Prevalence of and Risk Factors for Extrapyramidal Side Effects of Antipsychotics

Abstract

Background: Extrapyramidal side effects (EPS) have been identified as a complication of antipsychotic treatment. Previous meta-analyses have investigated EPS prevalence and risk factors in randomized clinical trials with highly selected patients, but studies in real-world schizophrenia are missing. Objectives: To examine the prevalence and clinical correlates associated with EPS in a nonselected national multicentric sample of stabilized patients with schizophrenia. Method: Between 2010 and 2016,patients suffering from schizophrenia (DSM-IV-TR) were recruited through the FondaMental Academic Centers of Expertise for Schizophrenia (FACE-SZ) network and data were collected during a comprehensive 1-day long standardized evaluation. The Simpson and Angus Scale and the Abnormal Involuntary Movement Scale were used to assess respectively Drug-Induced Parkinsonism (DIP) and Tardive Dyskinesia (TD). Results: The overall prevalence of DIP and TD was respectively 13.2% and 8.3% in our community-dwelling sample of 674 patients. DIP was associated with negative symptoms (PANSS sub-score) (aOR = 1.102, p<.001), First Generation Antipsychotic (FGA) (aOR = 2.038, p=.047) and anticholinergic drug administration (aOR = 2.103, p=.017) independently of sex, age, disorganization, and antipsychotic polytherapy. TD was associated with PANSS disorganized factor (aOR = 1.103, p=.049) independently of sex, age, negative symptoms, excitation, first-generation antipsychotic, benzodiazepine and anticholinergic drug administration. Conclusion: Our results indicate the high prevalence of EPS in a non-selected communitydwelling clinically stable sample of outpatients with schizophrenia. EPS should be systematically evaluated, especially in case of negative symptoms and disorganization or cognitive alteration in the monitoring of antipsychotic treatment. Monotherapy with an SGA should be preferentially initiated for patients with these sides-effects.

Identification and management of cardiometabolic risk in subjects with schizophrenia spectrum disorders: A Delphi expert consensus study

“…The antipsychotic-induced metabolic abnormalities also show a high interindividual variability suggesting the presence of genetic determinants [1,53,54]. Based on the above evidence, the choice of an antipsychotic should be made on an individual basis, taking into consideration the safety profile of the different antipsychotics, accurately weighing the risk of major adverse effects, for example, intolerance to extrapyramidal side effects which increases the risk of tardive dyskinesia [56], or presence of family risk factors for metabolic abnormalities which increases the risk of CVD.…”

Mirtazapine in schizophrenia – an undeservedly overlooked option?

“…For instance, 50.5% of patients suffered from EPS in a recent study by Roiter et al (2020). EPS are associated with depressive symptoms and a noticeable impairment in quality of life (Misdrahi et al , 2019).…”

Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies

“…Regarding the geographical distribution, the review included six studies from Europe [4,[25][26][27][28][29], five studies from Asia [30][31][32][33][34], two studies from Africa [35,36], one study from South America [37], and one study from North America [38]. Thirteen of these studies had employed cross-sectional design [4,26,[28][29][30][31][33][34][35][36][37] with two of which being a retrospective chart review [25,32] and the remaining two studies had employed cohort design [27,38]. The sample size of individual studies ranged from 28 [29] to 164,417 [38].…”

“…The sample size of individual studies ranged from 28 [29] to 164,417 [38]. Thirteen studies were conducted in hospital settings [4,[26][27][28][29][30][31][33][34][35][36][37][38] whereas two studies were conducted at rehabilitation centers [25,32]. Majority of studies were conducted on adult patients with schizophrenic or schizoaffective disorders whereas the rest studies were conducted on non-specific psychotic patients, acute psychotic patients with substance use disorder, and patients with severe mental illness.…”