Anti psychotic-induced extrapyramidal side effects in bipolar disorder and schizophrenia - A systematic review

Department of Psychiatry, Bipolar Disorder Research Center at the Mood Disorders Program, University Hospitals Case Medical Center/Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
Journal of Clinical Psychopharmacology (Impact Factor: 3.76). 05/2008; 28(2):203-9. DOI: 10.1097/JCP.0b013e318166c4d5
Source: PubMed

ABSTRACT Newer atypical antipsychotics have been reported to cause a lower incidence of extrapyramidal side effects (EPS) than conventional agents. This review is to compare antipsychotic-induced EPS relative to placebo in bipolar disorder (BPD) and schizophrenia.
English-language literature cited in Medline was searched with terms antipsychotics, placebo-controlled trial, and bipolar disorder or schizophrenia and then with antipsychotic (generic/brand name), safety, akathisia, EPS, or anticholinergic use, bipolar mania/depression, BPD, or schizophrenia, and randomized clinical trial. Randomized, double-blind, placebo-controlled, monotherapy studies with comparable doses in both BPD and schizophrenia were included. Absolute risk increase and number needed to treat to harm (NNTH) for akathisia, overall EPS, and anticholinergic use relative to placebo were estimated.
Eleven trials in mania, 4 in bipolar depression, and 8 in schizophrenia were included. Haloperidol significantly increased the risk for akathisia, overall EPS, and anticholinergic use in both mania and schizophrenia, with a larger magnitude in mania, an NNTH for akathisia of 4 versus 7, EPS of 3 versus 5, and anticholinergic use of 2 versus 4, respectively Among atypical antipsychotics, only ziprasidone significantly increased the risk for overall EPS and anticholinergic use in both mania and schizophrenia, again with larger differences in mania, an NNTH for overall EPS of 11 versus 19, and anticholinergic use of 5 versus 9. In addition, risks were significantly increased for overall EPS (NNTH = 5) and anticholinergic use (NNTH = 5) in risperidone-treated mania, akathisia in aripiprazole-treated mania (NNTH = 9) and bipolar depression (NNTH = 5), and overall EPS (NNTH = 19) in quetiapine-treated bipolar depression.
Bipolar patients, especially in depression, were more vulnerable to having acute antipsychotic-induced movement disorders than those with schizophrenia.

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Available from: Keming Gao, Aug 27, 2015
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    • "Mood stabilizers may be protective for brain structure and function (Emsell and McDonald, 2009; Benedetti et al., 2011), but whether saccade accuracy is restored with mood stabilizer treatment requires further investigation. Higher rates of extrapyramidal effects of antipsychotic medication have been noted in bipolar disorder compared with schizophrenia (Gao et al., 2008). Our data may be consistent with this in that prior to treatment, BDP patients showed a motor system disturbance that schizophrenia patients did not. "
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