Extrapyramidal side effects of antipsychotics: prevalence and risk factors. Results from the national FACE-SZ cohort Cover title Extrapyramidal side effects and antipsychotics

David Misdrahi (1, 2) , Arnaud Tessier (1, 2) , Antoine Daubigney (2) , Wassilios G. Meissner (2) , Franck Schürhoff (1, 3) , Laurent Boyer (4) , Ophelia Godin (5, 1) , Ewa Bulzacka (3, 1) , Bruno Aouizerate (1, 2) , Meja Andrianarisoa (1, 3) , Fabrice Berna (6, 1) , Delphine Capdevielle (7, 1) , Isabelle Chereau-Boudet (8, 9) , Thierry D’amato (1, 10) , Caroline Dubertret (1, 11) , Julien Dubreucq (1, 12) , Catherine Faget-Agius (13, 1) , Christophe Lançon (13, 1) , Jasmina Mallet (1, 14) , Christine Passerieux (1, 15) , Romain Rey (1, 10) , Aurélie Schandrin (1, 16) , Mathieu Urbach (1, 15) , Pierre Vidailhet (1, 17) , Pierre-Michel Llorca (9, 1) , Guillaume Fond (18, 13, 1, 4)

1 Fondation FondaMental [Créteil]
2 UB - Université de Bordeaux
3 Inserm U955 - Molecular virology and immunology – Physiopathology and therapeutic of chronic viral hepatitis (Team 18)
4 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
5 Pierre Louis Institute of Epidemiology and Public Health
6 FMTS - Fédération de Médecine Translationnelle de Strasbourg
7 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
8 Centres d'addictologies - Région Centre
9 NPsy-Sydo - Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux
10 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
11 UPD7 - Université Paris Diderot - Paris 7
12 Centre Référent de Réhabilitation Psychosociale [CH Alpes Isère]
13 APHM - Assistance Publique - Hôpitaux de Marseille
14 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
15 HANDIReSP - Laboratoire de recherches cliniques et en santé publique sur les handicaps psychique, cognitif et moteur
16 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
17 UNISTRA - Université de Strasbourg
18 AMU - Aix Marseille Université

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.

Domaines: Psychiatrie et santé mentale

David Misdrahi, Arnaud Tessier, Antoine Daubigney, Wassilios G. Meissner, Franck Schürhoff, et al.. Extrapyramidal side effects of antipsychotics: prevalence and risk factors. Results from the national FACE-SZ cohort Cover title Extrapyramidal side effects and antipsychotics. The Journal of clinical psychiatry, 2019, 80 (1), ⟨10.4088/JCP.18m12246⟩. ⟨hal-02473295⟩