Descriptive Psychopathology: The Signs and Symptoms of ...

246 Section 3: Examination domainsdiscussed in Chapter 3. In addition, there are neuromotor, cognitive and morphologicabnormalities that are consistent but not pathognomonic of schizophreniathat can be identified on examination.Both basal ganglia and cerebellar motor signs are described by Kraepelin whodiscussed a “cerebellar form” of dementia praecox, 72 and cerebellar volume lossis reported in patients with schizophrenia associated with negative features. 73Cerebellar and motor “soft signs” are reported in never-medicated schizophrenicpatients. 74 Cerebral cortical and subcortical abnormalities in structure and metabolicfunction are also reported, 75 and basal ganglia signs are seen in unmedicatedschizophrenics. 76 The abnormalities are associated with the negative featuresof the condition. 77 Schizophrenics also exhibit problems with smooth eye movementpursuit of objects, a difficulty linked to frontal circuitry disease. 78 Theproblems are found early in the condition. 79While dementia is not the inevitable outcome of schizophrenia, cognitive problemsare recognized early in the condition. The deficits, even when mild, involvemany cognitive processes, executive functioning the most dramatically affected.The deficits are associated with negative features and formal thought disorder, butnot with hallucinations and delusions. 80 Some researchers propose cognitive deficitsto be a diagnostic criterion for schizophrenia, but while most sufferers have cognitiveproblems consistent with frontal circuitry dysfunction, these are not specific. 81Structural anomalies of body parts (e.g. clinodactyly, small head circumference,ectopic eyes, ears and nares) are reported to be more common in schizophrenicpatients. These are reflections of a genetic or gestational perturbation, arerecognized in infancy, and are stable over a lifetime. Many non-ill persons exhibitone or two, while schizophrenic patients and persons with conduct disorder andviolent criminal behavior are found to have more. 82Pre-psychotic featuresOver 40 years of research has demonstrated that schizophrenia is not merely aseries of characteristic psychotic episodes. Children who later in life experiencepsychotic episodes characterized by emotional blunting with avolition and formalthought disorder are found to have abnormal emotional expression, inappropriatesocial interactions, cognitive inflexibility, and neuromotor problems. Substantialgenetic and intrauterine factors (e.g. maternal malnutrition, influenza)contribute to the condition. The more substantial is the evidence of these factors,the more severe are the childhood abnormalities and the later psychoses. 83 Thesefindings, particularly seen in children with a mother with schizophrenia, areconsidered by many researchers to support the idea that schizophrenia is adevelopmental disorder. 84