Prevalence of and Risk Factors for Extrapyramidal Side Effects of Antipsychotics: Results From the National FACE-SZ Cohort

OVERVIEW

When you see patients taking antipsychotics, do you systematically evaluate them for extrapyramidal side effects? This CME article discusses risk factors.

ABSTRACT

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.

J Clin Psychiatry 2019;80(1):18m12246

To cite: Misdrahi D, Tessier A, Daubigney A, et al. Prevalence of and risk factors for extrapyramidal side effects of antipsychotics: results from the national FACE-SZ cohort. J Clin Psychiatry. 2019;80(1):18m12246.

To share: https://doi.org/10.4088/JCP.18m12246

© Copyright 2019 Physicians Postgraduate Press, Inc.

Target Audience

  • Neurologists, Geriatric Psychiatrists, and NPs and PAs who specialize in Neurology and Psychiatry.

  • Primary Care Clinicians and Psychiatrists

Learning Objectives

After completing this educational activity, you should be able to:

  • Identify risk factors for extrapyramidal side effects in your patients taking antipsychotic agents
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
Activity opens: 
01/08/2019
Activity expires: 
02/28/2021
Cost:
$10.00

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

To obtain credit, read the article, correctly answer the questions in the Posttest, and complete the Evaluation. A $10 processing fee will apply.

CME Objective

After studying this article, you should be able to:

  • Identify risk factors for extrapyramidal side effects in your patients taking antipsychotic agents

Statement of Need and Purpose

The APA recommends that all patients taking an antipsychotic should be regularly monitored for movement disorders. However, evidence suggests that clinicians are underestimating and not discussing the risk of EPS with patients before prescribing antipsychotic medications. Barriers to making an accurate and timely diagnosis of EPS, such as TD and DIP, include clinicians’ lack of knowledge and training, not having sufficient time with a patient to address adverse effects, or underestimating the burden that antipsychotic side effects place on a patient’s life. Clinicians need education about EPS prevalence, risks, signs and symptoms, and useful screening tools to aid in early diagnosis. Release, Expiration, and Review Dates

This educational activity was published in January 2019 and is eligible for AMA PRA Category 1 Credit™ through February 28, 2021. The latest review of this material was December 2018.

Disclosure of off-label usage: The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration-approved labeling has been presented in this article.

Funding/support: This work was funded by Charles-Perrens Hospital, AP-HP (Assistance Publique des Hôpitaux de Paris), AP-HM (Assistance Publique des Hôpitaux de Marseille), FondaMental Foundation (RTRS Santé Mentale), the Investissements d’ Avenir program managed by the Agence Nationale de la Recherché (ANR) under reference ANR-11-IDEX-0004-02 and ANR-10-COHO-10-01, and INSERM (Institut National de la Santé et de la Recherche Médicale).

Role of the sponsor: The FondaMental Foundation (RTRS Santé Mentale) provided data management support. Charles-Perrens Hospital, AP-HP (Assistance Publique des Hôpitaux de Paris), AP-HM (Assistance Publique des Hôpitaux de Marseille), and Investissements d’ Avenir program had no role in the conduct or publication of the study.

Acknowledgments: The authors express thanks to the nurses and to the patients who were included in the present study. They thank Hakim Laouamri, MSc (FondaMental Foundation) and his team (Stéphane Beaufort, MSc; Seif Ben Salem, MSc; Karmène Souyris, MSc; Victor Barteau, MSc; and Mohamed Laaidi, MSc) for the development of the FACE-SZ computer interface, data management, quality control, and regulatory aspects. They thank Prof François Tison, MD, PhD, and Prof Dominique Guehl, MD, PhD, of Bordeaux University Hospital, for critical reading and the neurological point of view. The acknowledged individuals report no conflicts of interest with this study.

Faculty Affiliation

David Misdrahi, MD

FondaMental Foundation, Créteil, France

Arnaud Tessier, MSc

FondaMental Foundation, Créteil, France

Antoine Daubigney, MD

Neurology Department, Pellegrin Hospital, Bordeaux University Hospital; and Institute of Neurodegenerative Diseases, University of Bordeaux, UMR 5293, Bordeaux, France

Wassilios G. Meissner, MD, PhD

Neurology Department, Pellegrin Hospital, Bordeaux University Hospital; and Institute of Neurodegenerative Diseases, University of Bordeaux, UMR 5293, Bordeaux, France

Franck Schurhoff, MD, PhD

FondaMental Foundation, Créteil, France

Laurent Boyer, MD, PhD

Aix-Marseille University, School of Medicine, La Timone, EA 3279: CEReSS—Study and Research Center on Health Services and Quality of Life, Marseille, France

Ophélia Godin, MSc

FondaMental Foundation, Créteil, France

Ewa Bulzacka, MSc

FondaMental Foundation, Créteil, France

Bruno Aouizerate, MD, PhD

FondaMental Foundation, Créteil, France

Meja Andrianarisoa, MD

FondaMental Foundation, Créteil, France

Fabrice Berna, MD, PhD

FondaMental Foundation, Créteil, France

Delphine Capdevielle, MD, PhD

FondaMental Foundation, Créteil, France

Isabelle Chereau-Boudet, MD

FondaMental Foundation, Créteil, France

Thierry D’Amato, MD, PhD

FondaMental Foundation, Créteil, France

Caroline Dubertret, MD, PhD

FondaMental Foundation, Créteil, France

Julien Dubreucq, MD

FondaMental Foundation, Créteil, France

Catherine Faget-Agius, MD

FondaMental Foundation, Créteil, France

Christophe Lançon, MD, PhD

FondaMental Foundation, Créteil, France

Jasmina Mallet, MD

FondaMental Foundation, Créteil, France

Christine Passerieux, MD, PhD

FondaMental Foundation, Créteil, France

Romain Rey, MD

FondaMental Foundation, Créteil, France

Aurélie Schandrin, MD

FondaMental Foundation, Créteil, France

Mathieu Urbach, MD

FondaMental Foundation, Créteil, France

Pierre Vidailhet, MD, PhD

FondaMental Foundation, Créteil, France

Pierre-Michel Llorca, MD, PhD

FondaMental Foundation, Créteil, France

Guillaume Fond, MD, PhD

FondaMental Foundation, Créteil, France

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.

Drs Misdrahi, Daubigney, Meissner, Schurhoff, Boyer, Aouizerate, Andrianarisoa, Berna, Capdevielle, Chereau-Boudet, D’Amato, Dubertret, Dubreucq, Faget-Agius, Lançon, Mallet, Passerieux, Rey, Schandrin, Urbach, Vidailhet, Llorca, and Fond; Mr Tessier; and Mss Godin and Bulzacka have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

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The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

 

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of  1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

 

Available Credit

  • 1.00 AMA PRA Category 1 Credit™

Price

Cost:
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