Soft neurological signs in schizoaffective disorder – Indicator of psychotic spectrum or diagnostic bias (case report)

Abstract

Introduction

Neurological soft signs (NSS) refer to a group of neurological deficits with no apparent pathognomonic supstrate and comprise phenomena such as disorders of simple motor coordination, sensory integration, as well as disinhibition sings. Schizophrenia and other neuropsychiatric disorders are associated with a higher prevalence of NSS.

Case summary

A 21-year-old male presented to our hospital with symptoms including anxiety, delusions, mood alterations, insomnia, and hypomania. Neurological assessment revealed presence of soft neurological signs. Personal history was positive for hypoxic birth injury and psychiatric heredity. During his stay, the patient showed not only partial response to treatment during several months, but also extrapyramidal symptomatology (limb hypertonia, decreased associated movements during walking, arm dropping, and rigidity of the neck, as well as elevated blood levels of CK, CRP, and high body temperature). There was no progression of NSS. The addition of valproate to antipsychotic treatment led to mild improvement. An MRI exam indicated presence of lesions in the white mass.

Discussion

Although NSS have been more frequently associated with schizophrenia, especially in patients with dominant negative symptoms, there are findings, which suggest their presence in schizoaffective and bipolar disorders. Their presence is often an indicator of poor outcome, they can resemble EPS, and their association with frequency and severity of EPS is unclear.

Conclusion

The presence of NSS is not enough to discriminate schizoaffective disorder, a “vague” diagnosis from others in what is considered the psychotic spectrum.

Disclosure of interest

The authors have not supplied their declaration of competing interest.