Les objectifs de notre étude étaient de déterminer la prévalence, les scores, et la nature des signes neurologiques mineurs (SNM) et des anomalies physiques mineures (APM) chez des patients présentant un premier épisode psychotique et de rechercher les corrélations entre ces marqueurs et les caractéristiques des patients. Il s’agit d’une étude transversale portant sur 61 patients hospitalisés pour premier épisode psychotique. La procédure d’évaluation a consisté en la passation des échelles cliniques du fonctionnement prémorbide (PAS), des symptômes positifs et négatifs (PANSS), des impressions cliniques globales (CGI) et d’évaluation globale du fonctionnement (EGF) et des échelles des SNM de Krebs et al. et des APM de Gourion et al. La prévalence des SNM était de 83,6 % avec un score total moyen de 15,3±6,7. La prévalence des APM était de 62,7 % avec un score total moyen de 5,8±3,2. Des corrélations ont été trouvées entre les SNM et le mauvais fonctionnement prémorbide à la PAS, les dimensions négatives et de désorganisation à la PANSS, la gravité de la maladie à la CGI, l’altération du fonctionnement à l’EGF et les symptômes extrapyramidaux. Ces résultats rejoignent les données de la littérature rapportant des scores élevés des SNM et des APM chez les patients avec premier épisode psychotique. Les SNM, en particulier, semblent caractériser un processus physiopathologique plus sévère des troubles psychotiques et pourraient constituer un indicateur pronostique.

Over the last several decades, there has been an increasing number of neuroanatomical, neuroimaging, neurophysiological, and neuropsychological studies in search of structural, functional, and cognitive correlates of brain insult(s) that could ultimately lead to unravelling the pathophysiology of schizophrenia. A direct, easily administered, and inexpensive way of investigating brain dysfunction in schizophrenia is the study of neurological soft signs and minor physical anomalies, two putative indices of developmental abnormality. The study of these neurodevelopmental markers in the first-episode psychosis allows the detection of the neurodevelopmental abnormalities at the onset of psychosis.

The objectives of our study were to determinate the prevalence, the scores, and the nature of neurological soft signs (NSS) and minor physical anomalies (MPA) in patients with first-episode psychosis and to explore the correlations between these neurodevelopmental markers and the demographic, clinical and therapeutic features.

A cross-sectional study was carried-out on 61 patients (mean age: 28.9±9.4years; 86.9% were males), hospitalized for first-episode psychosis (DSM-IV-TR diagnosis of schizophrenia, schizophreniform disorder, brief psychotic disorder, delusional disorder, and psychotic disorder not otherwise specified). The evaluation procedure consisted of a retrospective assessment of the premorbid functioning by the Premorbid Functioning Scale (PAS) and the following clinical scales: Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF), the NSS scale of Krebs et al. (23 items exploring motor coordination, motor integrative function, sensory integration, involuntary movements or posture, quality of lateralization) and the MPA scale of Gourion et al. (41 items, exploring anomalies of face, eyes, ears, mouth, hands and feet).

The prevalence of NSS was 83.6% (cut-off point=9.5), with a mean total score of 15.3±6.7. The highest score was for the motor coordination. The prevalence of MPA was 62.7% (cut-off point=5), with a mean total score of 5.8±3.2. The most common MPA were the fine hair (50.8%), adherent earlobes (49.2%) and clinodactyly (31.1%). Correlations were found between the NSS total score and the Poor Premorbid Functioning (r=0.32, P=0.04), the PANSS total score (r=0.36, P=0.005), and the negative (r=0.45, P<0.001) and disorganization sub-scores (r=0.41, P=0.001), the CGI-severity of (r=0.30, P=0.02), the impairment functioning in the GAF (r=−0.26, P=0.04) and with extrapyramidal symptoms (r=0.52, P<0.001). However, no correlation was found between the NSS total scores, age, gender, the PANSS positive sub-score, the daily dosage of antipsychotics, the CGI-improvement score and the MPA total score. There was no correlation between MPA total score and demographic, clinical and therapeutic features of patients. Moreover, there was no correlation between the NSS or MPA scores and the short-term evolution (6months to 1year) towards schizophrenia.

These results confirm the data in the literature relating high NSS and MPA scores in patients with a first-episode psychosis. The NSS appear to characterize severe psychotic disorders with more negative and disorganization symptoms and poor social functioning and may be a prognostic indicator.