Academic journal article Hong Kong Journal of Psychiatry

A Case Controlled Study of Neurological Soft Signs in Childhood and Adolescent Mania

Academic journal article Hong Kong Journal of Psychiatry

A Case Controlled Study of Neurological Soft Signs in Childhood and Adolescent Mania

Article excerpt


Objective: Occurrence of neurological soft signs has not been well researched in childhood and adolescent affective disorder. This study was performed to provide data on the prevalence of neurological soft signs in childhood and adolescent mania, the correlation with disease severity, and relationship to treatment and clinical improvement.

Methods: Thirty four patients (mean age, 16.62 years; SD [+ or -] 1.49 years) admitted to hospital with bipolar-I disorder, according to the DSM-IV criteria, were evaluated with the Cambridge Neurological Inventory to assess neurological soft signs and the Young Mania Rating Scale to assess the severity of manic symptoms during the first day of admission. The examination was repeated after 4 weeks. Age- and sex-matched healthy controls were examined using the Cambridge Neurological Inventory.

Results: A significantly high incidence of neurological soft signs was noted in the patient group during both the assessments. However, there was a significant reduction of the total neurological soft signs score (p > 0.001) between the first and the second assessment.

Conclusion: Reduction of neurological soft signs with clinical improvement implies that neurological soft signs is a non-specific marker of neurological abnormality occurring during the height of a mania episode.

Key words: Neurological soft signs, Childhood, Adolescent, Affective disorder


The term 'neurological soft signs' (NSS) refers to any neurological deviation--motor, sensory, or integrative--that does not localise the site of a putative central nervous system (CNS) lesion. (1) The designation 'soft' is usually taken to indicate that the person with the sign shows no other features of fixed or transient neurological lesions or disorders. The clinical importance of soft signs is their value as an indicator of some CNS factors that may have causal or predictive value for associated psychological dysfunction, in particular learning and/or psychiatric abnormalities. (2)

Various neurological signs are described in a number of psychiatric disorders, including minimal brain dysfunction, (3) emotionally unstable character disorders, (1) polysubtances abuse, (4) obsessive compulsive disorders, (5) persistent emotional disorder in children, (6) and consistently so in schizophrenia. (7,8) Nasarallan reported that the soft signs are as common in mania as in schizophrenia. (9) Mukherjee also reported NSS in bipolar disorder, which was related to the duration of neuroleptic drug exposure. (10) Cherian also found a high incidence of NSS in patients with bipolar disorder. (11)

The presence of NSS in affective disorder is poorly studied and controversial. Most of the trials are single contact studies examining patients when they are symptomatic. Although there has been evidence of a high incidence of NSS in other childhood and adolescent psychiatric disorders, there is a dearth of research into its occurrence in childhood and adolescence mood disorder. The present study aimed to provide data on the prevalence of NSS in childhood and adolescent mania, its correlation with disease severity, and the relation to treatment and clinical improvement.



Thirty four patients with mania admitted to the Child Psychiatry Unit of the Central Institute of Psychiatry, Ranchi, diagnosed with bipolar-I disorder, (single manic episode, most recent episode manic) as per the DSM-IV criteria were included in the study. Children and adolescents, aged from 8 to 18 years, of both sexes, cooperated with the study, from 1 November 1998 to 31 October 1999. The exclusion criteria were presence of serious medical illness such as epilepsy, head injury, stroke, diabetes and endocrinological disorders; history of substance abuse defined by DSM IV criteria; mental retardation; pervasive developmental disorder; schizophrenia; pregnancy at entry to the study; or patients undergoing electroconvulsive therapy. …

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