Keywords
EPS
Movement Disorders
EPS monitoring Tools
Antipsychotic Medications
Psychiatric Disorders
How to Cite
Abstract
Background: Extrapyramidal symptoms (EPS) are drug-induced motor disorders associated with antipsychotic medications, including drug-induced parkinsonism, akathisia, dystonia, and tardive dyskinesia. EPS can lead to significant physical discomfort, functional impairment, and social withdrawal. The severity and prevalence of EPS vary based on factors such as drug choice, dosage, individual susceptibility, and duration of treatment, making it essential for healthcare providers to monitor and manage these symptoms carefully in patients undergoing antipsychotic therapy.
Methods: We conducted comprehensive searches in the PubMed, PsycInfo, and Google Scholar databases, initially identifying 522 records related to EPS in psychiatric disorders published between 2002 and 2024. The search strategy focused on original research articles, clinical trials, and observational studies. After screening and applying predefined inclusion and exclusion criteria, 13 studies were selected for analysis and inclusion in this review.
Results and Discussion: The review highlights the challenges of EPS management, emphasizing the need for early detection and personalized treatment strategies. Integrating advanced technologies, such as AI-driven platforms, offers promising prospects for improving EPS diagnosis and management. A multidisciplinary approach that combines clinical expertise, advanced technologies, and patient-centered care is essential for effective EPS management.
References
Ward KM. Antipsychotic-Related Movement Disorders : Drug- Induced Parkinsonism vs . Tardive Dyskinesia — Key Differences in Pathophysiology and Clinical Management DRUG-INDUCED PARKINSONISM. Neurol Ther [Internet]. 2018;7(2):233–48.
Available from: https://doi.org/10.1007/s40120-018-0105-0
Dayalu P, Chou KL. Extrapyramidal Symptoms and. 2008;1451–62.
Divac N, Prostran M, Jakovcevski I, Cerovac N. Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int. 2014;2014.
Butler MI, Chandrakanth J. Monitoring of extrapyramidal side effects in patients on antipsychotic treatment: A completed audit cycle. Ir J Psychol Med. 2016;33(3):165–9.
Nillafita E, Kusuma P, Oktaviani E, Harahap WA. Study of adverse effects of extrapyramidal syndrome use of combination of antipsychotics antidepressants in outpatient schizophrenia patients in RSUP Fatmawati for the period 2016-2020. 2023;13(July):185– 96.
Divac N, Prostran M, Jakovcevski I, Cerovac N. Extrapyramidal Adverse Effects. 2014;2014.
Park S, Tripathi A, Avasthi A, Grover S, Tanra AJ, Kato TA, et al. Relationship between body mass index and extrapyramidal symptoms in asian patients with schizophrenia : the research on asian psychotropic prescription patterns for antipsychotics ( reap-ap ). 2020;32(2):176–86.
Pierre JM. Extrapyramidal Symptoms with Atypical Antipsychotics Incidence , Prevention and Management. 2005;28(3):191–208.
Kaar SJ, Natesan S, Mccutcheon R, Howes OD. Neuropharmacology Antipsychotics : Mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology. Neuropharmacology [Internet]. 2019;(March):107704. Available from: https://doi.org/10.1016/j.neuropharm.2019.107704
Disease N. Drug-Induced Movement Disorders and Its Associated Factors Among Patients Attending Treatment at Public Hospitals in Eastern Ethiopia. 2020;1987–95.
Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. 2018;(October):341–56.
Hauser RA, Meyer JM, Factor SA, Comella CL, Tanner M, Xavier RM, et al. HHS Public Access Author manuscript antipsychotic-induced movement disorders in clinical practice. 2022;27(2):208–17.
Abu-naser D, Gharaibeh S, Meslamani AZ Al, Alefan Q, Abunaser R. Clinical Practice & Epidemiology in Assessment of Extrapyramidal Symptoms Associated with Psychotropics Pharmacological Treatments , and Associated Risk Factors Abstract : 2021;1–7.
Roiter B, Pigato G, Antonini A. Prevalence of Extrapyramidal Symptoms in In-Patients With Severe Mental Illnesses : Focus on Parkinsonism. 2020;11(November):1–7.
Das JK, Kumar R, Salam RA, Freedman S, Bhutta ZA. The effect of antiemetics in childhood gastroenteritis. 2013;13(Suppl 3).
Özge A, Domaç FM, Tekin N, Sünbül EA, Öksüz N, Atalar AÇ, et al. One Patient , Three Providers : A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases. 2023;
Powell A, Gallur L, Koopowitz L, Hayes MW. Parkinsonism in the psychiatric setting : an update on clinical differentiation and management. 2020;1–5.
Loonen AJM, Ivanova SA. Neurobiological mechanisms associated with antipsychotic drug-induced dystonia. 2021;
Musco S, Mcallister V, Caudle I. Dopamine-receptor blocking agent- associated akathisia : a summary of current understanding and proposal for a rational approach to treatment. 2020;1–13.
Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-Induced Tardive Dyskinesia : A Review and Update. 2017;
Lisoway AJ, Chen CC, Zai CC, Tiwari AK, Kennedy JL. Toward personalized medicine in schizophrenia : Genetics and epigenetics of antipsychotic treatment. Schizophr Res [Internet]. 2021;232:112–24. Available from: https://doi.org/10.1016/j.schres.2021.05.010
Tandon R. Antipsychotics in the Treatment of Schizophrenia: An Overview. 2011;72(suppl 1):4–8.
Ayd F, Wilson K. Acute dystonias. 1979. 35–67 p.
Weng J, Zhang Y, Li H, Shen Y, Yu W. Study on risk factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia. 2019;14–21.
Konstandi M, Johnson EO. Age-related modi fi cations in CYP-dependent drug metabolism : role of stress. 2023;(May):1–10.
Eun J, Dong Y, Shin W, Jang W, Han K, Kim D, et al. Female reproductive factors and the risk of Parkinson ’ s disease : a nationwide cohort study. Eur J Epidemiol [Internet]. 2020;35(9):871–8. Available from: https://doi.org/10.1007/s10654-020-00672-x
Bologna M, Paparella G, Fasano A, Hallett M, Berardelli A. Evolving concepts on bradykinesia Bradykinesia : terminology and clinical aspects. 2020;(2019).
Akathisia A, Pringsheim T, Gardner D, Addington D, Martino D, Morgante F, et al. The Assessment and Treatment of. 2018;
Chouinard G, Margolese HC. Manual for the Extrapyramidal Symptom Rating Scale ( ESRS ). 2005;76:247–65.
Guy R, Assessment WE, Revised P. Abnormal Involuntary Movement Scale ( AIMS ).1988;173(6):118–9.
Janno S, Holi MM, Tuisku K, Wahlbeck K. schizophrenia population. 2005;6:1–6.
Barnes TR. A rating scale for drug-induced akathisia . A Rating Scale for Drug-Induced.2012;672–6.
Carbon M, Kane JM, Leucht S, Correll CU. Tardive dyskinesia risk with fi rst- and second- generation antipsychotics in comparative randomized controlled trials : a meta-analysis. 2018;(October):330–40.
Caroff SN, Morley JF. Risk of Drug-induced Movement Disorders with Newer Antipsychotic Agents. 2022;12(1):1–18.
Muench J, Hamer ANNM. Adverse Effects of Antipsychotic Medications. 2010;81(5):617– 22.
Article R. Recent management of extrapyramidal syndrome in antipsychotic use. 23(2023):320–8.
Id JS, Hsu MM, Pantelyat AY, Id RTR. PLOS DIGITAL HEALTH Clinical gait analysis using video-based pose estimation : Multiple perspectives , clinical populations , and measuring change. 2024; Available from: http://dx.doi.org/10.1371/journal.pdig.0000467
Pothuri V. Natural Language Processing and Conversational AI. 2024;(September).
Reddy GP, Rohan D, Venkata Y, Kumar P, Prakash KP, Srikanth M. Artificial Intelligence- Based Effective Detection of Parkinson ’ s Disease Using Voice Measurements. 2024;1–8.
Claxton KL, Chen JJ, Swope DM. Drug-Induced Movement Disorders. 2007;415–29.
Bobes J, Rejas J. Frequency of Extrapyramidal Adverse Reactions in Schizophrenic Outpatients Treated with Risperidone , Olanzapine , Quetiapine or Haloperidol Results of the EIRE Study. 2002;22(9):609–22.
Ghaemi SN, Hsu DJ, Rosenquist KJ, Pardo TB, Goodwin FK. Extrapyramidal side effects with atypical neuroleptics in bipolar disorder. 2006;30:209–13.
Novick D, Haro ÞJM, Bertsch J, Haddad PM. Incidence of Extrapyramidal Symptoms and Tardive Dyskinesia in Schizophrenia Outpatient Health Outcomes Study. 2010;30(5):531– 40.
Zhornitsky S, Stip E, Pampoulova T, Chiasson J. Extrapyramidal Symptoms in Substance Abusers with and Without Schizophrenia and in Nonabusing Patients with Schizophrenia. 2010;25(13):2188–94.
Kirgaval RS, Revanakar S, Srirangapattna C. Prevalence of Extrapyramidal Side Effects in Patients on Antipsychotics Drugs at a Tertiary Care Center5. 2017;20(5).
Kadakia A, Brady BL, Dembek C, Williams GR, Kent M, Kadakia A, et al. The incidence and economic burden of extrapyramidal symptoms in patients with schizophrenia treated with second generation antipsychotics in a Medicaid population with schizophrenia treated with second generation antipsychotics in a. J Med Econ [Internet]. 2022;25(1):87–98. Available from: https://doi.org/10.1080/13696998.2021.2019501
Shettima FB, Sheikh TL, Wakil MA. Prevalence and Correlates of Extrapyramidal Side Effects Among Patients with Schizophrenia Spectrum Disorders on Typical and Atypical Antipsychotics. 2023;225–40.