Luria revisited: Complex motor phenomena in first episode schizophrenia and schizophrenia spectrum disorders Yuliya Zaytseva a,b,c,n , Natalya Korsakova d , Isaac Ya. Gurovich a , Andreas Heinz e , Michael A. Rapp e,f a Moscow Research Institute of Psychiatry, Moscow, Russia b Human Science Centre, Institute of Medical Psychology, Ludwig Maximilian University, Munich, Germany c Prague Psychiatric Centre, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic d M.V. Lomonosov Moscow State University, Moscow, Russia e Department of Psychiatry, Charité Campus Mitte, Berlin, Germany f Social and Preventive Medicine, University of Potsdam, Potsdam, Germany article info Article history: Received 25 April 2013 Received in revised form 4 August 2014 Accepted 8 August 2014 Keywords: Luria Fist-Edge-Palm test Bimanual probe Error monitoring First psychotic episode Schizophrenia Schizophrenia spectrum disorders abstract Patients with schizophrenia frequently exhibit motor deficits. However, to date, there are no studies comparing motor performance in first episode patients with schizophrenia and schizophrenia spectrum disorders (SSD; e.g. schizoaffective and brief psychosis). Participants comprised 57 first episode patients with schizophrenia, 32 first episode patients with SSD, and 51 healthy controls who underwent neuropsychological testing based on Luria's systematic approach, including the following tests on complex motor sequencing: the Fist-Edge-Palm (FEP) test and the bimanual probe (BP). Schizophrenia patients performed worse than SSD patients in FEP and BP, and both patient groups showed decreased scores compared to healthy controls. Furthermore, we found that a higher proportion of schizophrenia cases failed to correct their motor performance and needed external error correction, while SSD cases exhibited a higher proportion of self-correction in FEP and in BP. Lack of insight and poor executive functioning correlated with motor performance in schizophrenia, while impulse control and difficulties in abstract thinking were related to motor performance in schizophrenia spectrum disorder. Thus, psychomotor impairments appear already in first episode patients with schizophrenia and differ from impairments in SSD. Especially the inability to self-correct errors may be characteristic of schizophrenia, suggesting that impairments in error monitoring are related to psychomotor dysfunction in schizo- phrenia. & 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Since Kraepelin (1919), clinical observation has pointed to the presence of motor abnormalities in schizophrenia. Existing evidence suggests that psychomotor impairment is a prominent feature of schizophrenia, which may already be present before the onset of psychosis (Scheffer, 2004; Compton et al., 2007). Patients with schizophrenia frequently exhibit motor deficits referred to as “neuro- logical soft signs” that are thought to represent subtle brain alterations. At the same time, several studies suggest that subtle signs of neurological dysfunction are relatively common among children and adolescents with schizophrenia and related psychotic disorders (Karp et al., 2001), and characterize those at increased genetic risk for schizophrenia (Barkus et al., 2006). Specifically, Karp et al. (2001), using standardized neurological examination in a prospective cohort study, showed that adolescents with later onset of schizophrenia had a high frequency of neurologic abnormalities at a range of 92–100%. Soft signs have recently been reported in unaffected siblings of schizo- phrenia (Mechri et al., 2009), and have been proposed as a possible endophenotype for schizophrenia (Chan and Gottesman, 2008; Chan et al., 2010). The classification of neurological soft signs differs across studies with respect to the grouping and rating of symptoms. Recent findings suggest that neurological soft signs can be subdivided into sensory integration, motor coordination, complex motor tasks and disinhibition (Chan and Gottesman, 2008). In order to evaluate neurological signs in schizophrenia, several standardized scales have been developed (Buchanan and Heinrichs, 1989; Schröder et al., 1992; Chen et al., 1995; Jahn et al., 2006) each of which Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research http://dx.doi.org/10.1016/j.psychres.2014.08.009 0165-1781/& 2014 Elsevier Ireland Ltd. All rights reserved. n Correspondence to: Department of Outpatient Psychiatry and Organization of Psychiatric Care, Moscow Research Institute of Psychiatry, Poteshnaya Street, 3, 107076 Moscow, Russia. Tel.: þ7 499 963 7663. E-mail address: yuliya.zaytseva@gmail.com (Y. Zaytseva). Please cite this article as: Zaytseva, Y., et al., Luria revisited: Complex motor phenomena in first episode schizophrenia and schizophrenia spectrum disorders. Psychiatry Research (2014), http://dx.doi.org/10.1016/j.psychres.2014.08.009i Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎