Prevalence of and Risk Factors for Extrapyramidal Side Effects of Antipsychotics: Results From the National FACE-SZ Cohort.
J. Clin. Psychiatry. 2019-01-08; 80(1):
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Misdrahi D(1)(2)(3), Tessier A(2)(3), Daubigney A(4), Meissner WG(4), Schurhoff F(2)(5), Boyer L(6), Godin O(2)(7), Bulzacka E(2)(5), Aouizerate B(2)(8), Andrianarisoa M(2)(5), Berna F(2)(9), Capdevielle D(2)(10), Chereau-Boudet
I(2)(11), D’Amato T(2)(12), Dubertret C(2)(13), Dubreucq J(2)(14), Faget-Agius C(2)(15), Lançon C(2)(15), Mallet J(2)(13), Passerieux C(2)(16), Rey R(2)(12), Schandrin A(2)(17), Urbach M(2)(16), Vidailhet P(2)(9), Llorca PM(2)(11), Fond G(2); FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) Group.
(1)Centre Hospitalier Charles Perrens, CNRS UMR 5287-INCIA, 121 Rue de la Béchade, 33076 Bordeaux, France. .
(2)FondaMental Foundation, Créteil, France.
(3)Department of Adult Psychiatry, Charles Perrens Hospital, University of Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France.
(4)Neurology Department, Pellegrin Hospital, Bordeaux University Hospital; and Institute of Neurodegenerative Diseases, University of Bordeaux, UMR 5293, Bordeaux, France.
(5)INSERM U955, Translational Psychiatry Team, Créteil, France, Paris-Est Créteil University, DHU Pe-PSY, Psychiatry and Addictions Department, Henri Mondor Hospital, Créteil, France.
(6)Aix-Marseille University, School of Medicine, La Timone, EA 3279: CEReSS-Study and Research Center on Health Services and Quality of Life, Marseille, France.
(7)Sorbonne University, UPMC University of Paris, UMR_S 1136, Pierre Louis institute of Epidemiology and Public Health, Paris, France.
(8)Department of Adult Psychiatry, Charles Perrens Hospital; and Laboratory of Nutrition and Integrated Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France.
(9)Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France.
(10)Academic Department of Adult Psychiatry, La Colombière Hospital, CHRU Montpellier, University of Montpellier, Inserm 1061, Montpellier, France.
(11)CMP B, CHU, EA 7280 Faculty of Medicine, University of Auvergne, Clermont-Ferrand, France.
(12)INSERM U1028, CNRS UMR5292, Neurosciences Research Center of Lyon, Claude Bernard University, PSYR2 team, Le Vinatier Hospital, Bron, France.
(13)AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894 Paris Diderot University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France.
(14)Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France.
(15)AP-HM, Academic Department of Psychiatry, Marseille, France.
(16)Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, EA 4047 HANDIReSP, Versailles Saint-Quentin en Yvelines University, Versailles, France.
(17)Carémeau Hospital, Nîmes, France.
BACKGROUND: Extrapyramidal side effects (EPS) have been identified as a complication of antipsychotic treatment. Previous meta-analyses have investigated EPS prevalence and risk factors in randomized clinical trials with highly
selected patients, but studies in real-world schizophrenia are missing.
OBJECTIVE: To examine the prevalence and clinical correlates associated with EPS in a nonselected national multicenter sample of stabilized patients with schizophrenia.
METHODS: Between 2010 and 2016, patients suffering from schizophrenia (DSM-IV-TR criteria) were recruited through the FondaMental Academic Centers of Expertise for Schizophrenia (FACE-SZ) network and data were collected during a comprehensive 1-day-long standardized evaluation. The Simpson-Angus Scale and the Abnormal Involuntary Movement Scale were used to assess drug-induced parkinsonism (DIP) and tardive dyskinesia, respectively.
RESULTS: The overall prevalence of DIP and tardive dyskinesia was 13.2% and 8.3%, respectively, in this community-dwelling sample of 674 patients. DIP was associated with negative symptoms (Positive and Negative Syndrome Scale [PANSS] subscore) (adjusted odds ratio [aOR] = 1.102, P < .001), first-generation antipsychotic prescription (aOR = 2.038, P = .047), and anticholinergic drug administration (aOR = 2.103, P = .017) independently of sex, age, disorganization (PANSS disorganized factor), and antipsychotic polytherapy. Tardive dyskinesia was associated with PANSS disorganized factor (aOR = 1.103, P = .049) independently of sex, age, negative symptoms, excitation, first-generation antipsychotic prescription, and benzodiazepine and anticholinergic drug administration.
CONCLUSIONS: Our results indicate the high prevalence of EPS in a nonselected community-dwelling clinically stable sample of outpatients with schizophrenia. In the monitoring of antipsychotic treatment, EPS should be systematically evaluated, especially when negative symptoms and disorganization or cognitive alteration are present. Monotherapy with a second-generation antipsychotic should be preferentially initiated for patients with these side effects.
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