Extrapyramidal Symptoms in Neuroleptic Recipients

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Abstract
Adverse drug reactions (ADRs) in psychiatric therapy were continuously assessed in the AMUP study (AMUP = Arzneimittelüberwachung in der Psychiatrie (drug surveillance in psychiatry] conducted at two psychiatric university departments in the F.R.G. The Intensive Drug Monitoring (IDM) method was used to monitor 1107 patients, 754 of whom received neuroleptics (NLs). As is the rule in clinical psychiatric practice, polypharmacy was frequent, with combinations of two neuroleptics and combinations of a neuroleptic and an antiparkinson drug ranking first and second, respectively. Extrapyramidal motor symptoms (EPMS) were observed in 35% of the NL patients. In most cases they required a change in medication, usually addition of an antiparkinson drug. In about one quarter of all EPMS cases, withdrawal of the imputed NL was necessary. Parkinsonism was the most frequent single symptom, followed by acute dystonia and akathisia. Differences in EPMS rates between the two most frequently used neuroleptics, haloperidol, a high-potency butyrophenone, and perazine, a medium-potency phenothiazine, were distinct. EPMS were observed with haloperidol in 56% and attributed to haloperidol alone in 92% of these cases. With perazine, an EMPS occurred at a rate of only 14%, and in 37% of the cases EMPS were attributable to perazine in combination with other NLs. Age, sex, diagnosis and dosage of administered NLs were closely interrelated. For instance, NL patients over 60 years of age were almost exclusively female, the majority of them being endogenous depressives, whereas in younger patients the diagnosis of schizophrenia prevailed. Therefore, analysis of potential risk factors for development of EPMS must simultaneously include diagnosis, sex and age as well as concomitant physical disease, duration and dosage of all drugs administered before development of EPMS. However, the small case numbers in some subgroups, as we found them in this study based on everyday clinical practice, will probably be a limiting factor in such multivariate analyses.

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