The Effect of Antipsychotic Medication on Neuromotor Abnormalities in Neuroleptic-Naive Nonaffective Psychotic Patients
- 4 March 2010
- journal article
- Published by Physicians Postgraduate Press, Inc in The Primary Care Companion For CNS Disorders
- Vol. 12 (2)
- https://doi.org/10.4088/PCC.09m00799gry
Abstract
To examine the effect of antipsychotic medication on neuromotor abnormalities in a sample of psychotic patients never exposed to antipsychotic drugs. One hundred psychotic patients were assessed (from January 1998 to December 2002) using DSM-IV criteria for parkinsonism, dyskinesia, akathisia, catatonia, and dystonia at baseline and after 4 weeks of treatment with haloperidol (n = 23), risperidone (n = 52), or olanzapine (n = 25). We examined change scores in neuromotor ratings over the treatment period across treatment groups and rates of drug-responsive and drug-emergent neuromotor syndromes in patients with and without preexisting neuromotor abnormalities. Overall time effects revealed a worsening of parkinsonism (P = .002) and akathisia (P = .002) ratings and an improvement of dyskinesia (P = .001) and catatonia (P < .001) ratings. Main treatment effects revealed that patients taking haloperidol had a significant mean increase in akathisia scores compared with those of patients taking risperidone (P = .002) or olanzapine (P < .001). A significantly greater percentage of olanzapine-treated patients experienced remission of preexisting parkinsonism than did the other treatment groups (P = .047). Patients without preexisting motor abnormalities were more likely to experience drug-emergent parkinsonism if they were treated with haloperidol or risperidone than with olanzapine (P = .001) and were more likely to experience drug-emergent dystonia (P = .014) and akathisia (P = .013) if they were treated with haloperidol than with risperidone or olanzapine. The relationship between antipsychotic medication and neurologic abnormalities is more complex than previously acknowledged since antipsychotic drugs may both improve preexisting abnormalities and cause "de novo" neurologic syndromes. Overall, olanzapine has a more favorable neuromotor profile than risperidone, which in turn has a more favorable profile than haloperidol.Keywords
This publication has 39 references indexed in Scilit:
- Extrapyramidal side-effects of antipsychotics in a randomised trialThe British Journal of Psychiatry, 2008
- Neurological Signs and Involuntary Movements in Schizophrenia: Intrinsic To and Informative on Systems PathobiologySchizophrenia Bulletin, 2008
- Evidence That Early Extrapyramidal Symptoms Predict Later Tardive Dyskinesia: A Prospective Analysis of 10,000 Patients in the European Schizophrenia Outpatient Health Outcomes (SOHO) StudyAmerican Journal of Psychiatry, 2006
- Haloperidol Dose When Used as Active Comparator in Randomized Controlled Trials With Atypical Antipsychotics in SchizophreniaBritish Journal of Psychology, 2006
- Chlorpromazine Equivalent Doses for the Newer Atypical AntipsychoticsThe Journal of Clinical Psychiatry, 2003
- Atypical and Conventional Antipsychotic Drugs in Treatment-Naive First-Episode Schizophrenia: A 52-Week Randomized Trial of Clozapine Vs ChlorpromazineNeuropsychopharmacology, 2003
- An efficacy analysis of olanzapine treatment data in schizophrenia patients with catatonic signs and symptoms.2001
- Catatonia and other motor syndromes in a chronically hospitalized psychiatric populationSchizophrenia Research, 1997
- Are There More Than Two Syndromes in Schizophrenia?The British Journal of Psychiatry, 1992
- Optimal Dose of Neuroleptic in Acute SchizophreniaArchives of General Psychiatry, 1991