Characterization of spontaneous Parkinsonism in drug-naive patients with nonaffective psychotic disorders

Abstract

Spontaneous Parkinsonism (SP) in schizophrenia-related disorders is poorly characterized. The objective of this study was to examine the concordance and clinical validity of alternative definitions of SP in patients with nonaffective psychotic disorders. Two-hundred drug-naive patients with nonaffective psychotic disorders were examined for core parkinsonian signs, including bradykinesia, rigidity, and tremor, and diagnosed of SP according to the Simpson-Angus Scale (SAS) cutoff criterion, the UK Parkinson's disease brain bank (UKPDBB) criteria, the National Institute of Neurological Disorders and Stroke (NINDS) criteria, and criteria requiring the presence of all three core features (full syndrome criteria). Parkinsonian signs and criteria were examined in relation to a number of relevant clinical variables. The most frequent sign was rigidity (33.5%) followed by bradykinesia (16%) and tremor (12%). The prevalence rate of SP according to the SAS cutoff criterion, the UKPDBB criteria, the NINDS criteria for possible and probable SP, and the full syndrome criteria were 20.5, 13, 25.5, 18.5, and 4%, respectively. Bradykinesia was specifically related to negative symptoms, rigidity to neurological soft signs, and tremor to dyskinetic movements. The set of criteria showing more associations with clinical variables were the NINDS criteria for probable SP. Patients fulfilling these criteria had higher ratings for poor premorbid adjustment, negative symptoms, dyskinesia, neurological soft signs, and poor global treatment response than those without that diagnosis. The NINDS criteria for probable SP, i.e., presence of any two of the three core parkinsonian signs, seem to be the most suitable for clinical and research purposes.

Neurological Soft Signs, Spontaneous and Treatment Emergent Extrapyramidal Syndromes in Black Africans With First Episode Schizophrenia

“…Our finding suggesting that spontaneous motor syndromes may predict treatment-emergent EPS are largely in keeping with previous studies ( 10 – 12 ). Whereas we found that spontaneous EPS is associated with treatment-emergent Akathisia, prior studies implementing a longer term follow-up of up to 24 months have demonstrated this relationship for treatment-emergent dyskinesia ( 13 ).…”

“…To date, the three cross-sectional studies of the relationship between NSS and treatment-emergent EPS in never-medicated first-episode schizophrenia have reported conflicting findings ( 10 – 12 ). However, a previous finding of an association between baseline NSS and subsequent development of tardive dyskinesia (TD) ( 13 ), across 24 months observation of a multiracial African sample is profoundly important for the prevention of EPS in susceptible patient populations.…”

Evaluating subjective domains of antipsychotic‐induced adverse effects using heart rate variability

“…The association of UKU subscales with HRV parameters may be attributable to abnormalities in hypothalamic–pituitary–adrenal (HPA) axis activity in schizophrenia . A broad number of neuromotor abnormalities, particularly spontaneous parkinsonism, have been reported in drug‐naïve schizophrenia patients and these symptoms are closely related to decreased vagal activity . HRV therefore could be linked to HPA axis and parkinsonian manifestations, particularly hypokinesia and rigidity .…”

“…28,29 A broad number of neuromotor abnormalities, particularly spontaneous parkinsonism, have been reported in drug-naïve schizophrenia patients and these symptoms are closely related to decreased vagal activity. 30,31 HRV therefore could be linked to HPA axis 32,33 and parkinsonian manifestations, particularly hypokinesia and rigidity. 34,35 In contrast, there was no association between LUNSERS and any parameter of HRV in acute schizophrenia patients.…”

Neurobiology of schizophrenia: from outcome to pathophysiological insights

“…Spontaneous parkinsonism including bradykinesia, rigidity and tremor was investigated by Peralta et al [5] in 200 drug-naïve first-episode schizophrenia patients. The most frequent sign was rigidity, followed by bradykinesia, which was related to negative symptoms.…”