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Extrapyramidal symptoms and signs in first-episode, antipsychotic exposed and non-exposed patients with schizophrenia or related psychotic illness

Department of Psychiatry, University of British Columbia, Vancouver, Canada

Lili C. Kopala

Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada

Jonathan Rabinowitz

Department of Social Work, Bar Ilan University, Ramat Gan, Israel

Movement disorders in first-episode psychosis are increasingly recognized; however, the prevalence and clinical correlates areuncertain. We compared antipsychotic exposed (< 12 weeks) with nonexposed first-episode patients, and report prevalence as well as clinical and demographic variables associated with extrapyramidal dysfunction. Data are baseline assessments from a multicentre, international drug trial of first-episode psychosis (n = 535). Analysis included the Extrapyramidal Symptom Rating Scale, Premorbid Adjustment Scale, and the Positive and Negative Syndrome Scale. Of non-exposed patients, 28.1% (n = 47/167) had at least one mild sign of extrapyramidal dysfunction, as did 46.3% (n = 169/365) of previously exposed patients. Hypokinetic Parkinsonism was the most prevalent disorder. The severity of movement disorders and negative symptoms were correlated; however, the effect sizes were small. Logistic regression analysis indicated that the salient risk factors for all patients were: previous antipsychotic exposure [odds ratio (OR) = 2.4; 95% confidence interval (CI) 1.6–3.6] and poor premorbid functioning (OR = 1.8; 95% CI 1.2–2.6). For the non-exposed group (n = 167), the significant risk factors were: having severe mental illness in the family (OR = 2.9; 95% CI 1.2–7.2) and poor premorbid functioning (OR = 2.3; 95% CI 1.0–5.3). For the previously exposed group (n = 368), thesignificant variables were: poor premorbid functioning (OR = 1.8; 95%CI 1.2–2.8) and shorter duration of untreated psychosis (OR = 0.78; 95% CI 0.64–0.94). Although antipsychotic exposure was associated with extrapyramidal signs, the results indicate that many first-episode patients with no exposure to antipsychotics also had extrapyramidal dysfunction. In this group, family history and poor premorbid functioning appear to be associated with increased risk for movement disorders.

Key Words: antipsychotic drugs • first-episode psychosis • movement disorders • Parkinsonism • schizophrenia

Journal of Psychopharmacology, Vol. 19, No. 3, 277-285 (2005)
DOI: 10.1177/0269881105051539


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