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Prevalence of and Risk Factors for Extrapyramidal Side Effects of Antipsychotics

David Misdrahi 1 Arnaud Tessier 2 Antoine Daubigney 3 Wassilios Meissner 4 Franck Schurhoff 5 Laurent Boyer 6 Ophélia Godin 5 Ewa Bulzacka Bruno Aouizerate 7 Meja Andrianarisoa 1 Fabrice Berna 8 Delphine Capdevielle 9 Isabelle Chereau-Boudet 10 Thierry D’amato 1 Caroline Dubertret 1 Julien Dubreucq 11 Catherine Faget-Agius 6 Christophe Lançon 6 Jasmina Mallet 1 Christine Passerieux 12 Romain Rey 1 Aurélie Schandrin 13 Mathieu Urbach 1 Pierre Vidailhet 14 Pierre Llorca 15 Guillaume Fond 16
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. Objective: To examine the prevalence and clinical correlates associated with EPS in a nonselected national multicenter sample of stabilized patients with schizophrenia. Methods: Between 2010 and 2016, patients suffering from schizophrenia (DSM-IV-TR criteria) 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-Angus Scale and the Abnormal Involuntary Movement Scale were used to assess drug-induced parkinsonism (DIP) and tardive dyskinesia, respectively. Results: The overall prevalence of DIP and tardive dyskinesia was 13.2% and 8.3%, respectively, in this community-dwelling sample of 674 patients. DIP was associated with negative symptoms (Positive and Negative Syndrome Scale [PANSS] subscore) (adjusted odds ratio [aOR] = 1.102, P <.001), first-generation antipsychotic prescription (aOR = 2.038, P =.047), and anticholinergic drug administration (aOR = 2.103, P =.017) independently of sex, age, disorganization (PANSS disorganized factor), and antipsychotic polytherapy. Tardive dyskinesia was associated with PANSS disorganized factor (aOR = 1.103, P =.049) independently of sex, age, negative symptoms, excitation, first-generation antipsychotic prescription, and benzodiazepine and anticholinergic drug administration. Conclusions: Our results indicate the high prevalence of EPS in a nonselected community-dwelling clinically stable sample of outpatients with schizophrenia. In the monitoring of antipsychotic treatment, EPS should be systematically evaluated, especially when negative symptoms and disorganization or cognitive alteration are present. Monotherapy with a second-generation antipsychotic should be preferentially initiated for patients with these side effects.
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Submitted on : Tuesday, April 9, 2019 - 3:02:19 PM
Last modification on : Friday, July 10, 2020 - 7:58:47 AM

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David Misdrahi, Arnaud Tessier, Antoine Daubigney, Wassilios Meissner, Franck Schurhoff, et al.. Prevalence of and Risk Factors for Extrapyramidal Side Effects of Antipsychotics. The Journal of clinical psychiatry, 2019, 80 (1), ⟨10.4088/JCP.18m12246⟩. ⟨hal-02094198⟩



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