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Abstract Schizophrenia is a clinical syndrome of variable, but profoundly disruptive, psychopathology that involves cognition, emotion, perception, and other aspects of behavior. The expression of these manifestations varies across patients and over time, but the effect of the illness is always severe and is usually long lasting. The disorder usually begins before age 25, persists throughout life, and affects persons of all social classes. Both patients and their families often suffer from poor care and social ostracism because of widespread ignorance about the disorder. Although schizophrenia is discussed as if it is a single disease, it probably comprises a group of disorders with heterogeneous etiologies, and it includes patients whose clinical presentations, treatment response, and courses of illness vary. Clinicians should appreciate that the diagnosis of schizophrenia is based entirely on the psychiatric history and mental status examination. There is no laboratory test for schizophrenia. With respect to this disorder, the prefrontal cortex is the brain region of major interest for researchers in the field. Afferent and efferent connections of this large area of association cortex with other neocortical regions have been extensively described, as well as connections with cingulate cortex, limbic structures and basal ganglia. Aim of study: 1. Evaluation of frequency of soft neurological signs in patient with Schizophrenia. 2. Detection of difference of cerebral blood flow in schizophrenic patients schizophrenic patients with Negative and Positive symptoms by Transcranial Doppler Sonography. 3. Assessment of cognitive functions in schizophrenic patients. Study design: The study is a descriptive prospective one. The protocol and study design of this thesis was approved by local ethical committee in faculty of medicine, Assuit University, revised and approved by group of staff members of the faculty. An informed consent was obtained and signed from the subjects to participate in the study. Patients group: Fifty adult patients (33 males and 17 females) participated in the study. They were referred from the outpatient clinic of psychiatry at Assuit University Hospital and from private clinic of staff members of neurology and psychiatric department. Inclusion criteria: 1. Patients fulfill criteria for the diagnosis of schizophrenia based on DSM IV-TR criteria 2. Age (20:40 years) 3. Sex: both sex is included in the study 4. Patients should not receive ECT 6 months before the study Exclusion criteria: 1. History of major neurological deficits or trauma 2. Patients with chronic or serious medical condition that may affect the cognition. 3. History of drug abuse. 4. Schizophrenic patient received ECT 6 months or less before the study 5. Patients who their relatives refuse to give informed consent. Control group: Twenty five adult (aged 20: 40 years 14 male and 11 female) volunteered to participate in the study were from general population and matched with the patient group for age, sex and socioeconomic state. Methods: The following tests and investigations were applied to all the participants: 1. Standardized psychiatric interview. 2. General examination. 3. positive and negative syndrome scale “PANSS” 4. Soft neurological signs assessment 5. Transcranial Doppler sonography 6. Cognitive Ability Screening Instrument “CASI” Results: The present study show: Increased frequency of each of neurological soft signs scores measured by Cambridge Neurological Inventory part II among schizophrenic patients especially motor coordination and motor sequencing and their correlation with predominance of negative symptoms. The evaluation of mean velocity of CBF of MCA, ACA and BA by TCD no significant difference between patients and control groups except BA has a statistical minimal significance. But there was a correlation between positive symptoms with increased CBF and negative symptoms with decreased cerebral blood flow. Cognitive dysfunctions in schizophrenic patients highly affecting STM, orientation, mental manipulation, concentration, abstract thinking, judgement, drawing and fluency but affect in lesser extent on LTM and attention lastly it has no effect on language function it was affected by predominance of negative symptoms. |