.

[42]  S. Woods,et al.  Chlorpromazine equivalent doses for the newer atypical antipsychotics. , 2003, The Journal of clinical psychiatry.

[43]  G. Simpson,et al.  A RATING SCALE FOR EXTRAPYRAMIDAL SIDE EFFECTS , 1970, Acta psychiatrica Scandinavica. Supplementum.

[44]  William P. Hetrick,et al.  Timing dysfunctions in schizophrenia as measured by a repetitive finger tapping task , 2009, Brain and Cognition.

[45]  M. Kurtz.  Neurocognitive impairment across the lifespan in schizophrenia: an update , 2005, Schizophrenia Research.

[46]  Tyrone D. Cannon,et al.  Markers of Basal Ganglia Dysfunction and Conversion to Psychosis: Neurocognitive Deficits and Dyskinesias in the Prodromal Period , 2010, Biological Psychiatry.

[47]  J. Desmond,et al.  Contribution of alcohol abuse to cerebellar volume deficits in men with schizophrenia. , 2000, Archives of general psychiatry.

[48]  Stephen M Strakowski,et al.  MRI analysis of cerebellar vermal abnormalities in bipolar disorder. , 2005, The American journal of psychiatry.

[49]  M. Meyer,et al.  Self-affine fractal variability of human heartbeat interval dynamics in health and disease , 2003, European Journal of Applied Physiology.

[50]  E. Walker,et al.  Neuromotor precursors of schizophrenia. , 1994, Schizophrenia bulletin.

[51]  A. Goldberger,et al.  Loss of 'complexity' and aging. Potential applications of fractals and chaos theory to senescence. , 1992, JAMA.

[52]  T. Barnes.  A Rating Scale for Drug-Induced Akathisia , 1989, British Journal of Psychiatry.