Motor abnormalities and basal ganglia in first-episode psychosis (FEP)

Manuel J. Cuesta, Pablo Lecumberri, Lucia Moreno-Izco, Jose M. López-Ilundain, María Ribeiro, Teresa Cabada, Ruth Lorente-Omeñaca, Gabriel De Erausquin, Gracian García-Martí, Julio Sanjuan, Ana M. Sánchez-Torres, Marisol Gómez, Victor Peralta

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied. Methods We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2∗ volumes and R2∗ was used. Results FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients. Conclusions Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.

Original languageEnglish (US)
Pages (from-to)1625-1636
Number of pages12
JournalPsychological Medicine
Issue number10
StatePublished - Jul 2021
Externally publishedYes


  • Abnormal movements
  • R2
  • akathisia
  • catatonia
  • extrapyramidal signs
  • first-degree relatives
  • first-episode psychosis
  • healthy controls
  • mean diffusivity
  • neurological assessment
  • neurological soft signs
  • nuclear magnetic resonance
  • parkinsonism
  • relaxometry
  • schizophrenia
  • shape analysis
  • unaffected siblings
  • voxel analysis

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology


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