OBJECTIVE: This study assessed the prevalence of extrapyramidal signs
and spontaneous dyskinesia in neuroleptic-naive, first-episode
schizophrenic patients and examined the clinical correlates. METHOD: In a
prospective study of the psychobiology of schizophrenia, the authors
examined 89 neuroleptic-naive patients for the presence of extrapyramidal
signs by using the Simpson-Angus Rating Scale and for dyskinesia by using
the Tardive Dyskinesia Rating Scale. RESULTS: Fifteen patients (16.9%) had
extrapyramidal signs, but only one had spontaneous dyskinesia at baseline.
Presence of extrapyramidal signs was correlated with more negative symptoms
and poorer treatment outcome that was reflected in a longer time to and
lower level of remission. There was no correlation of spontaneous
extrapyramidal signs with age of patient, age at onset of psychotic
symptoms, or baseline psychopathology. There was no difference between
patients with and without spontaneous extrapyramidal signs in terms of the
subsequent development of persistent tardive dyskinesia, but the patients
with spontaneous extrapyramidal signs were more likely to develop
parkinsonian side effects after 8 weeks of antipsychotic treatment.
CONCLUSIONS: Extrapyramidal signs are present in a proportion of
neuroleptic-naive, first-episode schizophrenic patients, which suggests an
involvement of these signs in the schizophrenic process that probably
reflects basal ganglia pathology. The presence of spontaneous
extrapyramidal signs seems to have prognostic significance insofar as it is
linked to a poorer outcome and longer time to remission. Spontaneous
dyskinesia appears to be a relatively rare finding.