Am J Psychiatry 1991; 148:85-89
Copyright © 1991 by American Psychiatric Association
Use of neuroleptic-induced extrapyramidal symptoms to predict future vulnerability to side effects
GA Keepers and DE Casey
Inpatient Psychiatry Section, Portland VA Medical Center, OR 97207.
OBJECTIVE: Susceptibility to neuroleptic-induced extrapyramidal syndromes
varies widely, even within age and sex subgroups. Individual vulnerability
to extrapyramidal syndromes has been assumed to explain this, but the
utility of past history for predicting future occurrence of extrapyramidal
syndromes has not been studied extensively. This investigation was
undertaken to determine whether patients' previous histories of
extrapyramidal syndromes predict future episodes of extrapyramidal
syndromes and to compare the importance of this predictive factor with
patient age, sex, neuroleptic dose, and anticholinergic dose as predictors
of extrapyramidal syndromes. METHODS: The charts of 62 schizophrenic
patients with multiple neuroleptic treatment episodes were reviewed.
Extrapyramidal syndromes, neuroleptic drug doses, and anticholinergic drug
doses during the first 21 days of each treatment episode were recorded.
RESULTS: Previous extrapyramidal syndromes correctly predicted
extrapyramidal syndromes in subsequent treatments for 84% of the patients.
Variations in neuroleptic potency, neuroleptic dose, and anticholinergic
dose partially explained incorrect predictions. CONCLUSIONS: These results
support the hypothesis that patients with a history of extrapyramidal
syndromes are at greater risk for future extrapyramidal syndromes. If
confirmed, these results strongly support individual susceptibility as a
major predictor of extrapyramidal syndromes and indicate that prophylaxis
of extrapyramidal syndromes should be considered for patients who have
previously suffered extrapyramidal syndromes from similarly prescribed
neuroleptic therapy.
