Prevalence of extrapyramidal side effect among patients on first generation antipsychotic drugs admitted to JRRH and KIU-TH.
In this study, the prevalence of extrapyramidal side effect among patient on first generation antipsychotic drugs was at 54.5%.
The prevalence in our study was high compared to the findings reported in France by Aloisi and colleagues (11) where a prevalence of EPS of 13% was noted. This difference may be explained by the fact that Aloisi and colleagues selected only patient with schizophrenia. In addition, Aloisi and colleagues (11) used different tools from our study to screen EPS. Similar low rate was observed in Ethiopia, by Wubeshet and colleagues (12) who reported also a prevalence of EPS at 38% among patient on first generation antipsychotic drugs. This discrepancy may also be explained by the fact that Wubeshe and colleagues used Gass scale to screen EPS and select only patient who spent 3 months on antipsychotic drugs. In addition, only patient with schizophrenia were included in Wubeshe study (12).
An approximate rate to our findings was reported in UK by Luft and colleagues (13) where a rate of 53% of EPS was observed among patient on first generation of antipsychotic drug. However, Luft and colleagues (13) conducted their study in only patient on depot antipsychotic or long-acting risperidone injection.
Patterns of extrapyramidal side effect among patients on first generation antipsychotic drugs admitted to JRRH and KIU-TH.
In this study, dystonia (17.4%) was the most prevalent form of extrapyramidal side effects followed by parkinsonism (16.1%) and dyskinesia (13%).
Others authors reported DIP and dyskinesia as the most prevalent form as in a study conducted by Aloisi and colleagues (11) where a prevalence of 13% for parkinsonism and 8.3% for dyskinesia were reported among patient on first generation antipsychotic drugs. The difference in study population and tools used for screen patient may explain this discrepancy to our findings.
In UK Peluso and colleagues (14) reported similar findings with DIP and tardive dyskinesia as the most prevalent form of EPS among patient on antipsychotics drugs. However, Peluso and colleagues enrolled both patient on first and second generation and screen EPS after 12week of initiation of antipsychotic treatment.
Akathisia, parkinsonism and dyskinesia were also reported as the common form EPS in USA by Miller and colleagues (15) in patients on first generation antipsychotic drugs. The discrepancy in rate of form of EPS may be explained by different scale used for screening EPS and study population among others factors.
In his systematic literature review, Id and colleagues (16) reported also similar findings with prevalence of antipsychotic-induced Parkinsonism, akathisia, and tardive dyskinesia were respectively 20%, 11%, and 7%. However, this review included both first generation and 2nd generation antipsychotics.
Factors associated with occurrence of extrapyramidal side effect among patients on first generation antipsychotic drug.
Socio demographics factors.
In this study, smoker participants had 2.5 more likely risk to present with EPSE .Similar findings were reported in Jordan by Abu-naser and colleagues (17) where smoker participants on first generation antipsychotics drugs experiences more EPS. The findings of Chong and colleagues (18) in Singapore reported also similar finding with increases EPS in smoker participants.
This could be explained by the fact that smoking in increased dopaminergic activity from nicotine, leading to nigrostriatal hypersensitivity to dopamine, and neurotoxicity from the free radicals in cigarette smoke, causing damage to catecholaminergic neurons in the basal ganglia. In the other hand Smoking also increases the risk of cerebrovascular pathology, which may lead to increased risk of developing extrapyramidal side effect
In contrast to our findings, others authors reported no association between smoker and occurrence of EPS in patients on antipsychotic drugs as observed by Jiang and colleagues (19) in Singapore. However, Jiang and colleagues recruited only patient with schizophrenia.
Medical factors.
In this study, participants in whom schizophrenia was the raison of initiation of antipsychotic drugs had 1.2 more likely risk to present EPS. This was consistent with another study conducted in South Africa by Joubert and colleagues (20) here schizophrenic participants were more likely to experience EPS. Similar results were reported also in China by Weng and colleagues (21). The neurodevelopmental disorder or the dysfunction of the basal ganglia related to antipsychotic drugs and in schizophrenia its self may be the raison of high prevalence of EPS.
Also in this study participants who have taken antipsychotics drugs more than 1 month have more than 2.7 time to present with EPS. Lwahashi and colleagues (22) reported also similar findings where patients in their study on long standings on antipsychotic drugs experienced more EPS. In his systematic literature review ,Haddad and colleagues (23) observed also similar findings were patients on antipsychotics drugs to more than 12 weeks experiences more EPS. Wubeshet and colleagues (12) reported also that long standing of antipsychotic drugs in schizophrenic patient were significantly associated with occurrence with EPS. This was hypothetically justified by several authors in that, there may be a progressive loss of gray matter related to stress oxidative attributed to first generation antipsychotic drugs specifically haloperidol which can induce EPS(24).
In this study, participants with history of extrapyramidal side effects had 30 times more likely to experiences EPS. The findings of Blanchet (25) and Lwahashi and colleagues (22) are consistent with our findings where patients with history of extrapyramidal side effects had increased significant chance to present EPS.