INTRODUCTION:
In the era of expanding recent advancements and progress made in
The field of neuro psychiatry , a relatively neglected aspect is complete
Neurological examination which is non invasive, easy to administer and
Provides wealth of information regarding the various aspects of the
Disease. Impaired neurological performance has been documented in
Various psychiatric conditions and the concept of neurological
Examination in psychiatry ,a time old concept whose significance has
Gained importance with blurring of the thin line between neurology and
Psychiatry leading to the concept of neuropsychiatry. Neuro biological
Underpinnings of psychiatric conditions further propelled the significance
Of neurological examination in psychiatry.
Neurological examination in psychiatry, particularly has two
General aspects
1] Examination for ‘hard signs’ or ‘major signs’ or ‘localizable
Signs’ such as cranial nerve lesion, motor deficit, sensory impairment,
Reflex asymmetry which reflects presence or absence of neuropathology
And a localizing lesion.
2] Evaluation of performance decrements in neurological domains
Without any identifiable neurological lesion or disorder (Sanders &
Keshavan, 1998).
As mentioned above these decrements in neurological domains
Mainly includes the concept of our focus “NEUROLOGICAL SOFT
SIGNS” or “SOFT NEUROLOGICAL SIGNS”.(Sanders & Keshavan,
1998)
NEUROLOGICAL SOFT SIGNS
Dr. Loretta Bender ,a pioneer in neuro psychiatric aspects of
Childhood disorders introduced the concept of neurological soft signs in
1947 in reference to non diagnostic neurological abnormalities seen in
Children with schizophrenia .(Sadock, Benjamin James., Sadock, 2007)
DEFINITION
NSS are defined by Shaffer and o’connor as
“ Non normative performance (s) on a motor or sensory test(s)
Which would be identical or akin to test(s) of traditional neurological
Examination, but elicited from an individual who shows none of the
Features of fixed or transient neurological disorder ”
Shaffer et al also proposed that to consider a sign as an NSS it should
Have following features
1] No association should exist between an observed behaviour and
A positive history of neurological disease or trauma
2] It should not be a pathognomonic sign of any neurologic disease
Or encephalopathy
3] It should not be indicate any specific CNS pathology
Thus the NSS are minor neurological deviation in motor and sensory
Function that are not localized to any specific area of the brain and not
Characteristic of any specific neurological condition ,mostly indicating
Diffuse cerebral dysfunction.
Ever since they have been introduced they were termed as ‘soft
Signs’, ‘non focal signs’, ‘diffuse signs’, ‘minimal brain damage
Syndrome’ due to their lack of specificity ,validity or localization at that
Time. The term ‘soft’ also signifies the nature of wide but blurred
Boundaries of varying domains like EEG findings ,behaviour disturbance,
Learning disorders, neurological functions that were considered under the
Umbrella of soft signs.(Sanders & Keshavan, 1998)
The initial focus of these NSS remained mainly in the field of child
Psychiatry with description of concepts of ‘Minimal Brain Damage’ in
Children with hyperactivity, impulsivity and with no demonstrable
Neurological lesion. Later from 1990 with quantification of validated and
Standardised instruments for assessment of these signs, the focus shifted
To major psychiatric conditions leading to exhaustive research in the
Subject which provided significant understanding of the neurobiology,
Neuro anatomical correlates, genetic underpinnings , neuro developmental
Basis, endophenotypic markers and predictors of neuropsychological
Dysfunction in certain psychiatric conditions.
With this brief introduction about the neurological soft signs ,we
Now focus on existing documented literature that has changed the concept
Of these NSS, their significance in psychiatric conditions and the various
Aspects of their relation to Obsessive compulsive disorder which is the
Main focus of our study
