Extrapyramidal Symptoms in 10 Years of Long Term Treatment of Schizophrenia: Independent of Psychopathology and Outcome

One of the main arguments against prescribing first generation ‘typical’ antipsychotics is that extrapyramidal symptoms (EPS) can emerge as a side effect. EPS are distressing and interfere with the recovery and functioning of patients. Some of these symptoms persist over long periods of time, even after antipsychotic usage has been stopped. It is believed that second generation antipsychotics are less likely to cause EPS, which may aid in better functioning. We examined a cohort of patients of first episode schizophrenia, in a ten-year follow up study, for the presence of EPS. We assessed patients who had shown clinical recovery at the end of ten years of treatment. These patients were assessed for psychopathology using the PANSS, level of functioning by GAF, cognition by WMS and presence of EPS by AIMS. The present study show that abnormal EPS in first episode schizophrenia is present in 5% of patients at baseline, and 35.4% after 10 ten years. Patients in both groups of normal EPS and abnormal EPS showed equal clinical recovery on all parameters. Patients’ EPS symptoms at end point did not show any correlation with any end point clinical, social and cognitive parameters. We conclude that there is low incidence of EPS in the early phase of schizophrenia; however, EPS occur in about a third of all the patients after long term ten years treatment. EPS is not found to be correlated to level of psychopathology, and it does not correlate with any of the clinical and social outcome parameters.