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

Abstract

Background: Very little is known about the relationship between spontaneous and treatment-induced motor syndromes in Africans with first episode schizophrenia.Objective: We investigated the association between spontaneous NSS and EPS, with treatment-induced EPS in a homogenous sample of Black Africans with first episode schizophrenia.Methods: We examined Xhosa (South Africa) and Yoruba (Nigeria) patients, using the Neurological Evaluation Scale and extrapyramidal symptoms scale before and at 3 months after exposure to low dose flupenthixol decanoate. Pearson's correlations and Linear regression models, controlling for duration of untreated psychosis (D.U.P) and premorbid adjustments, were used in examining associations.Results: Among 99 participants in the baseline sample, 91 (91.8%) and 20 (20.2%) had at least one definite NSS and EPS, respectively, before exposure to antipsychotics. Treatment-induced EPS were recorded in 34 (38.6%). Spontaneous EPS was associated with treatment-emergent Akathisia in participants with a longer D.U.P (r = 0.75, β = 0.70, p = 0.008). This association was specific for Parkinsonism (r = 0.75, β = 0.85, p = 0.008) and dyskinesia (r = 0.75, β = 1.70, p = 0.008).Conclusion: Similar to previous findings for tardive dyskinesia in studies implementing longer-term follow-up, spontaneous EPS may also predict short-term antipsychotic-induced EPS such as akathisia. These results may be important for early identification of patients at risk of treatment-induced Akathisia-linked psychomotor agitation in first episode schizophrenia.

Differentiation in Neurological Soft Sign Scores on Schizophrenic Patients with Antipsychotic Treatment

“…We found that at the 4 weeks observation, there was an increase in NSS scores of patients who received haloperidol because of the development of extrapyramidal syndrome (EPS). This explained that EPS symptoms can appear at the beginning of therapy in schizophrenic patients and will affect NSS signs [18]. On the other hand, this phenomenon can also be a marker for assessing other EPS risks such as akathisia in individuals with acute schizophrenia and can be a consideration in the long-term management of schizophrenic patients.…”

Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies

“…Regarding the geographical distribution, the review included six studies from Europe [4,[25][26][27][28][29], five studies from Asia [30][31][32][33][34], two studies from Africa [35,36], one study from South America [37], and one study from North America [38]. Thirteen of these studies had employed cross-sectional design [4,26,[28][29][30][31][33][34][35][36][37] with two of which being a retrospective chart review [25,32] and the remaining two studies had employed cohort design [27,38]. The sample size of individual studies ranged from 28 [29] to 164,417 [38].…”

Psychosis in Parkinson’s disease and parkinsonism in antipsychotic-naive schizophrenia spectrum psychosis: clinical, nosological and pathobiological challenges

“…In PD, the cardinal diagnostic symptoms of this movement disorder (Movement Disorder Society Clinical Diagnostic Criteria for Parkinson’s Disease) involve bradykinesia/akinesia, rigidity, resting tremor and abnormalities of posture and gait [ 26 , 33 ]. In drug-naive schizophrenia, parkinsonism is characterized by these same features [ 19 – 24 ]. However, movement disorders in drug-naive schizophrenia can also include abnormal involuntary movements (AIM) that overlap phenomenologically with what would be described as tardive dyskinesia in schizophrenia patients who have received long-term treatment with antipsychotics [ 12 , 19 – 24 ] and dyskinesia in PD patients who have received long-term treatment with L-dopa [ 26 ].…”

“…In drug-naive schizophrenia, parkinsonism is characterized by these same features [ 19 – 24 ]. However, movement disorders in drug-naive schizophrenia can also include abnormal involuntary movements (AIM) that overlap phenomenologically with what would be described as tardive dyskinesia in schizophrenia patients who have received long-term treatment with antipsychotics [ 12 , 19 – 24 ] and dyskinesia in PD patients who have received long-term treatment with L-dopa [ 26 ]. Furthermore, parkinsonism and AIM can occasionally cooccur in patients with drug-naive schizophrenia; in such instances, it appears that while parkinsonism is evident primarily in peripheral regions, AIM have a primarily orofacial topography [ 19 – 24 ].…”

“…These challenges can be overcome through the assessment of drug-naive schizophrenia patients at their first presentation and, in developing countries where health service provision is as yet insufficient, over the continuing course of untreated illness. Critically, findings in these drug-naive states indicate that movement disorders, both parkinsonism and hyperkinesia, can be detected in schizophrenia at the first presentation and for several years thereafter [ 19 – 24 ]. Thus, we have posited that DA D 2 receptor antagonist antipsychotics, both FGAs and, although perhaps less so, SGAs, interact with the disease process in the manner of a modifier that ‘precipitates’ and ‘accentuates’ movement disorders intrinsic to schizophrenia [ 20 , 25 ].…”