Asymmetric Drug-Induced Parkinsonism and Psychopathology: A Prospective Naturalistic Study in Long-Stay Psychiatric Patients

Abstract

BackgroundDrug-induced parkinsonism (DIP) is the most common movement disorder induced by antipsychotics. Although DIP is mostly symmetric, asymmetric DIP is reported in a substantial part of the patients. We investigated the frequency of motor asymmetry in DIP and its relationship to the severity of psychopathology in long-stay psychiatric patients.MethodsWe obtained data from a cohort study of 207 long-stay psychiatric patients on the frequency and risk factors of tardive dyskinesia, akathisia, tardive dystonia, and DIP. From July 2003 to May 2007 (mean follow-up, 1.1 year) drug-induced movement disorders were assessed at least two times in each patient, with a frequency of persistent DIP of 56.2%. All patients who had at least one time parkinsonism in the upper/lower limb(s) were included for analyses (190 patients, 79 women; mean age, 48.0 ± 12.9 years). The Unified Parkinson Disease Rating Scale motor scale was used to calculate the frequency of asymmetric parkinsonism. Multilevel mixed models were built to explore the relationship between asymmetry in parkinsonism and the severity of psychopathology, measured on the Clinical Global Impression-Schizophrenia scale severity index (CGI-SCH SI).ResultsThe frequency of asymmetric parkinsonism was 20.8%. Asymmetry in parkinsonism was associated with symptom severity on all CGI-SCH SI scales (β range, 0.37–3.74) and significantly associated with the positive symptom scale (β, 3.74; 95% CI, 0.35–7.31).ConclusionDIP is asymmetric in a substantial part of patients. Asymmetric presentation of DIP is of clinical relevance as it is related to the severity of psychopathology and may alert the clinician of more severe psychopathology. Future research is recommended to provide insight into the neuropsychopathology and clinical value of asymmetric parkinsonism for psychiatric patients.

Antipsychotic-Related Movement Disorders: Drug-Induced Parkinsonism vs. Tardive Dyskinesia—Key Differences in Pathophysiology and Clinical Management

“…For example, abnormal movement patterns present asymmetrically in a significant minority of cases. Pieters et al [ 21 ] recently noted asymmetrical symptoms in as many as 20% of patients with DIP, as was also observed by Savica et al [ 9 ]. Furthermore, antipsychotic use may unmask Parkinson’s disease, which contributes the difficulty of diagnosing DIP in elderly patients [ 2 ].…”

Symptomatic Characteristics of Parkinson's Disease Induced by Neuroleptic Drugs, Based on a Functional Neuroimaging Diagnosis

“…While DIP is characterized by the rapid onset of symmetric symptoms, the absence of tremor or akathisia, and the occurrence of bucco-linguo-masticatory dyskinesias (3,19), clinically diagnosing patients with DIP can be difficult, as some symptoms overlap with PD (20). Furthermore, DIP may progress slowly or remit in approximately 10% of cases, even after the discontinuation of neuroleptic drugs.…”

Drug-induced parkinsonism: what should a psychiatrist know?

“…Several studies have described a greater asymmetric parkinsonian prevalence among PD uncovered by drugs than a pure DIP 36,39 . Pieters et al found 20,8% of DIP patients presents with asymmetric parkinsonian symptoms and the asymmetric presentation was associated with a greater severity of symptoms, especially cognitive behavioral symptoms and psychopathology 40 . However, even one-third of pure DIP patients may also exhibit asymmetric parkinsonian symptoms 39 .…”