Bulgarian Journal of Psychiatry, 2020; 5(3):25-34


Kaloyan Guevara1, 2, Georgi Onchev2

1Mental Health Centre “Prof. N. Shipkovenski” – Sofia
2Department of Psychiatry and Medical Psychology, Medical University – Sofia

Abstract. Neurological soft signs (NSS) are a neuropsychiatric phenomenon significantly modulated by the cortical-thalamic-cerebellar-cortical circuit, the basal ganglia, and by certain cortical areas. The local gyrification index and the ventricular – brain ratio are altered in patients with schizophrenia, and the pathology underlying these markers affects NSS expression. NSS are positively associated with negative symptoms which, when taken together, are of important predictive value for the course of the disorder. Neuroleptic therapy has neuroprotective effect and decreases NSS overall values, especially in first episode and remitting patients. The extrapyramidal symptoms caused by antipsychotics and NSS do not have significant correlation, and the former might be of genuine origin. Extrapyramidal symptoms are a sign of more severe, deficit, and treatment-resistant form of the disorder. NSS are strongly associated with all neuropsychological domains but not with the short-term and semantic autobiographical memory. There is a variety of tools for NSS assessment, but the Neurological Evaluation Scale has the most optimal psychometric properties. The trait and state characteristics of the NSS provide valuable information about the course of schizophrenia, which may be helpful in the choice of treatment approach.

Key words: schizophrenia, neurological soft signs 

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