Comparison between characteristics of patients experiencing Extrpyramidal side effects, between first and second generation antipsychotic use- A retrospective cross sectional study.

BACKGROUND: Antipsychotic medications are used to treat and manage symptoms for several psychiatric disorders and are commonly categorised into two classes namely first generation and second generation antipsychotics. Extrapyramidal motor symptoms are major adverse effects of antipsychotics mediated by blockade of dopamine signalling in the nigrostriatal dopamine system. First generation antipsychotics exhibit a narrow therapeutic window compared to second generation antipsychotics with respect to these Extrapyramidal side effects. The risk factors for EPS are complicated and are related to a lot of factors including demographics, antipsychotic dosage, duration of treatment and so forth. AIM OF THE STUDY: The aim of the study is to profile patients who have developed, extrapyramidal adverse effects and identify risk factors significantly associated with each subtype of extrapyramidal effects and to compare the risk factors between first and second generation antipsychotics. MATERIALS AND METHODS: A retrospective cross sectional study was conducted using case records of patients, who were treated as inpatients in IMH, Kilpauk from July 2021 to September 2021. Descriptive statistics was used to analyse patient characteristics, including age, gender, BMI category, specific antipsychotics, dosage, daily chlorpromazine equivalents and the presence of antipsychotics overdose with respect to first generation and second generation antipsychotics and the results were compared. RESULTS: There was a male preponderance among the study participants. In our study population, the most common antipsychotics precipitating EPSs were Haloperidol and Risperidone. There was significant association between gender and the type of EPS, tremors were significantly higher among females whereas hypersalivation and bradykinesia was more common among males in both first and second generation antipsychotics. There was no significant association between diagnosis and the type of EPS. REFERENCES: Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA. Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy. J Clin Psychopharmacol. 2019 Jul/Aug;39(4):336-343. doi: 10.1097/JCP.0000000000001061. PMID: 31205194; PMCID: PMC6594730. Krause M, Huhn M, Schneider-Thoma J, Bighelli I, Gutsmiedl K, Leucht S. Efficacy, acceptability and tolerability of antipsychotics in patients with schizophrenia and comorbid substance use. A systematic review and meta-analysis. Eur Neuropsychopharmacol. 2019 Jan;29(1):32-45. doi: 10.1016/j.euroneuro.2018.11.1105. Epub 2018 Nov 22. PMID: 30472164.