Antipsychotic treatment and extrapyramidal symptoms amongst schizophrenic inpatients

Abstract

Extrapyramidal symptoms (EPS) are seen in 50-75% of patients treated with typical antipsychotics and are a cause of treatment failure in at least 30% of the patients. Using atypical antipsychotics, the EPS incidence is lower, but a low-dosage strategy using typical antipsychotics is also known to cause fewer EPS. What conclusions can be drawn for the daily clinical practice? A naturalistic study including all schizophrenic inpatients in a psychiatric ward (n=123) analysed the effects of treatment concerning positive/negative symptoms, EPS, number of days to re-hospitalization and inpatient-days in the year after baseline admittance, using atypical and typical antipsychotics as recommended by the Danish Society of Psychiatry. The incidence of EPS was significantly higher in patients who were treated with typical antipsychotics in relation to atypical antipsychotics (46% vs. 12%, P<0.001). Patients with EPS had significantly more negative symptoms and a poorer level of function at discharge. Nevertheless, no difference regarding re-hospitalization and inpatient-days was found, whether the patient was treated with typical or atypical antipsychotics. However, it is important to underline that patients treated with atypical oral antipsychotic do as well as patients on typical depot antipsychotics.

Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations

“…In the same cohort, the proportion of EPS at 12 months was significantly higher in patients treated with typical LAIs (32%) and oral typical antipsychotics (30%) compared to risperidone (16%), quetiapine (10%), clozapine (9%), and olanzapine (8%) [52]. Among patients with or without EPS treated with typical LAIs, the GAF and total BPRS scores differed at hospital discharge [115]. An indirect measure of EPS is the use of anticholinergic drugs, which was reported as significantly higher in patients using LAIs (47%) compared with patients using oral SGAs (13%) [116] and has a rate ranging from 30.9% to 32.0% for overall LAIs [52,117].…”

Psychotropic Medication Use Among Older Adults: What All Nurses Need to Know

“…Akathisia is characterized by pacing and restlessness. Between 50% and 75% of all patients taking typical antipsychotic drugs experience EPSEs (Høiberg & Nielson, 2006); however, elderly patients are at higher risk for drug-induced parkinsonism and are at increased risk for EPSEs than are younger patients (Mott et al, 2005). …”

Efficacy and safety of bifeprunox in patients with an acute exacerbation of schizophrenia: results from a randomized, double-blind, placebo-controlled, multicenter, dose-finding study

“…These atypical antipsychotics display at least similar efficacy compared with the typical antipsychotics and are associated with decreased risks for EPS (e.g., Davis et al 2003;Høiberg and Nielsen 2006;Leucht et al 1999;Miller et al 1998;Tandon et al 2008), although atypical antipsychotics are not a homogenous group. In fact, the available atypical antipsychotics may differ in terms of efficacy (e.g., Davis et al 2003;, although some analyses have suggested there is little or no difference in efficacy across atypical agents (Tandon et al 2008;Tandon and Fleischhacker 2005).…”