Prevalence of Extrapyramidal Symptoms in In-Patients With Severe Mental Illnesses: Focus on Parkinsonism

Roiter, Beatrice; Pigato, Giorgio; Antonini, Angelo

doi:10.3389/fneur.2020.593143

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…Other EPS, such as akathisia (2.1%), TD (1.4%), and acute dystonia (0.7%), were also prevalent. 63 EPS has been associated with reduced treatment adherence, Table 3: worse mental prognosis, and greater mortality in patients with severe mental illness (SMI). 64,65 EPS is more severe and prevalent in individuals with SMI than in those with other mental illnesses, with a higher rate (68-74%) in hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Extrapyramidal Effects of First and Second Generation Antipsychotics: A Review

SM,

et al. 2023

IJDDT

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Antipsychotics are essential for treating major psychiatric disorders like schizophrenia. Second-generation antipsychotics were developed to reduce the risk of extrapyramidal symptoms (EPS) caused by antipsychotic medications. While second-generation drugs have a lower risk of EPS than first-generation treatments, studies show that they can still cause EPS, with clozapine being the least risky and risperidone the most. A literature search of PubMed and Scopus databases until April 2023 found that high doses, a history of past EPS, comorbidities, and specific second-generation medications can increase the risk of EPS. The choice of a first-generation comparator also influences study findings. Although the prevalence and severity of EPS vary with antipsychotics, these medications have not met expectations in terms of tolerability. EPS is still a clinical issue, even in the era of second-generation antipsychotics. This review offers a concise overview of EPS induced by antipsychotics.

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Section: Discussionmentioning

confidence: 99%

Extrapyramidal Effects of First and Second Generation Antipsychotics: A Review

SM,

et al. 2023

IJDDT

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“…2 In a study done by Roiter et al, the prevalence of EPS in psychiatric inpatients was 50.5%. 3 There is a bias toward antipsychotic medications, while other dopaminergic receptor blocking drugs (DRBDs) and non-DRBDs are underrepresented in the available data pertaining to DIMDs. The same holds true for other drugs commonly used in specialties outside of psychiatry.…”

Section: Epidemiologymentioning

confidence: 99%

Drug-Induced Movement Disorders

et al. 2023

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Drug-induced movement disorders (DIMDs) are most commonly associated with typical and atypical antipsychotics. However, other drugs such as antidepressants, antihistamines, antiepileptics, antiarrhythmics, and gastrointestinal drugs can also cause abnormal involuntary movements. Different types of movement disorders can also occur because of adverse drug reactions. Therefore, the important key to diagnosing DIMDs is a causal relationship between potential offending drugs and the occurrence of abnormal movements. The pathophysiology of DIMDs is not clearly understood; however, many cases of DIMDs are thought to exert adverse mechanisms of action in the basal ganglia. The treatment of some DIMDs is quite challenging, and removing the offending drugs may not be possible in some conditions such as withdrawing antipsychotics in the patient with partially or uncontrollable neuropsychiatric conditions. Future research is needed to understand the mechanism of DIMDs and the development of drugs with better side-effect profiles. This article reviews the phenomenology, diagnostic criteria, pathophysiology, and management of DIMDs.

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“…Patients with schizophrenia suffer from drug-induced extrapyramidal symptoms (EPS) quite often. 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).…”

Section: Other Targets For Mirtazapine In Schizophreniamentioning

confidence: 99%

Mirtazapine in schizophrenia – an undeservedly overlooked option?

Terevnikov

Joffe

2022

International Clinical Psychopharmacology

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Mirtazapine has often been prescribed as add-on treatment for schizophrenia in patients with suboptimal response to conventional treatments. In this review, we evaluate the existing evidence for efficacy and effectiveness of add-on mirtazapine in schizophrenia and reappraise the practical and theoretical aspects of mirtazapine-antipsychotic combinations. In randomized controlled trials (RCTs), mirtazapine demonstrated favourable effects on negative and cognitive (although plausibly not depressive) symptoms, with no risk of psychotic exacerbation. Mirtazapine also may have a desirable effect on antipsychotic-induced sexual dysfunction, but seems not to alleviate extrapyramidal symptoms, at least if combined with second-generation antipsychotics. It is noteworthy that all published RCTs have been underpowered and relatively short in duration. In the only large pragmatic effectiveness study that provided analyses by add-on antidepressant, only mirtazapine was associated with both decreased rate of hospital admissions and number of in-patient days. Mirtazapine hardly affects the pharmacokinetics of antipsychotics. However, possible pharmacodynamic interactions (sedation and metabolic offence) should be borne in mind. The observed desired clinical effects of mirtazapine may be due to its specific receptor-blocking properties. Alternative theoretical explanations include its possible neuroprotective effect. Further well-designed RCTs and real-world effectiveness studies are needed to determine whether add-on mirtazapine should be recommended for difficult-to-treat schizophrenia.

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Prevalence of Extrapyramidal Symptoms in In-Patients With Severe Mental Illnesses: Focus on Parkinsonism

Cited by 10 publications

References 23 publications

Extrapyramidal Effects of First and Second Generation Antipsychotics: A Review

Extrapyramidal Effects of First and Second Generation Antipsychotics: A Review

Drug-Induced Movement Disorders

Mirtazapine in schizophrenia – an undeservedly overlooked option?

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