Motor Symptoms and Schizophrenia

Abstract

Classical schizophrenia literature reports motor symptoms as characteristic of the disorder. After the introduction of neuroleptic drugs, the existence of genuine motor disorders was challenged. Renewed interest arose as symptoms were found in never-medicated patients. Reports focused on abnormal involuntary movements, parkinsonism, neurological soft signs, catatonia, negative symptoms, or psychomotor slowing. Since these syndromes refer to different concepts, however, the definitions are not congruent and the symptoms overlap. The prevalence rates of motor symptoms in schizophrenia are surprisingly high, and recent studies indicate a possible pathobiology. In particular, the development and maturation of the human motor system appears to be closely linked to the emergence of motor symptoms observed in schizophrenia. Post-mortem and neuroimaging results demonstrated aberrant structure and function of premotor and motor cortices, basal ganglia, thalamus, and the connecting white matter tracts. Animal models have focused on aberrant neurotransmission and genetic contributions. Findings of localized abnormal oligodendrocyte function and myelination point to the special role of the white matter in schizophrenia, and recent studies specifically found an association between motor abnormalities and white matter structure in schizophrenia. This review of the literature supports the idea that motor symptoms are closely related to the neurodevelopmental disturbances of schizophrenia and a distinct syndromal dimension with its own pathophysiology.

Kinematic parameters of throwing performance in patients with schizophrenia using a markerless motion capture system

“…Longitudinal studies have also demonstrated that children who later develop schizophrenia spectrum disorders had displayed late acquisition of milestones and poor coordination during the first few years of life (Erlenmeyer-Kimling et al 2000;Cannon et al 2002;Welham et al 2009;Clarke et al 2011;Moilanen 2011). These results suggest that motor deficits may serve as risk markers for the illness and are consistent with the neuro-developmental model of schizophrenia (Wolff and O'Driscoll 1999;Tigges et al 2000;Walther and Strik 2012).…”

“…Despite the high prevalence of motor deficits in schizophrenia (78-97% prevalence of NSS in first episode medicationnaive patients), investigations with quantitative measurements remained scarce (Walther and Strik 2012). There are some studies that employed kinematic analysis of repetitive hand movements, such as diadochokinesis and finger tapping (that are subtests included in the NSS rating scales), to evaluate motor function in schizophrenia.…”

Less Structured Movement Patterns Predict Severity of Positive Syndrome, Excitement, and Disorganization

“…In addition, disorganized behavior may also be related to symptoms associated with the motor dimension of schizophrenia, such as stereotypies or ambitendency. 4,6 This view is supported by 2 large studies in first episode medication naïve patients as well as admissions with schizophrenia spectrum disorders demonstrating positive correlations of disorganization and catatonia symptoms such as echophenomena, stereotypies, mannerisms, and agitation. 30,31 Likewise, the PANSS disorganization factor of van der Gaag et al 25 was associated with less predictable movement patterns.…”

“…10 Activity monitoring using actigraphy allows an objective assessment of schizophrenia motor behavior. 6,11 Reduced activity levels were repeatedly reported in patients using actigraphy. [12][13][14][15] However, few studies have aimed at investigating associations of objective motor behavior and psychopathological phenomena.…”

“…5 Motor behavior is altered in schizophrenia, including specific motor disturbances and general motor activity levels. 6,7 Indeed, schizophrenia patients engage less frequently in sports, 8,9 but more in sedentary behaviors, 9 and have less activity during leisure time than the average population. 10 Activity monitoring using actigraphy allows an objective assessment of schizophrenia motor behavior.…”