Evolution of antipsychotic-induced extrapyramidal symptoms in patients with schizophrenia in the real-life: A 4-year follow-up naturalistic study

• Published in: Schizophrenia research Vol. 248; pp. 279 - 286
• Main Authors: Monteleone, Palmiero, Cascino, Giammarco, Rossi, Alessandro, Rocca, Paola, Bertolino, Alessandro, Aguglia, Eugenio, Amore, Mario, Andriola, Ileana, Bellomo, Antonello, Biondi, Massimo, Brasso, Claudio, Carpiniello, Bernardo, Collantoni, Enrico, Dell'Osso, Liliana, di Giannantonio, Massimo, Fabrazzo, Michele, Fagiolini, Andrea, Giordano, Giulia Maria, Marcatili, Matteo, Marchesi, Carlo, Monteleone, Alessio Maria, Pompili, Maurizio, Roncone, Rita, Siracusano, Alberto, Vita, Antonio, Zeppegno, Patrizia, Galderisi, Silvana, Maj, Mario
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.10.2022
• Subjects: Antipsychotics; Evolution; Extrapyramidal side effects; Naturalistic study; Psychiatric/Mental Health; Schizophrenia; Schizophrenia; Antipsychotics; Evolution; Extrapyramidal side effects; Naturalistic study
• ISSN: 0920-9964; 1573-2509; 1573-2509
• DOI: 10.1016/j.schres.2022.08.015

Previous studies have shown, although not consistently, that first generation antipsychotics (FGA) are associated with a prevalence of extrapyramidal symptoms (EPS) higher than second generation antipsychotics (SGA). We assessed the prevalence and the incidence of antipsychotic-induced EPS in a large sample of community-dwelling Italian persons with schizophrenia before and after a 4-year naturalistic treatment, to shed light on their natural evolution and to identify possible predicting factors. EPS and psychopathology were assessed in 571 subjects with schizophrenia before (baseline) and after 4-year follow-up. Patients underwent treatment with SGA and/or FGA according to the referring clinicians' judgment. Relationships between EPS and psychopathology were assessed by network analysis, while a linear multiple regression investigated factors correlated to the presence of EPS at follow-up. EPS were significantly more frequent in the FGA- than in the SGA-treated group, and patients with EPS presented a more severe psychopathology. Parkinsonism was directly and positively connected with poor emotional expression at baseline and with poor emotional expression and disorganization at follow-up. Over the 4-year follow-up, emergent EPS were more frequent in FGA-treated patients, while relieved EPS occurred more frequently in SGA-treated persons. The presence of EPS at follow-up was significantly associated with EPS at baseline, illness duration, antipsychotic generation and the daily dose of antipsychotic medications. After a 4-year naturalistic treatment, EPS disappeared more frequently in SGA-treated patients, while they emerged more frequently in FGA-treated individuals. Therefore, although SGA did not eliminate the risk of EPS, these drugs seem to be associated to a more favorable EPS natural evolution.